Intervention to Decrease Perception of Horizontal Violence in Military Nursing

Horizontal violence (HV) behaviors within the nursing work environment can lead to negative psychological and physical outcomes for nurses, decreased job satisfaction, intention to leave and poor patient outcomes. The actual occurrence of HV within the hierarchical military health care work environment as well as effective interventions to alleviate any HV behaviors, however, have not been established.

The purpose of this study is to further develop this line of research by describing the prevalence of HV in the military nursing work environment and determining the effectiveness of an intervention to minimize HV. This study will use an anonymous 54-item electronic questionnaire to describe the perception of HV before and after an educational intervention.

The specific aims are to: 1) Describe the perceived experience of HV as measured by the Horizontal Violence Workplace Inventory - Modified including a) overt, b) covert, c) personal effects, and d) perpetrators; 2) Measure the relationship between HV and job satisfaction and intent to leave; and 3) Determine if there is a difference in the perceived experience of HV before and after the intervention.

The questionnaire data (including a 39-item modified HVWI-M, a job satisfaction item, two intent to leave items and 12 demographic items) will be from a convenience sample of nursing staff in 5 military healthcare facilities (Army, Air Force, and Navy). The questionnaire will be administered 1 month before and 3 months after an educational intervention intended to increase HV awareness and to train nursing staff how to use cognitively rehearsed responses when they encounter HV behaviors. Data analysis will include instrument validation tests for the HVWI-M, descriptive data statistics to describe the perceived experience of HV, regression to test for dependence, and comparisons between the before and after intervention data.

Aimed at caring for the caregiver and assisting in retention of quality nurses, this intervention study will provide a beginning description of HV in military nursing and generate needed evidence for the effectiveness of HV interventions.