nurses needed to be defined and that their coping skills needed to be improved. Boyle et al. (1991) asked workers via open-ended questions what the factors that contribute to reduce the stress level at work would be, and 69% answered that co-worker support was the most important. Social support contributes to stress reduction in the workplace. Support from co-workers or managers has positive effects on workers. However, experimental studies related to social support have been reported to be insufficient (Shirey 2004). Peterson et al. (2008) have reported that peer support groups could be a useful and inexpensive tool in alleviating burnout. Literature related to burnout is rich; however, certain solutions that would prevent burnout have not yet been developed (Marine et al. 2006). Although there are results reported that coping and social support reduce burnout, when the related literature is reviewed, it is seen that most of the conducted studies have been descriptive, cross-sectional and non- randomized (Duquette et al. 1994; Jenkins & Elliot 2004). Marine et al. (2006) reported limited evidence for the effective- ness of interventions aimed at reducing stress levels at the workplace. Although coping training and social support have been identified to be useful in reducing burnout, the effectiveness of these factors needs to be determined. Therefore, it was considered that it would be highly contributive to the literature if the effects of interventions such as coping and social support groups are shown through a randomized controlled trial.
Neuman Systems Model and burnout This study has been based on the concepts of the Neuman Systems Model (NSM). The focus of the NSM is a person’s or community’s reaction to stressors. It emphasizes how nurses can be assisted in preventing a stress response through primary prevention or be helped in adjusting to the stress response through
secondary and tertiary prevention (Neuman 2002).According to Neuman (2002), human beings are systems that are constituted of defence lines that protect the central core against stressors. Each defence line attempts to keep the basic structure. These are flexible line of defence (FLD),normal line of defence (NLD) and line of resistance (LOR). FLD is the outer fragmented line, and it encircles the NLD. It is dynamic and it can be altered in a short period of time. NLD is the usual wellness level of an individual, and it activates as the FLD is broken. LOR is the line that protects the basic structure of the individual, and it activates as the NLD is broken. Each of these lines involves physiological, psychological,sociocultural,developmental,andspiritualdimensions.Individuals respond to the stressor by means of these dimensions by taking account of the potential of the stressor. Lines of defence are damaged when they cannot respond to the stressor. Hence, the stressor unbalances the system (Neuman 2002). Considering the burnout process in nurses within the context of the NSM, chronic job stressors that exist in the environment may result in job stress (NLD invasion) if not buffered by the FLD. Once job stress shows up, nurses attempt to cope with the ongoing stress by using their LOR. If successful, burnout (core response) does not occur. However,if the LOR is weak and/or the stressors are very strong, then burnout eventually occurs. Although it is referred to as the burnout process, burnout is actually the response to a process (Günüs¸en et al. 2009). In this study, it was attempted to reduce the burnout levels of nurses by strengthening the psychological and sociocultural dimensions in the LOR by means of coping and social support groups. Neuman names this as secondary prevention. Because the participants in the study were nurses with high levels of burnout, secondary prevention can be considered to take place. The aim of the secondary prevention is to prevent the core response by means of strengthening the lines of resistance. The conceptual–theoretical–empirical structure of the study’s intervention part can be seen in Fig. 1.