From Trauma to Transformation: A Mixed-methods Study Developing and Validating the Triple-a Framework for Addressing Workplace Violence and Fostering PosttraumaticGrowth Among Nurses in ChinaThe Triple-A Framework for Workplace Violence and Growth
Abstract
Aim: To develop and validate the Triple-A (Acquaint, Analyze, Act) framework for addressing workplace violence (WPV) against nurses in China by integrating longitudinal quantitative data with qualitative insights from nurse educators.
Background: WPV is pervasive in Chinese healthcare, with severe psychological impacts. A paradigm shift is needed to foster resilience and post-traumatic growth (PTG), leveraging the underutilized perspective of nurse educators.
Methods: A 12-month prospective, explanatory sequential mixed-methods study was conducted. The quantitative phase tracked 312 nurses using the PCL-5, PTGI, and HADS at baseline, 6, and 12 months. The qualitative phase involved phenomenological interviews with 18 nurse educators. Data were analyzed via repeated measures ANOVA and Colaizzis method, then integrated to construct the Triple-A framework.
Results: Quantitative results showed a significant decrease in PTSD symptoms (F(2, 622) = 14.52, p < .001) and a significant increase in PTG (F(2, 622) = 9.84, p < .01) over time. Anxiety and depression also decreased significantly. Qualitative analysis revealed three interconnected
Themes: Acquaint (awareness and reframing), Analyze (risk recognition and assessment), and Act (proactive response and advocacy), forming the Triple-A framework and explaining the quantitative recovery trajectory.
Conclusion: The Triple-A framework is an evidence-based, culturally sensitive model that addresses both PTSD and PTG following WPV. It offers a structured roadmap for nursing management to implement trauma-informed systems that mitigate harm and promote growth.
Implications for Nursing Management: Leaders should institutionalize the Triple-A framework by integrating WPV education, establishing stigma-free reporting, fostering psychological safety, and enforcing zero-tolerance policies.
Background: WPV is pervasive in Chinese healthcare, with severe psychological impacts. A paradigm shift is needed to foster resilience and post-traumatic growth (PTG), leveraging the underutilized perspective of nurse educators.
Methods: A 12-month prospective, explanatory sequential mixed-methods study was conducted. The quantitative phase tracked 312 nurses using the PCL-5, PTGI, and HADS at baseline, 6, and 12 months. The qualitative phase involved phenomenological interviews with 18 nurse educators. Data were analyzed via repeated measures ANOVA and Colaizzis method, then integrated to construct the Triple-A framework.
Results: Quantitative results showed a significant decrease in PTSD symptoms (F(2, 622) = 14.52, p < .001) and a significant increase in PTG (F(2, 622) = 9.84, p < .01) over time. Anxiety and depression also decreased significantly. Qualitative analysis revealed three interconnected
Themes: Acquaint (awareness and reframing), Analyze (risk recognition and assessment), and Act (proactive response and advocacy), forming the Triple-A framework and explaining the quantitative recovery trajectory.
Conclusion: The Triple-A framework is an evidence-based, culturally sensitive model that addresses both PTSD and PTG following WPV. It offers a structured roadmap for nursing management to implement trauma-informed systems that mitigate harm and promote growth.
Implications for Nursing Management: Leaders should institutionalize the Triple-A framework by integrating WPV education, establishing stigma-free reporting, fostering psychological safety, and enforcing zero-tolerance policies.
Keywords
Workplace violence; Nurse educators; Post-traumatic growth; Post-traumatic stress disorder; Mixed methods; China, trauma-informed care; Triple-A framework
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[1] World Health Organization. (2022). Violence against health workers.
[2] Chen, S., et al. (2023). Journal of Nursing Management, 31(1), 45-56.
[3] Tedeschi, R. G., & Calhoun, L. G. (1996). Journal of Traumatic Stress, 9(3), 455471.
DOI: http://dx.doi.org/10.70711/cle.v2i8.8339
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