Effects of a Cognitive Rehearsal Program on Interpersonal Relationships, Workplace Bullying, Symptom Experience, and Turnover Intention among Nurses: A Randomized Controlled Trial

Jiyeon Kang; Jeung-Im Kim; Seonyoung Yun

doi:10.4040/jkan.2017.47.5.689

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Kang, Kim, and Yun: Effects of a Cognitive Rehearsal Program on Interpersonal Relationships, Workplace Bullying, Symptom Experience, and Turnover Intention among Nurses: A Randomized Controlled Trial

Original Article

J Korean Acad Nurs 2017;47(5):689-699.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.5.689

Effects of a Cognitive Rehearsal Program on Interpersonal Relationships, Workplace Bullying, Symptom Experience, and Turnover Intention among Nurses: A Randomized Controlled Trial

Jiyeon Kang¹, Jeung-Im Kim^2,, Seonyoung Yun³

¹Department of Nursing, Dong-A University, Busan

²School of Nursing, Soonchunhyang University, Cheonan

³Department of Nursing, Youngsan University, Yangsan, Korea

Address reprint requests to : Kim, Jeung-Im School of Nursing, Soonchunhyang University, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea Tel: +82-41-570-2493 Fax: +82-41-570-2498 E-mail: jeungim@sch.ac.kr

Received 5 April 2017 Revised 17 August 2017 Accepted 21 August 2017

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

This research aimed to investigate the effects of a cognitive rehearsal program (CRP) on workplace bullying among nurses.

Methods

A randomized controlled trial was performed. Participants were 40 nurses working in different university hospitals in B city, South Korea. The experimental group was provided with a 20-hour CRP comprising scenarios on bullying situations, standard communication, and role-playing. To evaluate effects of the CRP, we measured interpersonal relationships, workplace bullying, symptom experience, and turnover intention at pre-and post-intervention. Follow-up effect was measured in the experimental group only at 4 weeks after the intervention.

Results

After the intervention, there were significant differences in interpersonal relationships (F=6.21, p=.022) and turnover intention (F=5.55, p=.024) between experimental and wait-list groups. However, there was no significant difference in workplace bullying or symptom experience between the 2 groups. The beneficial effects on interpersonal relationships and turnover intention lasted at least up to 4 weeks after CRP.

Conclusion

The CRP for workplace bullying improves interpersonal relationships and decreases turnover intention. So it can be utilized as one of the personal coping strategies to reduce the the turnover among nurses. Further studies on the effects of unit- or hospital-based CRP and on the long-term effects of CRP are necessary.

Keywords: Workplace, Bullying, Nurses, Cognitive therapy, Role playing

References

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Figure 1.

Flow diagram of the study.

Table 1.

Cognitive Rehearsal Program Contents

Sessio	on Topics	Scenario	Activities
1	Nonviolent communication	Orientation on cognitive rehearsal	Lecture
		Introduction to nonviolent communication	Nonviolent communication card
		4 components: Observation, Feeling, Need, Request.	game
2	Withholding information	Reporting nurse is not giving important information on patient	Presentation of scenario
		care to the following shift nurse.	Role playing
			Making standard communication
			Re-role playing
			Feedback and evaluation
3	Backbiting	Colleague nurses are speaking ill of someone who is not	Presentation of scenario
		present.	Role playing
			Making standard communication
			Re-role playing
			Feedback and evaluation
4	Sabotage	A new graduate nurse is really tied up with her post-op patient.	Presentation of scenario
		Her colleague nurses refuse to answer the call bell from the	Role playing
		new nurse’s patient.	Making standard communication
			Re-role playing
			Feedback and evaluation
5	Disgracing	A preceptor nurse takes down every mistake that a new nurse	Presentation of scenario
		has made in the shift notes.	Role playing
			Making standard communication
			Re-role playing
			Feedback and evaluation
6	Undermining activities	A head nurse says to the staff nurse who keeps making	Presentation of scenario
		mistakes, “I do not think you are fit for nursing.”	Role playing
			Making standard communication
			Re-role playing
			Feedback and evaluation
7	Failure to respect privacy	Nurses A and B meet at the hospital lobby by chance. Nurse A	Presentation of scenario
		says to nurse B, “You had better study more, if you have time	Role playing
		to get dolled up.”	Making standard communication
			Re-role playing
			Debriefing
8	Physical aggression	A nurse is screaming and throwing alcohol sponges at another	Presentation of scenario
		nurse who made a mistake.	Role playing
			Making standard communication
			Re-role playing
			Feedback and evaluation
9	Verbal affront	A preceptor nurse makes sarcastic remarks to a new nurse, “I	Presentation of scenario
		wonder how you could pass the license exam.”	Role playing
			Making standard communication
			Re-role playing
			Debriefing
10	Self-empathy	A recently graduated nurse is asking the preceptor nurse how	Presentation of scenario
		to hang dialysis fluid. She already explained many times	Role playing
		before.	Making standard communication
			Re-role playing Feedback and evaluation

Table 2.

Homogeneity Tests between Experimental and Wait-List Groups (N=40)

Variables	Characteristics	Exp. (n=20)	Wait. (n=20)	χ² or t or U	p
		n (%), Median (IQR) or M±SD	n (%), Median (IQR) or M±SD
Gender	Female	18 (90.0)	19 (95.0)	0.36	.548
	Male	2 (10.0)	1 (5.0)
Age (years)		32.25±8.48	31.25±8.03	0.38	.704
Marital status	Single	14 (70.0)	15 (75.0)	0.13	.723
	Married	6 (30.0)	5 (25.0)
Religion	Yes	6 (30.0)	8 (40.0)	0.44	.507
	No	14 (70.0)	12 (60.0)
Education	Bachelor	12 (60.0)	15 (75.0)	1.03	.311
	≥Master	8 (40.0)	5 (25.0)
Length of time (months) worked as a nurse		83.50 (183.25)	101.50 (162.00)	179.50^†	.583
Length of time (months) worked at current site		31.50 (86.25)	34.00 (141.75)	151.00^†	.192
Department	Inpatient unit	4 (20.0)	8 (40.0)	7.53	.184
	ICU	12 (60.0)	9 (45.0)
	Operating room	3 (15.0)	1 (5.0)
	Emergency room	1 (5.0)	2 (10.0)
Position	Staff nurse	15 (75.0)	17 (85.0)	0.63	.429
	Charge nurse	5 (25.0)	3 (15.0)
Workplace bullying		1.73±0.47	1.50±0.41	1.62	.113
Interpersonal relationships		3.38±0.50	3.41±0.36	0.20	.841
Symptom experience		1.74±0.70	1.60±0.47	0.72	.475
Turnover intention		3.24±0.94	3.03±0.97	0.70	.486

Exp.=Experimental group; Wait.=Wait-list group; IQR=Interquartile range; ICU=Intensive care units.

^†Mann-Whitney U test.

Table 3.

Differences of Interpersonal Relationships, Workplace Bullying, Symptom Experience, and Turnover Intention between Experimental and Wait-List Groups (N=40)

Variables	Groups Exp. (n=20)	Pre-intervention	Post-intervention	Sources	F	p
		M±SD	M±SD
Interpersonal relationships	Exp. (n=20)	3.38±0.50	3.54±0.54	Group	0.30	.587
	Wait. (n=20)	3.41±0.36	3.24±0.48	Time	2.17	.149
				G×T	6.21	.022
Workplace bullying	Exp. (n=20)	1.73±0.47	1.75±0.56	Group	2.68	.110
	Wait. (n=20)	1.50±0.41	1.53±0.38	Time	0.32	.576
				G×T	0.01	.917
Symptom experience	Exp. (n=20)	1.74±0.70	1.70±0.70	Group	0.39	.537
	Wait. (n=20)	1.60±0.47	1.60±0.71	Time	0.11	.762
				G×T	0.11	.762
Turnover intention	Exp. (n=20)	3.24±0.94	2.91±1.08	Group	0.01	.932
	Wait. (n=20)	3.03±0.97	3.18±0.91	Time	0.75	.391
				G×T	5.55	.024

Exp.=Experimental group; Wait.=Wait-list group; G×T=Group×Time.

Table 4.

Follow-Up Effects of Cognitive Rehearsal Program in Experimental Group

Variables	Pre-intervention (n=20)	Post-intervention (n=20)	Follow-up effects (n=19)	F	p
	Mean (95% CI)	Mean (95% CI)	Mean (95% CI)
Interpersonal relationships	3.40 (3.27~3.54)	3.55 (3.42~3.68)	3.56 (3.42~3.69)	3.61	.037
Workplace bullying	1.73 (1.53~1.94)	1.75 (1.54~1.96)	1.57 (1.36~1.78)	2.05	.144
Symptom experience	1.74 (1.54~1.94)	1.71 (1.51~1.90)	1.65 (1.45~1.85)	0.50	.609
Turnover intention	3.20 (2.83~3.56)	2.80 (2.44~3.17)	2.83 (2.47~3.19)	3.17	.054

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