RESEARCH DISCUSSION 5 Discussion #5 Reliability and Validity Discuss your individual critical analysis of the posted article with in-text referencing to

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Discussion #5

Reliability and Validity

Discuss your individual critical analysis of the posted article with in-text referencing to support your thoughts and ideas. Include an APA-formatted reference list.

Choose one of the posted articles for critique and respond to the following prompts:

1.       Identify the article chosen. Briefly describe the purpose of the study and identify the independent and dependent variables.

2.       Define the operational definition of the variables. Evaluate the operational definitions for clarity.

3.       Describe how data were collected and the instruments used to measure the data. Discuss whether these instruments were appropriate for use in this study.

4.       What steps should researchers take to ensure fidelity in data collection? Analyze what steps were taken by the researchers in this study. 

5.       Was instrument validity addressed? If it was, describe how validity was addressed. If not, discuss how the researchers might have been confident that the instrument was valid.

6.       How does the strength and quality of evidence related to reliability and validity influence the applicability of findings to clinical practice?

7.       What is your cosmic question?

Compassion Fatigue RCT.pdf

3584 | wileyonlinelibrary.com/journal/jan J Adv Nurs. 2020;76:3584–3596.© 2020 John Wiley & Sons Ltd

Received: 2 May 2020 | Revised: 22 July 2020 | Accepted: 24 July 2020
DOI: 10.1111/jan.14568

O R I G I N A L R E S E A R C H : C L I N I C A L T R I A L

Effect of a compassion fatigue resiliency program on nurses’
professional quality of life, perceived stress, resilience:
A randomized controlled trial

Tuğba Pehlivan1 | Perihan Güner2

1Koç University Hospital, Istanbul, Turkey
2Istanbul Bilgi University Faculty of Health
Sciences, Istanbul, Turkey

Correspondence
Tuğba Pehlivan, Koç University Hospital,
Istanbul, Turkey.
Email: tpehlivan14@ku.edu.tr

Funding information
This research received no specific grant
from any funding agency in the public,
commercial, or not-for-profit sectors.

Abstract
Aims: This study aimed to conduct a short- and long-term Compassion Fatigue
Resiliency Program and compare its impact on nurses’ professional quality of life,
perceived stress, and resilience.
Design: The research was conducted between January 2017 January 2019 as a ran-
domized controlled trial.
Methods: The sample comprised 125 oncology–haematology nurses randomly as-
signed to a Experimental I, Experimental II, or control group. The Compassion Fatigue
Resiliency Program was conducted with the nurses as an intervention. Experimental
I received a short-term program (5 hr per day for 2 days, 10 hr in total) while
Experimental II received a long-term one (5 weeks, 2 hr per week, 10 hr in total).
Measurements were obtained during pre- and post-test and at 3-, 6-, and 12-month
follow-ups. Research hypotheses were analysed using multilevel models.
Results: The results of multilevel model analyses showed there was no statistically
significant difference between mean scores for compassion fatigue, burnout, per-
ceived stress, and resilience of nurses in the short- or long-term groups or of those
in the control group. Mean compassion satisfaction scores of nurses in the short- or
long-term groups were significantly higher than those in the control group. Mean
compassion satisfaction scores of nurses in the short- or long-term groups were sig-
nificantly higher than the control group’s pre-test mean after 6 and 12 months.
Conclusion: This study concluded that short- or long-term programs had no influ-
ence on compassion fatigue, burnout, perceived stress, and resilience; however, both
programs positively affected compassion satisfaction. We recommend that further
studies be conducted, which will help determine the effectiveness of new programs.
Impact: Caring for patients with cancer can generate work-related stress that can
negatively affect oncology nurses’ physical and emotional health, which could lead
to compassion fatigue. The program provided nurses with an opportunity to improve
their compassion satisfaction. Because there was no difference between both pro-
grams regarding mean compassion satisfaction scores, a short-term program may
be preferred to encourage more participation among nurses. We also recommend

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1 | I N T R O D U C T I O N

Cancer is a chronic disease that symbolizes the limitation of con-
trol over life and death and creates many physical and psychoso-
cial problems in patients (Wang et al., 2018). The disease and its
accompanying problems challenge not only patients and families
but also the healthcare team that provides treatment and care
(Onan & Işıl, 2010). Frequent exposure to specific conditions,
such as complex cancer treatments and patient deaths, is a sig-
nificant source of stress for oncology nurses (Wilczek-Rużyczka
et al., 2019). Every day, nurses witness patients’ pain and suffering,
engage in intensive treatment, are frequently exposed to death
and dying patients, face ethical dilemmas associated with cancer
treatment, and develop close relationships with those fighting the
disease (Jones, 2017). Exposing themselves to the pain and suf-
fering, developing close relationships, and demonstrating well-de-
veloped empathy and compassion may cause nurses to experience
compassion fatigue (CF), along with decreased compassion satis-
faction (CS) (Jang et al., 2016). In addition, the increasing num-
ber of patients, excessive workload, and shortage of free time are
cited as reasons for increased job stress and burnout among on-
cology nurses according to the literature (Tuna & Baykal, 2014).
High levels of job stress negatively affect nurses’ continuance
commitment, turnover rates, patient satisfaction, and patient
safety, as well as increase burnout (Grunfeld et al., 2005). Duarte
and Pinto-Gouveia (2017) showed that approximately 25% of on-
cology nurses experienced high levels of burnout, CF, and lower
levels of CS, while Ja and Hyunjoo (2017) determined high levels
of secondary traumatic stress (STS) in 27.9%, burnout in 35% and
CS in 25.7% of nurses.

1.1 | Background

Known as a negative consequence of helping individuals experienc-
ing traumatic events or suffering, CF has an adverse effect on physi-
cal and mental health as well as on job performance and satisfaction
(Arimon-Pagès et al., 2019). Additionally, CF was found to increase
nurse turnover rates in institutions, decrease patient satisfaction,

reduce the quality of patient care, and pose a risk to patient safety
(Mooney et al., 2017). Consequently, it can be concluded that at-
tempts to prevent or reduce CF are inevitable.

According to literature examining the methods of interven-
tional studies conducted to prevent CF in oncology nurses, two
of the most effective initiatives are institutional arrangements and
training programs (Fetter, 2012; Yu et al., 2016). Yu et al. (2016)
recommended conducting specific training programs for oncology
nurses to raise awareness of possible negative effects when caring
for cancer patients. It is also necessary to increase nurse resilience
by helping them recognize and cope with CF (Rishel, 2015) and
nurses should be directed to education and training programs that
will improve their resilience (Gillman et al., 2015). The Compassion
Fatigue Resiliency Program (CFRP) is a structured, comprehensive
training program developed for nurses to prevent and minimize CF
and improve resilience. Studies examining the implementation of
CFRPs for oncology nurses (Back et al., 2014; Potter, et al., 2013;
Potter et al., 2013) showed that it was effective in preventing CF.
When interventional studies on CFRPs were examined, samples
were found to be small (Flarity et al., 2016; Pfaff et al., 2017;
Potter, et al., 2013), almost all studies were quasi-experimental,
comprising subjects assigned to the same group for pre- and post-
test (Flarity et al., 2016; Pfaff et al., 2017; Potter, et al., 2013),
and all programs were implemented for a term of 5 weeks. These
studies recommended examining the program’s effectiveness
with larger samples, particularly conducting randomized con-
trolled trials using quantitative methods and conducting a short-
term program and following-up its effectiveness for up to 1 year
(Flarity et al., 2013; Kim & Park, 2016; Pfaff et al., 2017; Potter,
et al., 2013).

2 | T H E S T U DY

2.1 | Aims

Considering the gaps in the literature, this study aimed to implement
a CFRP for oncology nurses as a short-term and long-term program
and to compare its impact on the nurses’ professional quality of life
(CF, burnout, CS), PS, and resilience.

further studies should be conducted that include environmental improvements along
with the training programs.
Trial registered at ClinicalTrials.gov (The name of the trial register: Effect of a
Compassion Fatigue Resiliency Program; the clinical trial registration number:
NCT04372303).

K E Y W O R D S

burnout, compassion fatigue, compassion satisfaction, oncology–haematology nurses,
perceived stress, resilience

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2.2 | Design

The research was conducted as a randomized controlled trial.

2.3 | Setting and participants

The research was conducted with nurses from the oncology–hae-
matology inpatient services, outpatient chemotherapy units, and
bone marrow transplant (BMT) units of three private hospitals in
Istanbul between January 2017 and January 2019. No sample se-
lection models were applied and of 153 nurses working in these
services, 125 nurses meeting the inclusion criteria were included
in the study. Nurses were randomly assigned to the Experimental I,
Experimental II, or control group to prevent interaction between the
subjects working in the same hospital. Of the nurses, 34 completed
the short-term program (Experimental I), 49 completed the long-
term (Experimental II), and 42 were assigned to the control group
(Figure 1).

2.3.1 | Inclusion criteria

• Nurses working in inpatient oncology–haematology, outpatient
chemotherapy, or BMT unit

2.3.2 | Exclusion criteria

• Providing care for paediatric oncology patients
• Being a nurse manager
• Not providing direct patient care

2.4 | Data collection

2.4.1 | Personal information form

A personal information form included 14 questions about socio-de-
mographics, occupational information, and working conditions, and
the level of received social support.

2.4.2 | Professional quality of life scale-IV (ProQOL-
IV)

The ProQOL-IV, developed by Stamm (2005) and adapted to Turkish
by Yeşil et al. (2010), is a self-reporting instrument consisting of 30
items and 3 subscales: CF, CS, and burnout. The scale has no total
score. Each subscale is evaluated separately. Items 1, 4, 15, 17, and
29 should be reversed scored during the evaluation. The evaluation
process of items was based on a six-digit chart ranging from “never”
(0) to “very often” (5). In the Turkish adaptation, the Cronbach’s alpha

reliability coefficients were found to be 0.83, 0.62, and 0.81 for com-
passion fatigue, burnout, and compassion satisfaction, respectively
(Yeşil et al., 2010). There was no cut-off point in the validity and reli-
ability study of the Turkish version; however, Stamm (2005) stated in
their evaluation performed with high- and low-range groups of 25%
that scores above 17 indicate high CF levels while scores below 8 in-
dicate low, scores below 18 indicate low burnout levels while scores
above 27 indicate high, and scores above 42 indicate high CS levels
while those below 33 indicate low.

2.4.3 | Perceived stress scale

The Perceived Stress Scale, developed by Cohen et al. (1983) and
adapted to Turkish by Eskin et al. (2013), uses a five-point Likert
scale with four reverse worded items (4, 5, 7, & 8) and six positively
worded items (1, 2, 3, 6, 9, & 10). There are three versions of the
scale consisting of 14, 10, and 4 items. The Cronbach’s alpha reliabil-
ity coefficient was found to be 0.82 in the Turkish adaptation of the
10-point version. It was developed to measure the degree to which
individuals perceived their life as unpredictable, uncontrollable, and
overloaded during the previous month. The lowest possible score is
0 and the highest is 40. A high total score is considered a high level
of PS.

2.4.4 | Resilience scale for adults

The Resilience Scale for Adults, developed by Friborg et al. (2005),
and adapted to Turkish by Basım and Çetin (2011) has a lowest possi-
ble score of 33 and a highest of 165. The Cronbach’s alpha reliability
coefficient of the sub-dimensions vary between 0.6-6-0.81. In addi-
tion, the value was calculated as 0.86 for the reliability of the whole
scale. Positive and negative factors are distributed on two sides of
the scale to prevent participants from prejudiced attitudes. In this
study, resilience increased in direct proportion to the scores.

2.5 | Ethical considerations

Research committee ethical approval was received from Koç
University Ethical Board of Biomedical Research on 22 December
2016 (No:2016.263.IRB2.124). Institutional permissions and verbal
and written informed consent of the nurses were obtained before
the study.

2.6 | Study procedure

This study’s principal investigator had participated online in a CFRP,
developed by Eric Gentry (Licensed Mental Health Counselor)
(2002), and received the certificate, and then conducted the pro-
gram with the nurses. Meetings were held with each institution’s

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F I G U R E 1 CONSORT Flow Diagram showing the number of nurses in the study and those who dropped out at the different stages of the
study [Colour figure can be viewed at wileyonlinelibrary.com]

Assessed for eligibility (N = 153)

Excluded (N = 28)
Other reasons (Institution
did not plan program) (N =
28)

Lost to post-test (N = 0)
Lost to three-month follow-
up (N: 2)

Left the institution
Lost to six-month follow-up
(N: 7)

Left the institution
Lost to one-year follow-up
(N: 12)

Left the institution

Allocated to intervention
group I (N = 34)

Received the short-term
program (N = 34)

Allocated to control group
(N = 42)

Received no intervention
(N = 42)

Randomized (N = 125)

Enrollment

Allocated to intervention
group II (N = 49)

Received the long-term
program (N = 49)

Analysed at post-test (N =
34)

Allocation Allocation

Analysed at three-month
follow-up (N = 32)

Analysed at six-month
follow-up (N = 25)

Analysed at one-year
follow-up (N = 13)

Lost to post-test (N = 6)
Discontinued
intervention

Lost to three-month follow-
up (N: 0)
Lost to six-month follow-up
(N: 4)

Left the institution
Lost to one-year follow-up
(N: 8)

Left the institution

Follow-Up

Analysed at post-test (N =
43)

Lost to post-test (N = 2)
Left the institution

Lost to three-month follow-
up (N: 4)

Left the institution
Lost to six-month follow-up
(N: 7)

Left the institution
Lost to one-year follow-up
(N: 5)

Left the institution

Follow-Up

Analysed at post-test (N =
40)

Analysed at three-month
follow-up (N = 43)

Analysed at three-month
follow-up (N = 36)

Analysed at six-month
follow-up (N = 39)

Analysis Analysis

Analysed at one-year
follow-up (N = 31)

Analysed at six-month
follow-up (N = 29)

Analysed at one-year
follow-up (N = 24)

3588 | PEHLIVAN ANd GÜNER

directorate of nursing services to determine the training schedules
and content. The schedules were planned in accordance with the
hospital administration’s preferences and by taking nurses’ busy
schedules into consideration. Preliminary tests were applied to
Experimental I, Experiment II, and the control group before the
training. Experimental I received a short-term program (5 hr per
day for 2 days, 10 hr in total) while Experimental II received a long-
term one (5 weeks, 2 hr per week, 10 hr in total). No intervention
was applied to the control group. After the training, a post-test and
3-, 6-, and 12-month follow-up assessments were conducted for
all groups.

2.7 | Program

2.7.1 | Compassion fatigue resiliency program

The purpose of the program: The purpose of the program is to provide
oncology–haematology nurses with knowledge and skills that will in-
crease their level of resilience by helping them recognize compassion
fatigue, cope with its consequences, and work effectively.

2.7.2 | The objectives of the training program

Nurses, who successfully complete the program, will be able to:

• Explain the historical development of compassion fatigue among
caregivers,

• Define the developmental process of compassion fatigue,
• Specify the risk factors for compassion fatigue,
• Explain the symptoms of compassion fatigue,
• Raise awareness about their personal history,
• Explain the concept of stress and its impact on the body,
• Apply compassion fatigue resilience skills acquired in the program,
• Professionally create a self-directed resilience plan.

2.8 | Validity and reliability

The included scales have been tested for validity and reliability for
various settings and countries (Çolak Sarı, 2018; Deible et al., 2015;
Rushton et al., 2015; Tarantino et al., 2013; Tekin, 2011; Traeger
et al., 2013). We chose three private hospitals in Istanbul, which are
considered to be close to each other, such as institution (etc. work-
ing conditions) and the socio-demographic and professional char-
acteristics of nurses (age, educational status, clinical experience,
willingness to work in oncology, voluntarily career choice, and etc.),
that are known to affect outcome variables. Then, we randomly as-
signed each hospital to the Experimental I, Experimental II, or con-
trol group to prevent interaction between the nurses working in the
same hospital. Finally, the program was conducted by the principal
investigator who had participated online in a CFRP and received the
certificate.

2.9 | Data analysis

SPSS 25.0 software package was used to analyse data. Prior to the
employment of parametric statistical techniques, the Shapiro–Wilk
test was used to ensure the data distributed normally. A chi-square
test and one-way ANOVA determined whether the scales and in-
formation on demographic characteristics and work environment
differed among pre-initiative groups; in other words, to measure ho-
mogeneity. There was a statistically significant difference between
the groups regarding age, total work hours per week, total years of
professional experience, total years of oncology experience, level of
received social support, and marital status (p < .05). The comparison
of the mean scores for nurses’ compassion fatigue, burnout, compas-
sion satisfaction, perceived stress, and resilience according to pre-
initiative groups is given in Table 1.

Variables found to be statistically significant were included in
the model as a correction factor for primary hypotheses. Primary
research hypotheses were analysed using multilevel models (MLM).

Variables

Experimental I
(N= 34)
Mean (SD)

Experimental II
(N= 49)
Mean (SD)

Control
(N= 42)
Mean (SD) p-Value

Compassion fatigue 15.2 (7.7) 12.4 (6.0) 13.5 (8.1) .198

Burnout 21.3 (6.7) 19.2 (6.8) 20.3 (6.8) .382

Compassion satisfaction 38.5 (7.4) 39.6 (6.7) 35.5 (7.8) .036*

Perceived stress 32.7 (3.1) 31.8 (3.6) 31.7 (3.5) .308

Resilience 139.4 (15.6) 133.3 (19.3) 134.7 (16) .261

Abbreviations: Experimental II, Long-term training group.
†Standard deviations are given in parentheses.
‡Experimental I, Short-term training group.
§p-Values indicate the statistically significant differences between groups.
¶Bold values indicate statistically significant values; SD: standard deviation.
*Post hoc analysis indicated a statistically significant difference between Experimental II and
control group.

T A B L E 1 Comparison of the baseline
mean scores of compassion fatigue,
burnout, compassion satisfaction,
perceived stress, and resilience among
groups (N: 125)

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This analysis method has some advantages over others, such as
repeated measures ANOVA. These advantages can be defined as
the ability to deal with missing data in MLM and be included in
the analysis process of investigating individual differences (ran-
dom effect) (Tab achnick & Fidell, 2015). Consequently, MLM was
used to analyse the data. In the analysis process, distribution of

the random intercepts and slopes was determined, and models
were compared using log-likelihood function based on different
correlation assumptions for repeated measures and random ef-
fects. Then, the effect of group, time, and group X time interac-
tions and other explanatory variables were included in the model
and the final model-based results were reported. In the process of

T A B L E 2 Baseline characteristics of nurses (N: 125)

Characteristics

Experimental I
(N= 34)
N (%)

Experimental II
(N= 49)
N (%)

Control
(N= 42)
N (%)

Educational status

Vocational high school 7 (14.3) 5 (14.7) 5 (11.9)

Associate’s degree 2 (4.1) 4 (11.8) 3 (7.1)

Bachelor’s degree 35 (71.4) 21 (61.8) 32 (76.2)

Postgraduate 5 (10.2) 4 (11.8) 2 (4.8)

Level of received social support

Enough 10 (20.4) 13 (38.2) 20 (47.6)

Not enough 39 (79.6) 21(61.8) 22 (52.4)

Willing to work in oncology

Yes 47 (95.9) 34 (100) 40 (95.2)

No 2 (4.1) 0 (0) 2 (4.8)

Voluntary career choice

Yes 38 (77.6) 27 (79.4) 28 (66.7)

No 11 (22.4) 7 (20.6) 14 (33.3)

Type of shift

Permanent day shift 8 (16.3) 11 (32.4) 12 (28.6)

Day-night shift 41 (83.7) 23 (67.6) 30 (71.4)

Gender

Female 44 (89.8) 32 (94.1) 36 (85.7)

Male 5 (10.2) 2 (5.9) 6 (14.3)

Marital status

Married 14 (28.6) 2 (5.9) 8 (19)

Single 35 (71.4) 32 (94.1) 34 (81)

Department

Oncology inpatient service 7 (14.3) 8 (23.5) 11 (26.2)

Haematology inpatient service 11 (22.4) 3 (8.8) 0 (0)

Oncology–haematology inpatient service 0 (0) 4 (11.8) 21 (50.0)

Bone marrow transplantation unit 24 (49.0) 12 (35.3) 0 (0)

Outpatient chemotherapy unit 7 (14.3) 7 (20.6) 10 (23.8)

Experimental I
Mean (SD)

Experimental II
Mean (SD)

Control
Mean (SD)

Age 25.0 (5.1) 27.8 (5.3) 27.2 (5.3)

Work hours per week 53.8 (4.7) 48.1 (3.8) 48.4 (1.6)

Work hours per day 11.1 (1.0) 11.5 (1.0) 11.5 (1.0)

Total years of nursing experience 3.0 (3.7) 5.6 (5.7) 4.9 (4.7)

Total years in the current department 1.9 (1.8) 2.9 (2.2) 3.3 (2.8)

Abbreviation: Experimental II, Long-term training groupSD, standard deviation.
†Percentage (%) values and standard deviations are given in parentheses.
‡Experimental I, Short-term training group.

3590 | PEHLIVAN ANd GÜNER

determining the most significant model, variables with a p-value
greater than 0.10 were removed, respectively, and variables with a
p-value of approximately 0.10 or less were kept in the model, while
p < .05 was considered significant.

3 | R E S U LT S

3.1 | Demographics

Baseline characteristics are given in Table 2.

3.2 | Multilevel model results of CF subscale

There was no statistically significant difference between the main
effect of the initiative (group) variable and the outcome variable of
CF (p = .541), indicating that there was no statistically significant
difference between groups regarding mean CF scores of nurses
receiving short-term training (mean = 16.43, SD 8.46), long-term
training (mean = 14.20, SD 8.17), or those in the control group
(mean = 14.93, SD 8.04). The effect of the time variable related
to the CF outcome variable was statistically significant (p < .001).
Further analysis of the time variable indicated that the 3-month
(mean = 15.45, SD 9.21), 6-month (mean = 16.49, SD 8.97), and
1-year (mean = 14.90, SD 8.05) follow-up scores of nurses were
greater than their pre-test mean scores (mean = 13.54, SD 7.25)
and the difference was statistically significant (Table 3). The group
X time interaction for the CF outcome variable was statistically
significant (p = .047). There was a statistically significant differ-
ence between groups over the time period regarding mean CF
scores. The difference between pre- and post-test measurements
in the group that received only long-term training was statistically
significant regarding the difference between pre- and post-test
measurements for the control group (Table 3).

3.3 | Multilevel model results of burnout subscale

There was no statistically significant difference between the main
effect of the initiative (group) variable and the burnout variable
(p = .227), indicating that there was no statistically significant dif-
ference between the groups regarding mean burnout scores of
nurses receiving short-term training (mean = 22.30, SD 7.22),
long-term training (mean = 20.05, SD 6.90), or those in the control
group (mean = 21.01, SD 6.89). The effect of the time variable re-
lated to the burnout outcome variable was statistically significant
(p = .009). Further analysis of the time variable indicated that
3-month (mean = 21.26, SD 7.45), 6-month (mean = 21.85, SD 6.97),
and 1-year (mean = 21.51, SD 7.19) follow-up scores of nurses were
greater than their pre-test mean scores (mean = 20.14, SD 6.77) and
the difference was statistically significant (Table 4). The group X time
interaction for the burnout outcome variable was not statistically

significant (p = .710). There was no statistically significant differ-
ence between groups over the time period regarding mean burnout
scores.

3.4 | Multilevel model results of CS subscale

A statistically significant difference was found between the main
effect of the initiative (group) variable and the CS outcome variable
(p < .001), indicating that there was a statistically significant differ-
ence between all groups regarding mean CS scores. Further analysis of

T A B L E 3 Multilevel analysis with compassion fatigue as
outcome variable

β SE [95% CI] p

Intercept 1.89 3.68 [−5.40, 9.17] .609

Experimental I
versus. Control

0.86 1.85 [−2.78, 4.50] .641

Experimental II
versus. Control

−1.66 1.71 [−5.04, 1.72] .335

Posttest 0.40 0.97 [−1.51, 2.32] .678

Three-month
follow-up

2.48 1.14 [0.22, 4.73] .031

Six-month follow-up 3.16 1.27 [0.67, 5.66] .013

One-year follow-up 3.83 1.37 [1.12, 6.54] .006

Marital status 3.83 1.59 [0.68, 6.98] .017

Level of received
social support

3.10 1.32 [0.49, 5.71] .021

Post-test

Experimental I
versus. Control

0.42 1.44 [−2.41, 3.25] .771

Experimental II
versus. Control

3.16 1.35 [0.51, 5.81] .020

Three-month
follow-up

Experimental I
versus. Control

−0.97 1.68 [−4.28, 2.34] .564

Experimental II
versus. Control

−0.71 1.56 [−3.78, 2.37] .650

Six-month follow-up

Experimental I
versus. Control

−1.05 1.87 [−4.73, 2.64] .577

Experimental II
versus. Control

0.61 1.70 [−2.73, 3.96] .718

One-year follow-up

Experimental I
versus. Control

−3.31 2.22 [−7.68, 1.07] .138

Experimental II
versus. Control

−2.37 1.84 [−6.01, 1.26] .199

Note: Experimental II, Long-term training group.
‡Bold values indicate statistically significant values.
§Control was the reference group; SE, standard error.
†Experimental I, Short-term training group.

| 3591PEHLIVAN ANd GÜNER

the group variable indicated that mean scores of nurses who received
short-term (mean = 37.84, SD 8.05) and long-term (mean = 39.49, SD
7.14) training were greater than the control group (mean = 33.84,
SD 8.85) and the difference was statistically significant (Table 5).
The effect of the time variable related to CS outcome variable was
statistically significant (p = .013). Further analysis of the time vari-
able indicated that the 1-year (mean = 36.06, SD 9.73) and 6-month
(mean = 36.32, SD 9.76) follow-up scores of nurses were less than
their pre-test mean scores (mean = 37.92, SD 7.40) and the difference
was statistically significant (Table 5). The group X time interaction for
the CS outcome variable was statistically significant (p = .23). There
was a statistically significant difference between groups over the pe-
riod regarding mean CS scores. The difference between the pre-test
and 6-month and the pre-test and 1-year measurements of nurses re-
ceiving the short- or long-term training was statistically significantly
higher than the pre-test and 6-month measurements and the pre-test
and 1-year measurements of nurses in the control group (Table 5).

3.5 | Multilevel model results of PS scale

There was no statistically significant difference between the main effect
of the initiative (group) variable and PS (p = .849). This results indicated
no statistically significant difference between the groups regarding
mean PS scores of nurses receiving short-term training (mean = 32.29,
SD 3.27), long-term training (mean = 31.55, SD 3.28), and those in the

control group (mean = 31.66, SD 3.96). The effect of the time variable
related to PS outcome variable was not statistically significant (p = .742).
The group X time interaction for the PS outcome variable was not statis-
tically significant (p = .510). There was no statistically significant differ-
ence in mean PS scores between groups over the period.

3.6 | Multilevel model results of the resilience scale

There was no statistically significant difference between the main
effect of the initiative (group) variable and resilience (p = .625).

T A B L E …

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