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Unformatted text preview: RESEARCH APPRIASAL: PART ONE Research Appraisal: Part One University of Teas at Arlington NURS 5366 Principles of Research in Nursing 1 RESEARCH APPRIASAL: PART ONE 2 The purpose of this paper is to critically evaluate the research study, Responding to
disruptive behaviors in nursing: A longitudinal, quasi-experimental investigation of training for
nursing students (Sanner-Stiehr,2018).
The author of this paper is Ericka Sanner-Stiehr, according to a google search Ericka
Sanner-Stiehr worked as a nurse in ER departments and in other roles before she earned her
doctorate from the University of Missouri-Kansas City. She has current research on examination
of general influence on workplace values and intent to stay in the workplace. With her education
and produced research background I would say she is well qualified to conduct this study.
This article states that this study is a quantitative study that was part of a longitudinal,
quasi-experimental program of research. The independent variable discussed in this paper is the
cognitive rehearsal intervention, and the dependent variable is the nursing student self-efficacy.
The sample in the abstract mentions the study included 129 nursing students that were enrolled
in their final academic year in 3 traditional format, pre licensure nursing programs in the
Midwestern United States. The intervention mentioned includes a cognitive rehearsal
intervention that can increase self-efficacy to respond to disruptive behaviors in nursing. Further
research is needed to determine the effects of self-efficacy to respond once participants have
entered the nursing workplace (Sanner-Stiehr, 2018).
The clinical problem that this article discusses is how disruptive behaviors in the working
environment in nursing have severe consequences on turn over rate, especially for newly
licensed nurses. Disruptive behaviors are characterized by those referred to as, lateral/horizontal RESEARCH APPRIASAL: PART ONE 3 violence, incivilities, and bullying. Regardless of the term, these behaviors have serious
consequences such as compromising respectful relationships and decreasing the quality of
patient care. “A significant percentage of nurses leave their first job due to the negative
behaviors of their coworkers, and bullying is likely to exacerbate the growing nurse shortage. A
bullying culture contributes to a poor nurse work environment, increased risk to patients, lower
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient
satisfaction scores, and greater nurse turnover, which costs the average hospital $4 million to $7
million a year” (Edmonson & Zelonka, 2019). Maintaining adequate nurse staffing is essential
in the delivery of high patient care. Targeted nurses can experience symptoms of distress,
depression, and anxiety (Sanner-Stiehr, 2018). The sources used to support the authors research
were primary and secondary and were applicable and current at the time the study was
performed. There were about 60 sources used from 2010-2017. The primary source is one of
Sanner-Stiehr’s own article, which she published in 2015. Increasing Self Efficacy: Lateral
Violence Response Training for Nursing Students, the purpose of this study was to determine the
effect a cognitive behavioral rehearsal intervention had on nursing students' self-efficacy to
respond to lateral violence. In the ROL she mentioned cognitive rehearsal has been successfully
implemented in an undergraduate nursing curriculum to increase confidence to respond to
disruptive behavior situations (Sanner-Stiehr, 2018). The ROL suggested disruptive behaviors
contribute to high turn over rates, compromise patient care, cost the hospital millions of dollars
each year, contributing to a nursing shortage, thus reducing these behaviors must be a priority.
No gaps in research knowledge were addressed. RESEARCH APPRIASAL: PART ONE 4 Research Problem, Purpose, Research Questions/Hypotheses
The research problem in this study is that it was provided by participating pre-licensure
nursing programs, so nursing students in their last year were used at participants. Nursing
students are more likely to leave due to bullying and dissatisfaction in the workplace. The study
purpose was to examine the impact of a CR training intervention among pre-licensure nursing
students in their final academic year. The ROL focuses on newly licensed nurses (NLNs) during
their first year of professional practice having high turnover rates in their first year of practice
due to disruptive behaviors. Since they are new to the workplace, they lack experience in
exposure on how to deal with these behaviors in the workplace which leads them to be at risk for
ineffective coping, increased risk for burnout, and intent to leave. This research presents the first
stage of a longitudinal program of research that will ultimately be the impact of self-efficacy for
nursing students as they advance in their career to respond to these disruptive behaviors. The
purpose does address a gap in nursing knowledge because they tested nursing students although
the focus on this article was directed towards how disruptive behavior impacted NLNs. There
could be more information available if research was to follow up later in their nursing careers. In
the conclusion it states, “further research needs to be done to determine the self-efficacy to
respond once participants have entered the nursing workplace” (Sanner-Stiehr, 2018,p.105). The
research question asks what kind of impact a cognitive rehearsal intervention has on self-efficacy
to respond to disruptive behaviors among nursing students in their final academic year.
The first hypotheses identified was if participants report significantly increased self
efficacy to respond to disruptive behaviors at post-test, immediately following the intervention.
The second hypotheses were participants would report significantly increased self-efficacy to
respond to behaviors at both post-test and three months later, as compared to pre-test. The RESEARCH APPRIASAL: PART ONE 5 hypotheses follow the research problem and study for the objective was to determine the impact
of a cognitive rehearsal intervention on nursing students’ self-efficacy to respond effectively to
The framework is guided by an integrated dual-theory framework that targets selfefficacy, or confidence, to respond to disruptive behaviors embedded with a business training
model focused on organizational outcomes as described in the Kirkpatrick Model. Another
framework used was the Social Cognitive Theory, which describes the role of self-efficacy, or
how one would rate their confidence in how to perform a behavior in each set of situations
(Sanner-Stiehr, 2018). The purpose is clearly stated and supported by these frameworks so that
makes it explicit. This paper focuses on step 2 of the Kirkpatrick Model which states “Skill
acquisition including confidence to perform the skill responding to disruptive behaviors”
(Sanner-Stiehr, 2018, p. 106). The Kirkpatrick model has 4 steps and each step works toward the
goal of making sure training is effective. The SCT describes a mixture of cognitive and affective
variables influencing self-efficacy targeted by CR training. Both concepts provide the ability to
prepare student nurses and NLNs for disruptive behaviors in the workplace. The researcher uses
these models in the article to support this purpose.
The independent variable is the cognitive rehearsal being implemented to undergraduate
nursing curricula to increase confidence to respond to disruptive behavior situations. The
dependent variable is the nursing student’s self-efficacy to react to those behaviors. The objective
was to determine the impact of a cognitive rehearsal intervention on nursing student’s self- RESEARCH APPRIASAL: PART ONE 6 efficacy to respond effectively to disruptive behaviors (Sanner-Stiehr, 2018). Depending on how
much impact the CR intervention makes it will affect how nursing students respond to these
types of disruptive behaviors. In this study the conceptual definition is that a cognitive rehearsal
has been successfully implemented to NLNs and undergraduate nursing students to increase
confidence and prevent dissatisfaction. The self-efficacy to respond to Disruptive Behaviors
Survey, a 10-point scale, measuring self-efficacy and how they responded to these behaviors
would be the operational concept.
The demographic variables were that 129 students completed the surveys at pre and posttest. 109 completed the survey at 3 months later. 69.8% of participants were between 20-25,
with that being the majority and 14.7 % were between 26-30, 7.8% were between 31-35, 3.1%
were between 36-40, and 4.7% were 45 or older (Sanner-Stiehr, 2018). The majority of the
sample was Caucasian (82.2 %) with other races including African American, Hispanic or
Latino, Asian, and Hawaiian. An extraneous variable discussed in this theory would be past
engagement the students have had and whether it was successful or unsuccessful.
This study design for this research is longitudinal quasi-experimental design.
Researchers use experimental designs because they assure a high level of internal validity, the
way an experiment works is that it produces experimental and control groups that are very
similar through random assignment. Then the researcher applies a treatment to the experimental
group and measures all subjects to determine how much difference occurs between groups (Gray,
Grove & Sutherland, 2016). This design type matches the objective and hypotheses because it
picked a group that was very similar, nursing students and NLNs, this treatment allowed RESEARCH APPRIASAL: PART ONE 7 interventions that positively affected each group of students. The CR was successfully
implemented to increase confidence to respond to disruptive behaviors.
The study procedures used for this design was approved by the Institutional Review
Board from all the clinical sites. Sampling techniques were used to recruit pre-licensed nursing
students enrolled their final year from 3 different programs in the Midwestern United States, 2
located in urban settings and one in a rural setting. They were required to be able to read, write,
and speak English. Participants received a $15 amazon electronic gift card incentive upon
completion of follow up after 3 months. The study used the SERDB questionnaire for the method
of measurement, which consisted of a 10 item self-report scale guided by the SCT. A
demographic questionnaire was also included to describe the study population.
The interventions were conducted by the PI and an assistant during class time, which
consisted of teaching effective response strategies to disruptive behaviors. This was developed
by the PI and has been used in previous research with promising results. 5 steps included in the
intervention that targeted both cognitive and affective domains. The first step included education,
the second step included role-modeling effective response techniques, third step included
practicing their own responses, and providing feedback and finally debriefing and sharing their
thoughts about the whole process.
The description of the study was clear and easily replicated by other researchers. The
name of the questionnaire was listed and the steps it took in detail. There was only one group of
participants which were pre-licensure students. The extraneous variable was if the students had
prior exposure to disruptive behaviors which cannot be controlled. RESEARCH APPRIASAL: PART ONE
The limitations were that the study population was not diverse by ethnicity, race, gender,
or geographic location. A small sample size was used which makes it possible for the PI to have
personal interactions, but the reliability of results is limited. Also, self-report measures are a
threat to validity (Sanner-Stiehr, 2018). 8 RESEARCH APPRIASAL: PART ONE 9 References Edmonson, C., & Zelonka, C. (2019). Our own worst enemies. Nursing Administration
Quarterly, 43(3), 274-279.
Gray, J., Grove, S., & Sutherland, S. (2017). Burns’ and Grove’s The practice of Nursing
Research: Appraisal, synthesis, and generation of evidence (8 ed.). St. Louis, MO:
Sanner-Stiehr, E. (2018). Responding to disruptive behaviors in nursing: A longitudinal, quasiexperimental investigation of training for nursing students. Nurse Education Today, 68,
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- Fall '16
- Denise Cauble