The purpose of this study was to examine the effects of a violence coping program (VCP) based on Polk's middle-range theory of resilience on nursing competency, resilience, burnout, and the ability to cope with violence in nurses working in emergency rooms.
A quasi-experimental study, with a nonequivalent control group and a pretest-posttest design, was conducted. Participants were 36 nurses who worked in emergency rooms and had experienced violence; 18 nurses from D hospital and 18 nurses from C hospital were assigned to the experimental and control groups, respectively. The experimental group received the VCP twice per week for 8 weeks.
Levels of resilience,
The results suggest that the VCP could be an effective strategy for reducing burnout and improving resilience, active coping behavior, and nursing competency. Therefore, it would be a useful intervention for improving the quality of nursing care provided in emergency rooms.
Program development procedure and testing for program effectiveness.
Conceptual framework.
Content of the Violence Coping Program
Session No., Topic Resilience pattern | Content | Theoretical Foundation |
---|---|---|
1. Understanding of violence | ||
Philosophical pattern | The concept of violence | The belief that self knowledge is valuable |
Requisite for establishment and cases of violence | Reflection on oneself and events | |
My experience practices and discussion | ||
2. Understanding of Medical violence | ||
Philosophical pattern | Status and actual situation regarding violence experienced by | Maintenance of a balanced perspective |
medical professionals | regarding one's life | |
Emergency status of violence The need for education to | ||
cope with violence | ||
3. Risk management of violence | ||
Situational pattern | Identification of triggers and risk factors for violence | The ability to perform a realistic |
Responding to violence | assessment | |
Use of active problem-oriented coping | ||
4. Emotional Coping | ||
Dispositional pattern | Laughter therapy: The promotion of positive emotion. | Positive self-esteem |
Healthy expression of anger: Reduction of negative emotion | Belief in self-efficacy | |
5. Responding effectively to verbal violence | ||
Situational pattern | Status of verbal violence | Reflection on new situations |
Verbal violence regarding treatment | Flexibility | |
Situational measures to prevent verbal violence | Perseverance | |
6. Understanding of medical communication | ||
Relational pattern | Medical Communication | A deep commitment to the relationship |
Efficient Communication | The development of personal intimacy | |
7. Guidelines for violence in the emergency room | ||
Situational pattern | Emergency room medicine practices related to violence | Reflection on new situations |
prevention activities | Use active problem oriented coping | |
Guidelines for responses to violence in emergency room | ||
8. Legal response to violence | ||
Situational pattern | Guidelines for legal action by medical institutions in response | Awareness of what can and cannot be |
to violent incidents in the emergency room | accomplished | |
Guidelines for the management of cases involving violence in | Cognitive appraisal skills | |
the emergency room and care facilities | ||
Reporting violence and record keeping | ||
Summary of lectures |
Homogeneity Tests for Subject’s Characteristics and Study Variables (
Characteristics/Variables | Categories | Total | Exp. (n=18) | Cont. (n=18) | c2/t/z | |
---|---|---|---|---|---|---|
n (%) or M±SD | n (%) or M±SD | n (%) or M±SD | ||||
Age (year) | 23~29 | 19 (52.8) | 8 (44.4) | 11 (61.1) | 1.03 | .317 |
30~50 | 17 (47.2) | 10 (55.6) | 7 (38.9) | |||
Median (IQR) | 28.50 (8) | 30.50 (9) | 26.50 (7) | -1.92 | .055§ | |
Clinical careers (year) | <2 | 6 (16.7) | 1 (5.6) | 5 (27.8) | 3.36 | .202* |
2~4 | 11 (30.6) | 7 (38.9) | 4 (22.2) | |||
≥5 | 19 (52.8) | 10 (55.6) | 9 (50.0) | |||
Median (IQR) | 6.50 (5) | 7.00 (4) | 5.00 (6) | -1.30 | .203§ | |
Clinical careers in emergency | <2 | 13 (36.1) | 4 (22.2) | 9 (50.0) | 3.85 | .134* |
department (year) | 2~4 | 13 (36.1) | 9 (50.0) | 4 (22.2) | ||
≥5 | 10 (27.8) | 5 (27.8) | 5 (27.8) | |||
Median (IQR) | 3.50 (5) | 4.50 (5) | 2.50 (4) | -0.98 | .339§ | |
Desire of department movement | Yes | 34 (94.4) | 16 (88.9) | 18 (100) | 0.82 | .486* |
No | 2 (5.6) | 2 (11.1) | 0 (0.0) | |||
Types of violence† | ||||||
Verbal violence | Yes | 36 (100) | 18 (100) | 18 (100) | <.01 | >.999* |
No | 0 (0.0) | 0 (0.0) | 0 (0.0) | |||
Physical threat | Yes | 24 (66.7) | 12 (66.7) | 12 (66.7) | <.01 | >.999 |
No | 12 (33.3) | 6 (33.3) | 6 (33.3) | |||
Physical violence | Yes | 10 (27.8) | 5 (27.8) | 5 (27.8) | <.01 | >.999 |
No | 26 (72.2) | 13 (72.2) | 13 (72.2) | |||
Sexual harassment | Yes | 2 (5.6) | 1 (5.6) | 1 (5.6) | <.01 | >.999* |
No | 34 (94.4) | 17 (94.4) | 17 (94.4) | |||
Frequency of violence | ≥4 | 22 (61.1) | 12 (66.7) | 10 (55.6) | 0.47 | .494 |
experience (number/month) | 1~3 | 14 (38.9) | 6 (33.3) | 8 (44.4) | ||
Violence Intensity | M±SD | 7.06±1.41 | 7.17±1.50 | 6.94±1.35 | 0.11 | .913 |
Resilience | 3.48±0.54 | 3.46±0.52 | 0.28 | .778 | ||
Coping | ||||||
Passive coping behavior | 1.72±0.67 | 2.00±0.69 | -1.10 | .355§ | ||
Active coping behavior | 2.28±0.57 | 2.00±0.59 | -1.40 | .239§ | ||
Nursing competency | 3.17±0.35 | 3.21±0.32 | -0.33 | .742 | ||
Burnout | 3.05±0.43 | 3.02±0.41 | 0.27 | .778 |
Exp.=Experimental group; Cont.=Control group; IQR=Interquartile range.
*Fishers’s exact test; †Multiple Response; §Mann–Whitney U test.
Effects of the Violence Coping Program in Emergency Room Nurses (
Variables | Groups | Pretest | Post1 | Post2 | Sources | F/c2 ( |
Sphericity test | Post1 | Post2 |
---|---|---|---|---|---|---|---|---|---|
M±SD | M±SD | M±SD | W (p) (G-G) | t/z ( |
t/z ( |
||||
Resilience | Exp. (n=18) | 3.48±0.54 | 4.15±0.28 | 4.06±0.20 | Group | 20.53 (<.001) | .49 (<.001) | 7.01 | 8.97 |
(<.001) (<.001) | |||||||||
Cont. (n=18) | 3.46±0.52 | 3.41±0.36 | 3.38±0.25 | Time | 47.12 (<.001) | e=.663 | |||
Group×Time | 59.41 (<.001) | ||||||||
Coping | |||||||||
Passive coping | Exp. (n=18) | 1.72±0.67 | 0.39±0.50 | 0.33±0.49 | 22.92* (<.001) | -5.14† | -4.91† | ||
behavior | (<.001) (<.001) | ||||||||
Cont. (n=18) | 2.00±0.69 | 2.00±0.59 | 1.78±0.55 | 1.72* (.423) | |||||
Active coping | Exp. (n=18) | 2.28±0.57 | 4.67±0.49 | 3.39±0.50 | 33.09* (<.001) | -4.41† | -4.74† | ||
behavior | (<.001) (<.001) | ||||||||
Cont. (n=18) | 2.00±0.59 | 1.94±0.64 | 2.17±0.51 | 2.17* (.338) | |||||
Nursing | Exp. (n=18) | 3.17±0.35 | 4.05±0.29 | 3.85±0.20 | Group | 47.78 (<.001) | .95 (.398) | 8.67 | 13.41 |
Competency | (<.001) (<.001) | ||||||||
Cont. (n=18) | 3.21±0.32 | 3.19±0.30 | 3.10±0.13 | Time | 47.12 (<.001) | ||||
Group×Time | 59.41 (<.001) | ||||||||
Burnout | Exp. (n=18) | 3.05±0.43 | 2.17±0.24 | 2.34±0.17 | Group | 36.29 (<.001) | .78 (.017) | -9.44 | -10.23 |
(<.001) (<.001) | |||||||||
Cont. (n=18) | 3.02±0.41 | 3.11±0.35 | 3.08±0.25 | Time | 35.02 (<.001) | e=.820 | |||
Group×Tim | 52.74 (<.001) |
Exp.=Experimental group; Cont.=Control group; Post1=right after intervention trials ended; Post2=4 weeks after intervention trials ended; G-G=Greenhous-Geisser e; G×T=Group×Time. Friedman test. †Mann–Whitney U test.