Date of Award
2026
Document Type
Doctor of Nursing Practice (DNP)
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Committee Chair
Azita Amiri
Committee Member
Michelle Hasselblad
Subject(s)
Medical personnel--Violence against, Medical personnel--Safety measures, Violence in the workplace, Health services administrators
Abstract
Workplace violence has escalated over the past decade in ambulatory care settings. A large percentage of healthcare workers report experiencing disruptive behavior such as verbal violence yet often lack support from leaders. Healthcare leaders often report a lack of confidence and standard processes for addressing these instances. This Doctor of Nursing Practice (DNP) project sought to determine whether the Interrupt Question Educate and Echo (IQEE) communication framework could strengthen ambulatory leaders’ self-efficacy in responding to disruptive behavior. A synthesis of current evidence informed the development of the project’s evidence-based intervention. The evidence indicates that targeted training interventions, including scenario-based learning and communication frameworks, improve the ability to respond to disruptive behavior. The PICOT question guiding the project was: In ambulatory leaders who work in adult ambulatory clinics (P), does implementation of the Interrupt Question Educate and Echo framework (I) improve leaders’ self-efficacy in responding to disruptive behaviors (O) immediately post, and at six and twelve weeks after the intervention (T), compared with baseline? The project included a structured 90-minute educational session that defined the types of disruptive behavior, introduced the IQEE framework, and facilitated role-play scenarios to apply the framework. After the workshop, supplemental tools were provided to support the application in real-time situations. Leaders’ self-efficacy was measured at pre-intervention, immediate post-intervention, and at 6- and 12-week post-intervention. Self-efficacy was measured using a validated self-efficacy scale. Descriptive statistics and paired comparisons were used to evaluate changes across the four time points. Leaders demonstrated improvements in self-efficacy immediately after and sustained the improvement at both 6- and 12-weeks post-intervention. Participants reported increased confidence in responding to disruptive behaviors, citing particular benefit from working through practice scenarios based on real-life situations. Participants also provided comments that further supported the framework’s usability; many requested that the workshop be extended to frontline staff. Implementing the IQEE framework improved ambulatory leaders’ self-efficacy and provided a structured, repeatable method for addressing disruptive behavior. Findings support scenario- and role-play-based education that integrates standardized communication training into ambulatory leadership development to strengthen leadership competencies and foster a more respectful, effective work environment.
Recommended Citation
Miller, Lindsay, "Improving leaders’ self-efficacy in responding to disruptive behaviors using the IQEE framework" (2026). Doctor of Nursing Practice (DNP). 154.
https://louis.uah.edu/uah-dnp/154