الفهرس 
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Abstract
One of the most important types ofworkplace violence ishorizontal violence (HV). It is defined as any injurious behavior aimed by one worker toward another who is of equal status within a hierarchy that seeks to control the person by disregarding and diminishing his or her value as a human being.HV used to describe violence that exists among nurses. It is harmful behavior that is directed toward a nurse by another colleague, via attitudes, actions, and words. In HV there is a dominant/submissive relationship between the perpetrator and the targeted worker rather than having supportive nurse coworker.
Based on Freire’s theory of oppression, Attitudes of an oppressed group or oppressed self were labeled as internalized sexism and minimization of self.Communication and peer relations are affected when feeling oppressed. When they are supportive, nurses trust their peers, when there is less support; nurses do not trust their peers and avoid communicating and interacting with them.
The distinguishing quality that sets nursing apart from other professions is the art of caring.Caring means a loving feeling and exhibiting concern and empathy for others. HV one of the most workplace negative behaviors that affecting nurses’ caring behaviors.WatsonTheory of Human Caring (1999) was used as a framework for this research study.
Aim of the study
The study aims to determine the relationship between the occurrence of horizontal violence among nurses and their caring behaviors toward patients.
Setting:
The study was conducted in all intensive care units at Alexandria Main University Hospital.
Subjects:
Study subjects comprises of all nurseswhoprovidedirect patient care (n=65) out of 144 nurseswho are working in the previously selected units and were available during the period of data collection.
Tools of the study:
Data for this study were collected using the following tools.
Tool I: Negative Acts Questionnaire-Revised (NAQ-R). Consists of 22 negative behaviors it was used to assess the occurrence of horizontal violence among nurses at work.
Tool II: Peer Relations scale. It consists of ten items used for assessing the extent to which relationships are supportive among peers at work.
Tool III: Nurses Workplace Scale (NWS). Composed of twelve items, it was used to assess nurses’ work related views of themselves and nursing as a group.
Tool IV: Assault Response Questionnaire (ARQ). Composed of thirty four items, it was used to assess the emotional, biophysiological, and social reactions after victimization to violent situation.
Tool V: Caring Behavior Observation Checklist (CBOC). It consists of 108 items categorized into 8 subscales of caring behaviors. It was used for measuring caring behaviors of nurses toward patientsthrough observation of nurses during care provision.
Tool VI: Sociodemographic characteristics Questionnaire. To assess demographics and workplace data such as age, sex, marital status, number of children, etc.
Methods:
1. An approval for conducting the study was obtained from the ethical committee of the faculty of nursing.
2. An official permission was obtained from the director of the study hospital.
3. The tools (NAQ-R, Peer Relations scale, NWS, and ARQ) were translated into Arabic and submitted to a panel of ten experts in the field of the study to test their content validity.
4. The reliability of the tools (NAQ-R, Peer Relations scale, NWS, and ARQ) was tested using cronbach alpha coefficient and they were reliable.
5. A pilot study was carried out on 10% (n= 7) of staff nurses as follow: one nurse from, coronary care unit, two nurses from neurological unit, one nurse from urological unit, one nurse from emergency unit, one nurse from medical unit and one nurse from facioMaxillary, the necessary modification were done.
Data collection
Individualized observation was conducted for each study nurse by the researcher when providing patients care. Each nurse was observed four times on two different shifts (morning and evening) and along the shift. Night shifts were excluded because fewer interventions are performed.
Fourquestionnaires were hand delivered to nurses who are working a 6- hour- day shift present in the selected units which are (socio-demographic characteristics, NAQ-R, NWS, and ARQ). Needed instructions about the aim of the study and to gain their cooperation were given before the distribution of the questionnaire.
Results
1. Females’ nurses represented the highest percentage 78.5%. More than one-half of nurses (52.3%) were married. 35.4% of nurses were in the age group of 20 to less than 25 years. Regarding nurses’ educational qualification, more than one third (38.5%) of nurses had a diploma of secondary technical nursing school. Additionally, more than one- quarter (27.7 %) had a Bachelor of Science degree in Nursing. As regard to years of experience 36.9% of nurses had 10 to less than15 years of experience. In relation to studied nurses staff type the majority of them (95.4%) were Basic staff and worked Full time 89.2%.
2. No statistically significant correlation of overall nurses’ levels of exposure to HV and their caring behavior was found.
3. There is a statistical significant positive correlation between nurses’ levels of exposure to HV and their work related views of themselves and nursing as a group.
4. Assault responses after victimization, statically significantly positively correlated with each of nurses’ level of exposure to horizontal violence, nurses’ work related views of themselves and nursing as a group and their caring behaviors.
5. Nurses’ peer relations did not provide any statistically significant correlations with others study variables.
6. No statistically significant correlation of overall nurses’ work related views of themselves and nursing as a group and their caring behaviors was found.
In the light of the study findings the following recommendations are suggested for:
II. Recommendations for preventing and eliminating HV
A. Hospital administrators should:-
1. Develop and implement Policies related to control and terminate the perpetrators who inflict horizontal violence to minimize its incidence and detrimental effects.
2. Establish specific systematic procedures for reporting and solving any complaints related to horizontal violence.
3. Promote safe workplace environment through
providing open and constructive communication and principles of dialogue among nursing staff ( reporting system, recording and documentations, formal and informal staff meetings),
B. Nurse managers should:-
1. Promote the use of employee assistance programs for nurses who demonstrate negative behaviors, or those as victims of horizontal violence, such as establish educational counseling programs including psycho-social, behavioral and medical counseling.
2. Establish educational programs for all team members regarding:
Hazards of horizontal violence, how to deal with any conflicts occur in the clinical settings.
Assertiveness and ability to advocate oneself and other.
Conflict resolution and brainstorming for solutions
Negotiation skills
Communication and open dialogue amongst team members
C. Recommendations for improving nurses’ caring behavior:
Nurse managers should:
1. Conduct time management training program in order to teach nurses how to use their time effectively when caring of their patients.
2. Involvement of nurses in decision making related to patent care and encouraging generation of new ideas by conducting problem solving and problem discussion conferences, in order to improving critical thinking and problem solving abilities of nurses.
3. Develop standard for nurse- patient ratio for each unit, this will reduce work overload on nurses and enable them to spend more time with patients for caring and teaching.
4. Consider jog design in form of; organizing tasks duties and responsibilities to be performed by nurses through proper task assignment according to nurses’ abilities and experiences, proper supervision on their performance.
5. Establish system of feedback and reinforcement for nurses regarding their caring behaviors to feel that they recognized and supported.
6. Conduct periodic informal evaluation of nurses’ performance to identify their strengths and weaknesses in ordered to enable them to improving their caring behaviors.
7. Establish formal orientation programs for a newly hired nursing graduate that focus on caring behaviors and its importance for patient welfare and to be able to care for their patent.