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Article Critique: Violence in Hospitals


Violence in hospitals has been prevailing, and many scholars have shunned from highlighting the vice. Many studies have highlighted the issue of medical practitioners harassing their patients; consequently, nurses also become victims of violence from their corresponding patients. Nurses have always been on the receiving end for treating patients unfairly but sometimes they react to the improper approach by their clients (“World Medical Association”, 2008). Rodgers et al., (2006) argues that violence can be defined in a number of ways depending on the situation. There are distinct impacts of violence in hospitals towards nurses that adversely affect the services offered in the facilities. In light of this, “Nurse’s Attitude towards Difficult and Good Patients in Eight Public Hospitals” is authored by professor Khalil and published on June 2009. The article highlights the opinion of nurses towards abusive and difficult patients. Khalil aimed at identifying how nurses felt about their patients by categorizing them as good or difficult.

The nurses interviewed were all licensed by the Nursing Council and had working experience. According to Khalil (2009), sometimes nurses neglect their patients and offer below per services due to the frustration from the patients. It might be argued that nurses are sometimes exposed to physical assault and verbal abuses from the medical care consumers resulting in poor services. Khalil argues that there is violence in hospitals where nurses fall victims, and they result in neglecting or performing poorly. Therefore, this paper critiques the argument, findings, and recommendations highlighted by Khalil in the research.

Study Description

The main objectives of this research are to understand whether nurses are exposed to violence by their clients. In most cases, nurses, especially in public hospitals, have been accused of being unkind to their patients. They may respond to them with an irked voice or shut them down. In their defense, nurses argue that they are sometimes provoked and endure worse than the public know. Khalil (2009) wanted to know this issue first hand from the care-givers. Secondly, the research aims at identifying whether nurses offer services depending on the patient’s behavioral aspects. The article’s hypothesis is that nurses are vulnerable to patients’ harassment. Therefore, the research uses both qualitative and quantitative approaches to fathom this quagmire. The qualitative descriptive study was used to explore the violence in nursing conducted between 2005 and 2006 in South Africa hospitals. The respondents were all certified nurses by the South Africa Nursing Council. The researcher used confidential questionnaires as the quantitative design to obtain information from the respondents. Questionnaires were disseminated in eight public hospitals in 2006 to supplement the information collected via qualitative approach.

Participants were expected to share their experiences on specific aspect of violence while in their line of duty. Another section was meant for the nurses to describe their colleagues’ attitude towards their patients. The questionnaire also sought to understand whether the nurses provoked their consumers for them to be aggressive. There were two categories of patients that the respondents were to identify: “good” and “bad patients.” The researcher sort approval from the directors of the participating hospitals and Health Science Human Ethics Committee from the University of Cape Town. 373 nurses participated but some of them were selected to answer specific questions. For instance, 72% of the patients answered about the good patients while the rest provided information about the difficult patients. 94% also provided answers to the question regarding nurses provoking their patients.

Analytical Critique

First, Khalil does not include a literature review in the study but highlights a brief background study in the introductory part. Literature review is fundamental in a study in order to understand what other scholars have discovered in relation to the topic in question. Lack of literature review in this study does not make it inferior. However, it would be very helpful to the reader to understand the background of the problem, and how other scholars recommended. Khalil (2009) begins by acknowledging that there are few studies that have examined the issue of aggressiveness by patients and their relativeness towards medical practitioners. This might explain the reason why the study did not employ the use of a literature review.

Secondly, the study approaches both research designs, which include qualitative and quantitative designs. Qualitative design is employed when unearthing information from a general perspective in order to get results. It sometimes helps in building the research in order to engage in a deep research to answer the research questions. Additionally, the quantitative approach aids in substantiating the claims found by the qualitative technique. Khalil (2009) identifies that there is a problem in the nursing field. The qualitative research is obtained from the statistics of violence in nursing report of 2004 to 2006. After identifying that the topic is relevant, Khalil (2009) decides to gain empirical evidence by conducting a quantitative research. The sample of participants is good enough to represent the views of other institutions and nurses.

According to the Australian newspaper, the number of nurses attacked by patients increased by 30% in 2005 to 2006 (Penn, 2006). The Canadian Nurses Association in collaboration with the international council of nurses initiated a campaign of zero tolerance of violence in the working environment (Shields & Wilkinns, 2009). This was after identifying that the number of reported cases was increasing each year. This implies that Khalil topic is relevant and aims at addressing current issues affecting the medical care field. Previously, scholars have concentrated on blaming the nurses for poor performance and lack of etiquette when treating their clients. Khalil brings the flip side that nurses may be reacting out of a provocation. According to Khalil (2009), patients may overreact due to delay in the health facilities. At some point, they verbally harass these health care officers whereas the delay may be caused by uncontrollable conditions, such as system failure.

The research methodology employed is dissemination of questionnaires to the respondents. They are confidential to ensure that the respondents share their experiences and information without fear. When questionnaires are issued through the management, employees are afraid to express their views. Therefore, confidential questionnaires are designed to encourage nurses to be open with their experiences. However, the confidentiality might be compromised if the hospitals’ management seeks to assess the documents. It requires the researcher to be vigil and ensure that they are not accessed to avoid intimidation of the participants

The results show that 271 participants responded to the “good patient” question. They were expected to explain who are good patient and their attitude towards them. Most of them described “good patients” as calm, polite, follow instructions, permit nurses to carry out their procedures, and are helpful to other patients. It was discovered that a mean of 56.7 % patients were described as good patients. Most of these patients upheld the behaviors described above and it was noted that they also gave presents to the nurses. However, it was considered the least desirable behavior. Significantly, nurses indicated that they reacted much positively to good patients. They in turn rewarded them and gave them much attention.

On the contrary, “bad patients” or “difficult patients” were identified in 116 questionnaires. They included 52 general nurses, 39 psychiatric, 19 midwives, and 6 pediatric nurses. The observed behaviors were uncooperative patients, rude, abusive, always complaining, demanding, find faults, and others, according to the nurses. Lack of cooperation was noted as the most disturbing behavior followed by aggressiveness and abuse. The nurses also noted that rudeness deprived their morale of treating a patient. The results indicated at least 24.7% of their clients were “bad patients.” It was also noted that there were patients who attacked others and nurses. The article asserts that three hundred and fifty four, which is 94.9% of the participants, have witnessed nurses offer discriminatory services to patients due to their behavior. They cited that they may totally ignore physically abusive patients as they feel insecure. 165 participants refuted claims that they have witnessed nurses harassing a patient as they treat each client equally. From the report of violence in nursing, it was identified that 79 nurses had referred to counseling as they had experienced harassment by patients. 23 nurses had been dismissed for mistreating patients in the health facilities.

According to these statistics, it is evident that the study unearthed an existing issue of violence in nursing. Penn (2006) asserts that nurses spend the highest percentage of time with the patients than other medical care officers. This makes them the most favorable in addressing patients’ issues. Therefore, the relationship between nurses and patients is fundamental in ensuring that there is quality medical care offered to the society. The study by Khalil is important because it demonstrates the attitude of nurses towards their clients. Similarly, there should be other studies related to this topic in order to understand whether violence in nursing is profound in other institutions.

It is evident that nurses tend to treat the patients who have good rapport well. This means that some of the patients fail to be attended to fully due to their behavioral aspects. This is an unfortunate incident that can be avoided by ensuring those nurses are well protected. Khalil says that most of the nurses provided appropriate intervention to uncooperative patients. This implies that nurses should be prepared through training how to encounter such incidences. They should also go through constant counseling to avoid traumatic situations as a result of harassment (Rodgers et al., 2004). There should be also an effective way of cautioning the patients against treating nurses irresponsibly. Nurses are not also left out as it was reported that they also played part in harassing patients. Stern measures should be taken to any medical practitioners found guilty of mistreating or neglecting patients. A code of ethics should be availed to the entire team so that they should familiarize with the expected code of behavior. Therefore, Khalil (2009) article found out that there was an issue of violence in nursing.


Khalil, D. (2009). Nurse’s Attitude towards Difficult and Good Patients in Eight Public Hospitals. International journal of nursing practice. 15: 437-443

Pen, S., 2006. Violence against nurses: an epidemic. The West Australian.

Rodger, M., Hills, J., Kristjanson, L., 2004.A Delphi study on research priorities for emergency nurses in Western Australia.Journal of Emergency Nursing 30 (2), 117–125.

Shields, M., & Wilkins, K. (2009). Factors related to on-the-job abuses of nurses patients. Health reports.20 (2): 1-13

World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. 2008. Available from URL: http://