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Coping Styles toward Hospital Violence in Clinical Nurses: An Application of Q Methodology

Eunho Ha1, Jinyoung Cho2
Korean Journal of Adult Nursing 2013;25(3):263-274.
Published online: June 18, 2013

1Red Cross College of Nursing, Chung-Ang University, Seoul

2Nursing Department Graduate School, Inha University, Incheon, Korea

Corresponding author: Cho, Jinyoung Nursing Department Graduate School, Inha University, Incheon, 253 Yonghyun-4 dong, Nam-gu, Incheon 402-751, Korea Tel: +82-10-2753-7314, Fax: +82-32-874-5880, E-mail: cho-jy72@hanmail.net
• Received: January 16, 2013   • Accepted: June 18, 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    Clinical nurses are at high risk of incurring hospital violence during their working life. Hospital violence and its outcomes have an impact on the job satisfaction, the recruitment and retention of nurses as well as the quality of care delivered to patients. The purpose of this study was to identify coping styles toward hospital violence in clinical nurses using Q-methodology.
  • Methods
    Q-methodology, which analyzes the subjectivity of each type of attitude, and coping styles was used. The 40 selected Q-statements from each of 35 participants were classified into the shape of a normal distribution using a 9-point scale. The collected data were analyzed using the pc-QUANAL program.
  • Results
    The results revealed four discrete groups of clinical nurses toward hospital violence: take strong action and promote the recurrence prevention, appear psychosomatic symptoms, investigate the cause and focus on prevention, and request hospital assistance and keep up my duty.
  • Conclusion
    The findings indicate that development of nursing intervention program based on the four types could beneficially contribute to the violence prevention in hospital.
  • Key Words: Nurses; Hospitals; Violence
Table 1.
Distribution of Q-sample Cards and Scores
Raw scores (Strongly disagree) (Neutral) (Strongly agree)
-4 -3 -2 -1 0 1 2 3 4
Transformed scores 1 2 3 4 5 6 7 8 9
Number of cards 2 4 5 7 9 7 5 4 2
Table 2.
Eigen Value, Factor Weight, and Characteristics of Participants (N=35)
Type Eigen value Participants no. Factor weight Age Mar Edu Rel WP (y) Pos Exp of violence Exp of VE SP
I (n=22) 28.4% 04 2.28 36 Yes Col No 14 CN Yes Yes No
20 2.00 31 No Uni Yes 9 CN Yes No No
09 1.78 34 No Mas Yes 12 CN Yes Yes No
19 1.66 24 No Col No 2 N Yes Yes Yes
23 1.28 27 Yes Col Yes 11 N Yes No No
14 1.20 26 Yes Uni No 6 N Yes No No
21 1.17 29 No Uni No 8 N Yes No No
16 1.16 29 No Col Yes 8 N No Yes No
32 1.15 24 No Col No 3 N No No No
34 1.14 24 No Uni No 2 N Yes Yes No
07 1.09 23 No Col No 2 N No No No
12 1.08 22 Yes Col Yes 1 N Yes No No
15 1.04 31 No Col Yes 9 CN Yes No No
06 1.01 26 No Col No 6 N No No No
02 0.95 26 No Uni No 2 N Yes No No
31 0.92 29 No Col Yes 8 N Yes Yes No
13 0.91 24 Yes Col No 2 N Yes No No
24 0.88 36 Yes Col No 14 N No No No
05 0.78 41 Yes Col No 17 UM Yes No No
30 0.63 34 No Col Yes 12 N Yes Yes Yes
25 0.49 33 Yes Uni No 12 CN No No No
26 0.34 30 Yes Col Yes 10 N Yes Yes No
II (n=6) 8.0% 28 1.94 26 No Col Yes 4 N Yes No No
29 1.85 27 No Uni No 5 N Yes No No
10 0.78 26 No Uni No 3 N Yes No No
22 0.48 30 Yes Col Yes 6 N No No No
03 0.47 34 Yes Col Yes 4 N No No No
27 0.42 33 Yes Uni No 10 CN Yes No No
III (n=6) 6.8% 33 1.35 26 Yes Col No 4 N Yes No No
17 0.84 33 Yes Uni Yes 11 UM Yes No No
18 0.82 22 No Col No 1 N No Yes No
11 0.58 36 Yes Uni Yes 12 UM Yes No No
08 0.44 22 No Col No 1 N No No No
01 0.21 30 No Col Yes 10 N Yes No No
IV (n=1) 35 0.10 24 No Col No 2 N No No No

Mar=marriage; Edu=education; Rel=religion; WP=working period; Pos=position; Exp=experience; VE=violence education; SP=security personnel

Table 3.
Q- Statement and Z-Scores (N=35)
Q-Statement Z-Score
I(n=22) II (n=6) III (n=6) IV (n=1)
Q1. Give pain verbally, physically, mentally. 1.16 -0.75 1.09 -0.49
Q2. Make feel embarrassed and humiliated. 0.05 -0.62 0.77 0.49
Q3. Take out their anger on nurses after fighting or arguing with somebody (doctors vs patients or relatives) -0.68 -0.03 0.36 -0.49
Q4. Nurses need to be countered boldly to violence, and act out of self-defence. 0.76 -0.52 -1.61 0.97
Q5. Delaying nursing activities with the turmoil caused by frequent phone, smoking, drinking is also violence. 0.42 -2.02 1.33 -0.49
Q6. Threatening against nurses with making a tough-looking face, shaking fingers at face, taking off jacket, and showing off tattoos. -0.05 1.36 -0.11 0.97
Q7. Words and actions seem to ignore the nurses. 0.06 1.54 0.43 0.00
Q8. Aggressive words and behaviour of a unconscious patient are not violence. -0.22 -1.57 -0.06 0.97
Q9. Being insulted, and disgraced in front of others (doctors, patients, patient's relatives, colleagues, etc.) 0.28 -0.38 0.20 0.00
Q10. Sexual jokes or actions of doctors, patients, and relatives towards nurses are also violence. 0.04 0.08 -1.34 0.00
Q11. Violence is a selfish behavior affecting interpersonal relationships. -0.35 0.56 -1.14 0.00
Q12. Violence from patients tends to overlook nicely. or acquiesce by reason of the weaker. 0.30 -0.13 -0.09 0.49
Q13. Can not continue nurse job being abused. 0.88 0.49 -1.90 0.00
Q14. Think continually about being abused, so can not concentrate on work, the counseling is required. -0.13 0.37 -0.75 0.97
Q15. Nurses are also weak women, bullying weak women can not justified, and should be punished as social evil. 1.22 1.70 -0.52 1.94
Q16. Nurse who is being abused can be attacker of violence. -0.23 0.68 -0.35 0.97
Q17. Decline job efficiency of nurses and deteriorate self-esteem. 1.33 0.30 0.60 0.00
Q18. Nurses face a lot of exposure to violence than other employees in the hospital. 1.19 0.14 1.67 0.00
Q19. Three-shifts work environment and unfair duty roster itself are violence. 0.12 -1.00 -0.42 -0.97
Q20. Active support of the hospital for the prevention of violence is necessary. 1.49 1.35 1.39 1.46
Q21. Verbal abuse of unit managers, senior nurses, and doctors is more serious. -0.83 0.53 -0.55 -0.97
Q22. Violence in the hospital is anyone experiences once, so can not be prevented. -2.28 -1.82 0.37 1.46
Q23. Stabilizing angry patient's relatives is not important thing. -0.96 -1.13 -1.29 -0.97
Q24. When violence occurs, report first, and than submit an accident report. 0.56 0.82 -0.50 1.46
Q25. When violence occurs, it is the safe way to leave the place first, and call security guards. 0.31 -0.38 1.12 0.00
Q26. Be absolutely furious at being abused, but tolerate or suppress that situation. -1.50 -1.34 0.96 -1.94
Q27. Nurses have to understand and be nice unconditionally even if patients use violence. -1.84 -1.99 -0.44 1.94
Q28. Colleague's support is the biggest help when violence occurs. -0.02 0.90 -0.74 -1.46
Q29. Patients who use violence must be compulsorily discharged. 1.69 -0.80 -0.40 -1.94
Q30. An unconditional apology without any further action is unjust whenever incidents of violence explode. 0.88 0.82 -0.29 -0.49
Q31. Violence attackers cannot be punished like a criminal penalty because of hospital image. -2.03 -1.33 0.42 -1.46
Q32. Regret that I am a nurse whenever experience violence. -0.23 0.67 -0.42 -1.46
Q33. Have no desire to do patient care actively. -0.37 0.20 -0.58 0.49
Q34. Determine the cause of the violence, and must find ways to solve the problem. 0.32 0.95 2.23 -0.97
Q35. Be afraid of going to work, so want to move into another workplace. -0.58 -0.05 0.21 0.49
Q36. Patient who used violence should not be hospitalized concerned about retaliation against employees. 1.04 0.05 0.34 -0.97
Q37. Institutional strategy that protects nurses from violence is necessary. 1.76 0.88 1.92 0.49
Q38. Feel so sad and teary, so keep drinking with colleague nurse after working, and lament my misfortune. -1.24 0.37 0.84 -0.49
Q39. Pray to God and depend on religion. -1.47 -0.64 -2.11 0.49
Q40. Can not work because of developed sleep disturbance, headache, palpitation, anorexia, stomach pain, diarrhea, and dyspnea. -0.66 1.69 -0.64 -0.49
Table 4.
Consensus and Average Z-Scores
Item description Average Z-Score
Q20. Active support of the hospital for the prevention of violence is necessary. 1.42
Q23. Stabilizing angry patient's relatives is not important thing. -1.09
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    Citations to this article as recorded by  
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    • Development and Validation of the Hospital Violence Attitude Scale-18 (HVAS-18) for Clinical Nurses
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    • Convergent approach of phenomenological methodology about Emergency Nurses' experience of hospital violence
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    Coping Styles toward Hospital Violence in Clinical Nurses: An Application of Q Methodology
    Korean J Adult Nurs. 2013;25(3):263-274.   Published online June 30, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.3.263
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    Coping Styles toward Hospital Violence in Clinical Nurses: An Application of Q Methodology
    Korean J Adult Nurs. 2013;25(3):263-274.   Published online June 30, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.3.263
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    Coping Styles toward Hospital Violence in Clinical Nurses: An Application of Q Methodology
    Coping Styles toward Hospital Violence in Clinical Nurses: An Application of Q Methodology

    Distribution of Q-sample Cards and Scores

    Raw scores (Strongly disagree) (Neutral) (Strongly agree)
    -4 -3 -2 -1 0 1 2 3 4
    Transformed scores 1 2 3 4 5 6 7 8 9
    Number of cards 2 4 5 7 9 7 5 4 2

    Eigen Value, Factor Weight, and Characteristics of Participants (N=35)

    Type Eigen value Participants no. Factor weight Age Mar Edu Rel WP (y) Pos Exp of violence Exp of VE SP
    I (n=22) 28.4% 04 2.28 36 Yes Col No 14 CN Yes Yes No
    20 2.00 31 No Uni Yes 9 CN Yes No No
    09 1.78 34 No Mas Yes 12 CN Yes Yes No
    19 1.66 24 No Col No 2 N Yes Yes Yes
    23 1.28 27 Yes Col Yes 11 N Yes No No
    14 1.20 26 Yes Uni No 6 N Yes No No
    21 1.17 29 No Uni No 8 N Yes No No
    16 1.16 29 No Col Yes 8 N No Yes No
    32 1.15 24 No Col No 3 N No No No
    34 1.14 24 No Uni No 2 N Yes Yes No
    07 1.09 23 No Col No 2 N No No No
    12 1.08 22 Yes Col Yes 1 N Yes No No
    15 1.04 31 No Col Yes 9 CN Yes No No
    06 1.01 26 No Col No 6 N No No No
    02 0.95 26 No Uni No 2 N Yes No No
    31 0.92 29 No Col Yes 8 N Yes Yes No
    13 0.91 24 Yes Col No 2 N Yes No No
    24 0.88 36 Yes Col No 14 N No No No
    05 0.78 41 Yes Col No 17 UM Yes No No
    30 0.63 34 No Col Yes 12 N Yes Yes Yes
    25 0.49 33 Yes Uni No 12 CN No No No
    26 0.34 30 Yes Col Yes 10 N Yes Yes No
    II (n=6) 8.0% 28 1.94 26 No Col Yes 4 N Yes No No
    29 1.85 27 No Uni No 5 N Yes No No
    10 0.78 26 No Uni No 3 N Yes No No
    22 0.48 30 Yes Col Yes 6 N No No No
    03 0.47 34 Yes Col Yes 4 N No No No
    27 0.42 33 Yes Uni No 10 CN Yes No No
    III (n=6) 6.8% 33 1.35 26 Yes Col No 4 N Yes No No
    17 0.84 33 Yes Uni Yes 11 UM Yes No No
    18 0.82 22 No Col No 1 N No Yes No
    11 0.58 36 Yes Uni Yes 12 UM Yes No No
    08 0.44 22 No Col No 1 N No No No
    01 0.21 30 No Col Yes 10 N Yes No No
    IV (n=1) 35 0.10 24 No Col No 2 N No No No

    Mar=marriage; Edu=education; Rel=religion; WP=working period; Pos=position; Exp=experience; VE=violence education; SP=security personnel

    Q- Statement and Z-Scores (N=35)

    Q-Statement Z-Score
    I(n=22) II (n=6) III (n=6) IV (n=1)
    Q1. Give pain verbally, physically, mentally. 1.16 -0.75 1.09 -0.49
    Q2. Make feel embarrassed and humiliated. 0.05 -0.62 0.77 0.49
    Q3. Take out their anger on nurses after fighting or arguing with somebody (doctors vs patients or relatives) -0.68 -0.03 0.36 -0.49
    Q4. Nurses need to be countered boldly to violence, and act out of self-defence. 0.76 -0.52 -1.61 0.97
    Q5. Delaying nursing activities with the turmoil caused by frequent phone, smoking, drinking is also violence. 0.42 -2.02 1.33 -0.49
    Q6. Threatening against nurses with making a tough-looking face, shaking fingers at face, taking off jacket, and showing off tattoos. -0.05 1.36 -0.11 0.97
    Q7. Words and actions seem to ignore the nurses. 0.06 1.54 0.43 0.00
    Q8. Aggressive words and behaviour of a unconscious patient are not violence. -0.22 -1.57 -0.06 0.97
    Q9. Being insulted, and disgraced in front of others (doctors, patients, patient's relatives, colleagues, etc.) 0.28 -0.38 0.20 0.00
    Q10. Sexual jokes or actions of doctors, patients, and relatives towards nurses are also violence. 0.04 0.08 -1.34 0.00
    Q11. Violence is a selfish behavior affecting interpersonal relationships. -0.35 0.56 -1.14 0.00
    Q12. Violence from patients tends to overlook nicely. or acquiesce by reason of the weaker. 0.30 -0.13 -0.09 0.49
    Q13. Can not continue nurse job being abused. 0.88 0.49 -1.90 0.00
    Q14. Think continually about being abused, so can not concentrate on work, the counseling is required. -0.13 0.37 -0.75 0.97
    Q15. Nurses are also weak women, bullying weak women can not justified, and should be punished as social evil. 1.22 1.70 -0.52 1.94
    Q16. Nurse who is being abused can be attacker of violence. -0.23 0.68 -0.35 0.97
    Q17. Decline job efficiency of nurses and deteriorate self-esteem. 1.33 0.30 0.60 0.00
    Q18. Nurses face a lot of exposure to violence than other employees in the hospital. 1.19 0.14 1.67 0.00
    Q19. Three-shifts work environment and unfair duty roster itself are violence. 0.12 -1.00 -0.42 -0.97
    Q20. Active support of the hospital for the prevention of violence is necessary. 1.49 1.35 1.39 1.46
    Q21. Verbal abuse of unit managers, senior nurses, and doctors is more serious. -0.83 0.53 -0.55 -0.97
    Q22. Violence in the hospital is anyone experiences once, so can not be prevented. -2.28 -1.82 0.37 1.46
    Q23. Stabilizing angry patient's relatives is not important thing. -0.96 -1.13 -1.29 -0.97
    Q24. When violence occurs, report first, and than submit an accident report. 0.56 0.82 -0.50 1.46
    Q25. When violence occurs, it is the safe way to leave the place first, and call security guards. 0.31 -0.38 1.12 0.00
    Q26. Be absolutely furious at being abused, but tolerate or suppress that situation. -1.50 -1.34 0.96 -1.94
    Q27. Nurses have to understand and be nice unconditionally even if patients use violence. -1.84 -1.99 -0.44 1.94
    Q28. Colleague's support is the biggest help when violence occurs. -0.02 0.90 -0.74 -1.46
    Q29. Patients who use violence must be compulsorily discharged. 1.69 -0.80 -0.40 -1.94
    Q30. An unconditional apology without any further action is unjust whenever incidents of violence explode. 0.88 0.82 -0.29 -0.49
    Q31. Violence attackers cannot be punished like a criminal penalty because of hospital image. -2.03 -1.33 0.42 -1.46
    Q32. Regret that I am a nurse whenever experience violence. -0.23 0.67 -0.42 -1.46
    Q33. Have no desire to do patient care actively. -0.37 0.20 -0.58 0.49
    Q34. Determine the cause of the violence, and must find ways to solve the problem. 0.32 0.95 2.23 -0.97
    Q35. Be afraid of going to work, so want to move into another workplace. -0.58 -0.05 0.21 0.49
    Q36. Patient who used violence should not be hospitalized concerned about retaliation against employees. 1.04 0.05 0.34 -0.97
    Q37. Institutional strategy that protects nurses from violence is necessary. 1.76 0.88 1.92 0.49
    Q38. Feel so sad and teary, so keep drinking with colleague nurse after working, and lament my misfortune. -1.24 0.37 0.84 -0.49
    Q39. Pray to God and depend on religion. -1.47 -0.64 -2.11 0.49
    Q40. Can not work because of developed sleep disturbance, headache, palpitation, anorexia, stomach pain, diarrhea, and dyspnea. -0.66 1.69 -0.64 -0.49

    Consensus and Average Z-Scores

    Item description Average Z-Score
    Q20. Active support of the hospital for the prevention of violence is necessary. 1.42
    Q23. Stabilizing angry patient's relatives is not important thing. -1.09
    Table 1. Distribution of Q-sample Cards and Scores

    Table 2. Eigen Value, Factor Weight, and Characteristics of Participants (N=35)

    Mar=marriage; Edu=education; Rel=religion; WP=working period; Pos=position; Exp=experience; VE=violence education; SP=security personnel

    Table 3. Q- Statement and Z-Scores (N=35)

    Table 4. Consensus and Average Z-Scores

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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