Long-Term Effect of a Comprehensive Active Resilience Education (CARE) Program for Increasing Resilience in Emergency Nurses Exposed to Workplace Violence: A Secondary Analysis of a 12-Week Follow-up Study

Abstract

Background: The mental health of emergency nurses exposed to workplace violence must be prioritized. Current resilience interventions require further investigation regarding the long-term effects. Additionally, it remains unclear whether the level of violence influences the intervention effect.

Aim of study: To investigate the long-term effect of the CARE program on resilience, and to assess differences in the effectiveness of the CARE program with various workplace violence levels.

Methods: This two-armed quasi-experimental study was conducted from March 2023 to October 2023, following the TREND checklist. Emergency nurses exposed to workplace violence (n = 71) were recruited in a tertiary hospital in Shanghai, China. The intervention group received the CARE program. The control group received routine violence training provided by the hospital. Data were collected at baseline, after the intervention, 4-week, and 12-week follow-up.

Results: The scores of nurse resilience were significantly improved at the 4-week follow-up and the 12-week follow-up, as compared with the control group. Resilience, anxiety, perceived organizational support, and nurses' intent to stay scores showed a significant effect in the group-time interaction effect. Subgroup analysis indicated that emergency nurses with high exposure to workplace violence demonstrate better resilience change scores than low-risk emergency nurses.

Conclusion: The CARE program was effective in enhancing resilience, decreasing anxiety, and promoting perceived organizational support and nurses' intent to stay among emergency nurses exposed to workplace violence. The effectiveness of the nurse resilience intervention was dependent on the level of workplace violence experienced at the beginning of the study.

Implications for nursing and health policy: This study provides an effective method to enhance the resilience of emergency nurses. The CARE program can be replicated and integrated into systematic education programs for all nurses. More efforts should be made to reduce the incidence of workplace violence in hospitals, such as establishing policies and implementing early warning systems to protect nurses' physical and mental health.

Keywords: emergency department; mental health; nurses; resilience; workplace violence.