Document

JAN

JOURNAL OF ADVANCED NURSING

ORIGINAL RESEARCH

Stress resiliency, psychological empowerment and conflict management styles among baccalaureate nursing students
Eula W. Pines, Maureen L. Rauschhuber, Gary H. Norgan, Jennifer D. Cook, Leticia Canchola, Cynthia
Richardson & Mary Elaine Jones
Accepted for publication 1 October 2011

Correspondence to E.W. Pines: e-mail: [e-mail]
Eula W. Pines PhD RN PMHCNS-BC
Associate Professor of Nursing
Ila Faye Miller School of Nursing, University of the Incarnate Word, San Antonio, Texas, USA
Maureen L. Rauschhuber PhD RN RNC
Associate Professor of Nursing
Ila Faye Miller School of Nursing, University of the Incarnate Word, San Antonio, Texas, USA
Gary H. Norgan MSN PhD RN
Professor of Nursing
Ila Faye Miller School of Nursing, University of the Incarnate Word, San Antonio, Texas, USA
Jennifer D. Cook MBA PhD RN
Assistant Professor of Nursing
Ila Faye Miller School of Nursing, University of the Incarnate Word, San Antonio, Texas, USA
Leticia Canchola MSN RN
Instructor of Nursing
Ila Faye Miller School of Nursing, University of the Incarnate Word, San Antonio, Texas, USA
Cynthia Richardson MSN RN
Instructor of Nursing
Ila Faye Miller School of Nursing,University of the Incarnate Word, San Antonio, Texas, USA
Mary Elaine Jones MSN PhD
Professor of Nursing
Ila Faye Miller School of Nursing, University of the Incarnate Word, San Antonio, Texas, USA

PINES E.W., RAUSCHHUBER M.L., NORGAN G.H., COOK J.D., CANCHOLA L.,

Stress resiliency, psychological empowerment and conflict management styles among baccalaureate nursing students. Journal of Advanced Nursing 68(7), 1482–1493. doi: 10.1111/j.13652648.2011.05875.x
RICHARDSON

C.

&

JONES

M.E.

(2012)

Abstract
Aims. This article is a report of a Neuman Systems Model-guided correlational study of the relations of stress resiliency, psychological empowerment, selected demographic characteristics (age, ethnicity, semester in school) and conflict management styles.
Background. Emerging evidence suggests that stress resiliency and psychological empowerment can strengthen student nurses in academic achievement and coping with stress. Little is known about conflict management styles of students and the relationship to empowerment, resiliency and the implications for managing workplace conflict.
Methods. A correlational study was conducted in Spring 2010 with 166 baccalaureate students. Most participants were female, single, Hispanic and 25 years old.
The data collection instruments included the Stress Resiliency Profile, the Psychological Empowerment Instrument, the Conflict Mode Instrument and a demographic inventory. Descriptive and inferential correlational statistics were used to analyse the data.
Results. Students scored in the high range for focusing on their deficiencies in conflict situations; they scored above the 60th percentile for avoiding and accommodating behaviours and were less likely to use competing or collaborating strategies to manage conflict. Empowerment scores were significantly correlated with stress resiliency scores. Students with high scores on empowerment had high scores on the skill recognition subscale of the Stress Resiliency Profile suggesting more resilience; high scores on empowerment were related to high necessitating subscale scores of the Stress Resiliency Profile suggesting a predisposition to stress.
Conclusions. Neuman Systems Model may provide guidance for educators to strengthen student nurses’ management of stressors in the workplace.
Keywords: empowerment, interpersonal conflict, Neuman Systems Model, nursing, resiliency 1482

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Introduction
Interpersonal conflict in healthcare settings leads to workplace adversity for student nurses and new nurses (International Council of Nurses 2006, American Psychiatric Nurses
Association 2008, Center for American Nurses 2008, Joint
Commission for Hospitals 2008, Trossman 2010). These new healthcare providers are vulnerable and must deal with interpersonal conflict as they transition into the workforce
(Longo 2007, Hinchberger 2009, Thomas & Burk 2009).
Interpersonal conflict, most commonly horizontal violence, is an international problem as evidenced by research in
Australia (Farrell 1999), New Zealand (Curtis et al. 2007), and is an emerging threat to the nursing profession in the
United States (Vessey et al. 2009). In this article, the terms interpersonal conflict and horizontal violence are used interchangeably and defined as any act of aggression or hostility perpetrated by a colleague on another colleague
(Longo & Sherman 2007) including emotional, physical and verbal threats and intimidating covert or overt aggressive behaviours, and innuendoes or criticism (McKenna et al.
2003).
Bullying is a term closely associated with horizontal violence, but refers to repeated acts of horizontal violence
(Longo & Sherman 2007). Aggressive behaviours, incivility or lack of mutual respect (Laschinger et al. 2009), or power games (Kelly & Ahern 2009), can lower a person’s resiliency.
Resulting feelings of powerlessness and psychological distress eventually lead to attrition in nursing programmes (Pryjmachuk et al. 2009) and among new nurses (Vessey et al. 2009).
Management of these forms of interpersonal conflict requires behavioural skills which can be taught (Thomas 2002).
A growing body of knowledge supports the association of stress resilience, psychological empowerment and academic achievement for students in nursing programmes (St.
Germain et al. 2007) and the association of stress resiliency with psychological empowerment for Registered Nurses
(Simoni et al. 2004). Parallel studies describe conflict management styles of practicing nurses (Hodges et al. 2010) and nursing students (Sportsman & Hamilton 2007). Few studies have examined student nurses’ perceived experience with interpersonal conflict in relation to stress resiliency, psychological empowerment and personal conflict management styles using a systems approach.

Background
This study was guided by the Neuman Systems Model (NSM)
(Neuman & Fawcett 2011). Neuman views the client as a central core of basic survival factors surrounded by lines of
Ó 2011 Blackwell Publishing Ltd

Stress resiliency

defence and resistance designed to protect the core and maintain stability and balance (Neuman & Fawcett 2011).
Five interacting variables (physiological, psychological, sociocultural, developmental and spiritual) within the client system interrelate and interact, thus determining the ability of the client to resist stressors in the internal and external environment (Neuman & Fawcett 2011). Individuals react to stressors in the environment such as interpersonal conflict, an interpersonal stressor, with a stress response which could invade the normal line of defence if not mitigated by the flexible line of defence (Neuman & Fawcett 2011). Whether or not the normal line of defence is protected from stressor invasion depends on the interrelationship of the interacting variables (Neuman & Fawcett 2011). The variables of this study are linked to the interacting variables of the NSM.
Psychological empowerment, stress resiliency and conflict management style are linked to the psychological variable; ethnicity is linked to the sociocultural variable; and age and semester in school are linked to the developmental variable.
Primary prevention in conflict management occurs before the system reacts to a stressor, strengthening the individual’s flexible line of defence by increasing the resiliency of nursing students and empowering them to cope with the stressor of interpersonal conflict.
Stress resiliency and psychological empowerment are human traits, combining to strengthen the capacity of an individual to respond to stressors. More than 50 years of scientific evidence supports the power of resilience in relation to positive outcomes among children, adolescents, families and trauma survivors (Reivich & Shatte 2002, American
Psychological Association 2010). Resilience is defined as the ability to bounce back (Smith et al. 2008). The personal attributes of resilient people include an ‘internal locus of control, pro-social behaviour, empathy, positive self-image, optimism, and the ability to organize daily responsibilities’
(McAllister & McKinnon 2009, p. 373). Spreitzer (1995) posits that empowered individuals are more resilient.
Empowerment is viewed as a psychological process that enables establishing and attaining goals (Brancato 2006).
According to Uner and Turan (2010), the concept of empowerment connotes ‘power, control, ability, competence, self-efficacy, autonomy, knowledge, development, self-determination, and strengthening of one’s own group in society’
(p. 1). Psychological empowerment consists of four cognitive dimensions: meaning, competence, self-determination and impact (Spreitzer 1995). Meaning is the value an individual attributes to personal work goals and results in high commitment and concentration of energy; competence or self-efficacy, is an individual’s beliefs in his or her capability to perform activities with skill and mastery. Self-determination
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refers to an individual’s sense of having a choice in initiating and regulating actions and work behaviours; and impact reflects the degree to which an individual can influence strategic or operating outcomes at work (Spreitzer 1995).
Seen from this perspective, psychological empowerment is necessary for nurses to navigate the complex environment of healthcare systems. Spreitzer (1995) stated that when individuals are psychologically empowered they feel that they have a voice in organizational decision-making and thus psychological empowerment is how one views oneself in the work environment. Brancato (2006) likewise emphasized that nurses must first understand the concept of empowerment to engage in organizational decision-making.
Studies of stress and resiliency date back to the 1800s in both the physiological and psychological literature (Reivich
& Shatte 2002). A number of relevant reviews provide the foundation for the importance of resilience in the nursing workplace (Jackson et al. 2007, Scholes 2008, McAllister &
McKinnon 2009).
Stress resiliency has been linked to psychological empowerment in a number of studies of Registered Nurses in the workplace (Catlette & Belzoni 2005, Hodges et al. 2008,
Kelly & Ahern 2009, Pellico et al. 2009, Thomas & Burk
2009, Hodges et al. 2010). Most used qualitative strategies to describe perspectives of stress and resilience among both practicing nurses and nursing students. Using a predictive design in a study of 142 predominantly white female
Registered Nurses randomly selected from four units in two hospitals in a mid-Atlantic state, Simoni et al. (2004) found that nurses had above average empowerment scores; 24% of the variance in empowerment scores was explained by skill recognition and deficiency, two subscales of the Stress
Resiliency Profile (SRP). The authors concluded that nurses who believe in their abilities and do not focus on deficiencies experience empowerment. This suggests that an individual’s interpretative style has the potential to affect empowerment, and points to the need to increase stress resiliency to help manage conflict in the workplace (Larrabee et al. 2010).
Research suggests that stress resiliency is a factor in the retention of nurses. In a qualitative study of 19 newly graduated and experienced Registered Nurses, Hodges et al.
(2010) found that professional resilience emerged as an overarching theme when determining how both new baccalaureate nurses and experienced nurses understood, adapted and negotiated challenges in their respective acute care settings. An emerging group of studies tested strategies for enhancing stress resiliency and empowerment to affect academic outcomes and retention among student nurses. Steinhardt and Dolbier (2008) used an experimental design to test the
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effectiveness of a 4-week intervention to enhance resilience, coping strategies and protective factors and to decrease symptomatology during a period of increased academic stress among a sample of 57 predominantly female undergraduate white college students. Students who participated in the
2-hour weekly sessions achieved significantly higher resilience scores, more effective coping strategies, higher scores on protective factors and lower scores on symptomatology.
Young (2009) investigated the relationship of stressors, stress resiliency, psychological empowerment and academic success and the effect of an intervention to increase resilience and empowerment in a sample of 132 baccalaureate nursing students at two campus sites over a 2-year period using both qualitative and quantitative strategies. Preliminary findings indicated that 98% of participants were retained; successful students experienced slightly above average psychological empowerment and scored at least average in stress resiliency.
Interpersonal conflict in the workplace is inevitable, but the Joint Commission for Hospitals (2008) identified intimidating, disruptive behaviours and incivility as contributors to adverse outcomes for patients, nurses and healthcare organizations. For example, the Institute for Safe Medication
Practices (2004) found that 7% of 2095 nurses, pharmacists, and other providers surveyed reported intimidation as a major contributor to their medication errors. While horizontal violence or bullying behaviours are common in other healthcare disciplines, these behaviours threaten the profession of nursing and the nursing workforce (Trossman 2010).
In a national survey of 303 predominantly white, female
Registered Nurses, Vessey et al. (2009) found that 70% of staff nurses indicated that they experienced bullying in the workplace. Consequently, nurses avoided potential situations where they might be shunned, insulted, or abused to the possible detriment of patient care outcomes in healthcare organizations. Staff nurses who had worked 75% stated they had resigned from the position where they were bullied. Authors concluded that novice nurses serving in their first positions were of particular concern given the effect of bullying on self-esteem. Dyess and Sherman (2009) used a focus group to study learning needs during the transition to work phase among
81 new Registered Nurses participating in a leadership workshop. Most participants were white, female, and averaged 32 years of age, working in acute care settings. They described frequent experiences with horizontal violence. The authors recommended assisting new graduates to identify and learn strategies for appropriate responses. Similar findings from other studies suggest that nursing students experience interpersonal conflict, including verbal abuse and intimidatÓ 2011 Blackwell Publishing Ltd

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ing behaviours from nurses in the clinical setting, indicating the need for assistance to settle conflict using appropriate conflict management styles (Longo & Sherman 2007,
Thomas & Burk 2009).
Few studies of nursing students have examined conflict management styles. Sportsman and Hamilton (2007) described the styles of 126 primarily female nursing and allied health undergraduate and graduate students using the
Thomas Kilmann Conflict Mode Instrument (CMI). Most participants chose compromise followed by avoidance as preferred styles of managing conflict; competition was the least chosen style. While 56% chose two or more styles, these styles were most frequently avoidance or accommodation;