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Lee and Sung: The Effects of Violence Coping Program Based on Middle-Range Theory of Resilience on Emergency Room Nurses’ Resilience, Violence Coping, Nursing Competency and Burnout
Original Article

J Korean Acad Nurs 2017;47(3):332-344.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.3.332

The Effects of Violence Coping Program Based on Middle-Range Theory of Resilience on Emergency Room Nurses’ Resilience, Violence Coping, Nursing Competency and Burnout

Seung Min Lee1, Kyung Mi Sung2,

1Nursing Department, Masan University, Changwon

2College of Nursing · Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

Address reprint requests to : Sung, Kyung Mi College of Nursing · Institute of Health Sciences, Gyeongsang National University, 816-15, Jinju-Daero, Jinju 52727, Korea Tel: +82-55-772-8246 Fax: +82-55-772-8222 E-mail: sung@gnu.ac.kr

Received 15 June 2016       Revised 15 March 2017       Accepted 16 March 2017

Copyright © 2017 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

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.

Methods

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.

Results

Levels of resilience, F=59.41, p<.001, active coping behavior, c2=33.09, p<.001, and nursing competency, F=59.41 p<.001, increased significantly and levels of passive coping behavior, c2=22.92, p<.001, and burnout, F=52.74, p<.001, decreased significantly in the experimental group.

Conclusion

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.

Keywords: Psychological resilience, Violence, Psychological adaptation, Clinical competence, Professional burnout

References

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Figure 1.
Program development procedure and testing for program effectiveness.
jkan-47-332f1.tif
Figure 2.
Conceptual framework.
jkan-47-332f2.tif
Table 1.
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
Table 2.
Homogeneity Tests for Subject’s Characteristics and Study Variables (N=36)
Characteristics/Variables Categories Total Exp. (n=18) Cont. (n=18) c2/t/z p
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.

Table 3.
Effects of the Violence Coping Program in Emergency Room Nurses (N=36)
Variables Groups Pretest Post1 Post2 Sources F/c2 (p) Sphericity test Post1 Post2
M±SD M±SD M±SD W (p) (G-G) t/z (p) t/z (p)
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.

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