Effects of Lateral Violence in the Preoperative Setting

Lateral violence is evidently a phenomenon which undermines the efforts towards efficient service delivery in the preoperative department. Lateral violence entails nurse-on-nurse aggression and conflicts. The primary aim of this chapter is to discuss how the research objectives will be achieved. It will focus on how data will be gathered, generated and analyzed. Additionally, research design, instrumentation, data collection and analysis technique would be presented. The results of the research question will be displayed in the sequential order in a way that the research question will be systematically addressed. The following quantitative data gathering will be used: study setting, sample, instrument, data collection, data analysis, and protection of human subjects.

Project Design/Methods 

The methodology that will be used in this study will be descriptive survey design which will allow for the analysis of relationships among variables. The design will be suitable since it best explores the relationship between variables while at the same time quantifiably measuring the overall reliability of the connection. According to Amaratunga et al. (2002), the descriptive design is also ideal since specific information exists concerning the phenomena under study. It will further help to describe the characteristics of the target population. The researcher will gather data from the subjects to determine their experiences and views about potential effects of lateral violence and analyze the collected information. Finally, he will come up with a conclusion based on the analysis of lateral violence within the preoperative setting. Bertrand & Goupil (2000) assert that the quantitative data that will be obtained from these databases will provide reliable and conclusive data and results which will be credible.

Population and Sampling 

The setting for the study will be in one of the local single acute care medical centers in the Southeast, US. The acute care hospital offers a range of services including surgical, behavioral health, emergency, rehabilitative, cardiology, medical, orthopedic, women’s health, neuroscience, and oncology. The sample population for the study will be comprised of nurses working in the preoperative department (Onwuegbuzie & Leech, 2007). All the participants will be required to be Licensed Practical Nurses (LPN) and Registered Nurses who provide direct patient care in the preoperative department in one of the local hospitals. The sample size for the study will be comprised of 20 nurses. Before the collection of data, the researcher had concluded that the minimum tolerable sample size for the study should be about 20 respondents due to issues related to time and resource constraints (Sargeant, 2012). Excluded from the survey sample were the nurses who held different leadership positions.

The sample size for the study will be determined through the use of simple random sampling where every nurse will have an equal opportunity of being included in the study (DiCicco ‐ Bloom & Crabtree, 2006). In using this technique, the researcher will prepare a population frame and then employ random numbers to identify the sample units from a group of the larger target population. Electronic sheets would be highly useful in the generation of random numbers that will give every subject within the target population equal chance of being picked. The researcher will have to ensure that the sample size will be a representative of the entire population and comprise of both the males and females.

Data Collection 

After the thesis topic has been approved, a literature review will be performed. Upon identifying the need for the study, a suitable setting and population to be included in the survey and survey tool will be identified. Email distribution lists will be obtained through preoperative care hospital’s electronic mail system. The researcher will communicate with the management of the hospital to seek permission to go on with the study after the approval of IRB. According to Denscombe (2012), participant consent would be important to ensure that they are all willing to take part in the study and they understand the aim and content of the research and their role. Informed consent forms will be delivered to each participant electronically together with a link to the study survey. Based on the work of Quinn et al. (2003), a pretest will be given to the participants before the actual data collection.

Each participant will receive similar instructions on the topic and resources to eliminate chances for superfluous impact on the outcomes. The identified participants will be given one week to complete the questionnaire. Further, all the completed surveys will be submitted to an electronic database. The results of the survey will be stored on the personal computer of the researcher which will be protected with a complex password and then stored in a secured location. All electronic surveys will be made readily available via the Qualtrics Online Survey Software. Based on the idea that such software makes use of a separate URL than the IP address of the subject's email, the result’s confidentiality will be maintained (Rodgers, 2000). Therefore, such software will help in creating the survey and assist in the result analysis.

Instrumentation 

One of the instruments that will be used in the collection of data from the participants is the modified version of Workplace Aggression Research Questionnaire (WAR-Q) (Neuman & Keashly, 2004). The tool will further be comprised of two major parts. Part 1 A will contain the description of the 60 aggressive behaviors which will allow the subjects to identify the frequency they experienced these behaviors, three open-ended questions and one-item question for measuring how one is disturbed by particular violent behavior. The description of the violent act will further be divided into six distinct sub-scales as follows; direct, physical, active, indirect, verbal and passive.

Part 1 B will entail two tables and one open-ended question. One of the tables will be comprised of three questions to determine whether any action was taken against the individual who exhibited bullying behavior. The second table will entail 14 questions focusing on the factors that contributed to the identified bullying behavior. In part 1 C, there will be two-item stress measure tool. Further, section 2 will consist of the demographic information. The demographic variables that will be measured in the survey will include: years of experience, race, age, current job category, gender, and race. For each of the behavioral question asked in the survey, participants were provided with choices to identify the most suitable answer (Carpenter, 2010).

The second suitable tool that will be employed is the WCLS survey. The tool is ideal for determining whether three conceptual components including caring moment, transpersonal caring relationship and clinical Caritas Watson’s Theory of Human Caring were available. The device will be comprised of five questions that will use a 7- point Likert scale suitable for measuring the overall frequency of caring behavior experienced by preoperative nurses. The questions will focus on the caring frequency that nurses have gone through with their colleagues.

Protection of Human Subjects 

Human rights protection is critical to all research that entails human beings (Emanuel, Wendler, & Grady, 2000). The research proposal will be submitted and approved by the IRB at the preoperative care. The participants will be recruited via preoperative care hospital’s electronic mail system. All information will be gathered anonymously. An informed consent form that consists of the purpose of the study, the procedures adopted, voluntary participation, level of confidentiality, and potential risks and benefits will be sent to each participant was sent electronically together with a link for the online survey (Emanuel, Wendler, & Grady, 2000). When the participants fill in the survey, it will assume an implied consent. It is true that some of the questions that will be asked might be sensitive. The risk of psychological distress from responding to such type of questions will be disclosed under the benefits and risks portion of the informed consent form.

All the subjects will be required to participate voluntarily, and there would be no repercussion for those who would wish to withdraw (Kazdin, 2011). Additionally, there will be no incentives to the participants to take part in the research and participation will be voluntary with no penalty for refusing to participate. The researcher will inform them how he will maintain their confidentiality and security of collected information that might significantly identify a participant. However, there will be no identifying data used in the process of gathering data and the researcher will ask the participants not to give identifying data.

Data Analysis 

Boellaard (2009) posits that the data collected from the research should be analyzed thoroughly to make sense of it. Qualtrics will thus provide a fundamental breakdown of the entire results from the survey. According to Charmaz & Belgrave (2007), a grounded theory methodology will also be helpful in this study where it will allow the researcher to evaluate participant’s themes continuously. With the use of the steps outlined in the grounded theory, an iterative and inductive method, the themes will be developed from the participant’s words. Set of codes about the identified concepts when developing instruments will be adopted as the starting point.

The questionnaires will be coded to transcribe the results into a computer. The information will be compiled then systematically ordered to match up with initial research question to make sure that the whole process is manageable. The coded data will further be processed with the use of Statistical Package for Social Sciences (SPSS) to provide in-depth statistical analysis (Bryman & Cramer, (2005). Arguably, SPSS will offer an apparent breakdown of the response given by the participants based on separate categories of questions. A comprehensive statistical analysis of the information gathered will be completed together with the correlation statistics to establish whether there exists any correlation between nurse’s caring behavior and the lateral violence level faced by the nurses. Further, discrepancies, similarities and even potential variances in the collected data will be analyzed. The data will be presented in tabulation, charts, and tables for comparison. Descriptive statistics will further be utilized in summarizing the demographic features of the participants and their responses (Bryman & Cramer, 2002). A preliminary theory will be identified to sufficiently explain lateral violence behavior, which will, later on, be compared to the original data sources.

Reliability 

The reliability of the research instrument, in this case, will help establish the overall quality of the collected information and that of the entire research. Timmermans & Tavory, (2012) argue that reliability is apparently synonymous with repeatability; therefore, any measurement which results to a consistent result over time is reliable. The researcher will seek the opinions and perspectives of the experts and supervisor during the whole process of questionnaire development to make sure that it gathers most relevant data that would help answer each research question adequately. In this case, the research will further use test-retest method to ascertain the reliability of the study. Additionally, Cronbach’s alpha formula would be applied when it comes to the calculation of the data coefficient’s reliability and accept reliability value closer to 1.

Validity 

Validity is merely the truthfulness or even accuracy of the measurements, and this is often regarding the probability that the research question might be misinterpreted or understood and if the research instruments will provide sufficient coverage of the study objectives (Ragin & Amoroso, 2010). Pilot testing entails conducting a preliminary test of the data gathering instruments and the adopted procedures to establish their efficiency and eliminate potential problems. This would allow the researcher to make a necessary corrective revision to the tools and data collection procedures to make sure that data gathered is valid. All questions will be pre-tested and adjusted appropriately before carrying out the study to confirm the overall effectiveness of the instruments (Chan, To, & Chan, 2006). It would be essential to improve overall efficacy, and the only way to obtain this would be to make utilize direct quotes in the study. For the study to sufficiently enhance the interpretive validity in this study, the researcher will use tables.

Analytical Techniques 

In this quantitative research, the researcher will pay closer attention to the development of a new analytical framework that will help guide generation of data collection technique and data analysis. DeMarco (2002) claimed that expert opinion would be sought for the development of the analytical framework. Thus, to respond to the theoretical questions adequately using quantitative empirical data, a theory will be used to help inform the collection of data and its analysis. Solórzano & Yosso (2002) pointed that the analytical framework, in this case, will help connect theoretical question to the empirical analysis by making a summary of what is presently theoretically known concerning the lateral violence.

Lateral violence in the nursing survey will include three different constructs for analysis which in this case will consist of the mediators, perceived seriousness, and oppressors that will be derived from the oppressed group theory (Roberts, 2000). It will also incorporate Health Belief Model (HBM). The HBM fundamental components are the perceived benefits, anticipated severity, suspected susceptibility, and barriers. In addition to this, the HBM also entails the salient procedures including the self-efficacy and cues to actions that are believed to be critical for the analysis of data. Lateral violence is thus operationally defined as follows: the apparent gravity includes the alleged impact of the lateral violence on either an individual or group (Bish, Sutton, & Golombok, 2000). Secondly, do oppressors focus on specific characteristics of leaders, organization and even the coworkers’ behavior that might act as a barrier. The third aspect is mediator and will focus on the character of each nurse and the hospital together with colleague behaviors which might give productive measures to alleviate lateral violence (Artto et al., 2011).

Project Evaluation Plan 

The primary focus in the project evaluation is on the desired outcomes of the project and how to measure them. It is all about building accountability and benchmark into the plan and using them to evaluate the entire plan as the project progress and when it is finished. In this case, the project evaluation plan will give the project a strategic structure, provide evidence for the outcomes and contribute to the knowledge base about effective lateral violence prevention in preoperative. Fitzpatrick, Sanders, & Worthen (2004) noted that the exploration and analyzing of the relationship between the project’s objective, activities, outcome, and impacts should be managed. The plan will offer a set of instruments that would help to evaluate the advancement in the implementation of the project and significant elements including activities, goals, and objectives. The evaluation plan will further assess the overall efficiency and effectiveness of the project by exploring and analyzing both the impacts and outcomes. The following steps described how the researcher would go about in the development of the evaluation plan.

Step 1. Identify Outcomes and Impact 

The objective and goal of the project will be used as the structure for the overall assessment of the project (Fitzpatrick, Sanders, & Worthen, 2004). The achievement of the objective and goal will be done through creating specific short- or middle-term outcome and benefits. Therefore, by gauging the outcome, the researcher will be able to understand the extent of goal achievement. The outcome will in the process generate long-term impacts. Therefore, through evaluating project impact, the researcher will be able to identify the overall project effect on the target population.

Step 2. Choose Evaluation Method 

It would be important to identify suitable evaluation method that would be used in measuring the outcomes and impact. Fitzpatrick, Sanders, & Worthen (2004) posit that the most suitable method that would be utilized to determine whether the goals and objectives of the project were achieved and whether it generated the desired change will be interviews and surveys. The evaluation method will, therefore, focus on both the benefits and outcome in addition to the impacts. In the evaluation process, the researcher will conduct on-going monitoring on a daily basis. Therefore, to determine whether the project is on track to achieve the desired result, the mid-term evaluation will be performed. Final evaluation will be conducted to see whether overall change happened by the end of the project

Step 3. Report on the Evaluation 

According to Saunders, Evans, & Joshi (2005), the final step entails reviewing the whole task and creates final project evaluation report. The report will be comprised of the researcher’s conclusion concerning the ability of the project to produce the change that is desired and achieving the preset objects and goals. In using the evaluation criteria, the researcher will explore if the task was performed in a consistent approach with the original plan and whether all the actions adopted contributed to the accomplishment of the project.

Summary 

The study’s primary aim was to evaluate the effects of lateral violence in the preoperative setting. The study will be descriptive survey design. The informed consent form with a link to the online survey will be sent out to the participants electronically. WAR-Q, Demographic Questionnaire, and WCLS survey will be placed in the online survey database called Qualtrics. Email distribution lists will be obtained through preoperative care hospital’s electronic mail system after the approval of IRB. In the data analysis, the in-depth statistical analysis will be performed with the use of the SPSS software. Qualtrics will offer a fundamental breakdown of the entire results from the survey. Descriptive statistics will also be employed to summarize demographic features of the participants. The researcher will seek the opinions of experts when developing a questionnaire to improve reliability. The questions will be pre-tested and adjusted appropriately before carrying out the study to enhance the validity of the instruments. Finally, analytical framework and project evaluation plan would be addressed to determine the success of the project.

References

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Appendices 

Demographic Information 

1. What is your age? 

Under 21

21 - 30

31 - 40

41 - 50

51 - 60

61 or older

2. What is your gender? 

Male

Female

3. What is your race? 

Latino

African American

Native American

Caucasian

Asian

Hispanic

Others

4. How long have you been practicing nursing? 

< 1 years

1 - 4 years

5 - 9 years

10 - 14 years

15 - 19 years

20 - 24 years

25 years or more

6. For how long have you been working in the preoperative? 

< 1 year

1 - 4 years

5 - 7 years

8 -11 years

12 - 16 years

17 and more

Respond to these question based on human care experience with your nurse colleague

	Never	rarely	Sometimes	Often	Always
I am treated with kindness and love
Models core self-care to meet the needs of others and self
Has a trusting relationship with me
Develops a conducive caring environment for professional growth
Values my values and beliefs

Have you ever experienced any of the outlined behaviours within the last 6 months?

	Never	Once	A few times	Several times	Monthly	Weekly	Daily
Glared at by a colleague in a hostile way
Subjected to some form of sexist remarks
Subjected to insults and name calling
Subjected to racial and ethnic acts
Received negative comments related to your religious beliefs
Treated rudely and disrespectfully
Subjected to negative comments related to your disability
Subjected to hostile pr even obscene gesture
Been yelled at in a hostile way
Subjected to potential threats

Based on the above behaviours, how have you been bothered by them?

Not at all

A Little

Moderately

Quite a bit

Within the last 6 months did you?

	Yes	No
Report any of violent behaviour that you experienced to your Superiors?
Confront the colleague who engaged in any of such Behaviors?
File a formal complaint concerning such experiences?

Please use the scale to make your rating

	Strongly Disagree	Disagree	Neither Disagree nor agree	Agree	Strongly Agree	Don't know
I am stressed on my current job
Work-related violence has been a major a source of my stress