Measuring workplace bullying in a U.S. nursing population with the Short Negative Acts Questionnaire

Association of nurse managers' paternalistic leadership and nurses' perceived workplace bullying: The mediating effect of organizational climate

AIMS

To explore the association between nurse managers' paternalistic leadership and nurses' perceived workplace bullying (WPB), as well as to examine the mediating role of organizational climate in this association.

BACKGROUND

There is a lack of empirical evidence regarding the relationship between nurse managers' paternalistic leadership, organizational climate and nurses' perceived WPB. Clarifying this relationship is crucial to understand how paternalistic leadership influences WPB and for nursing managers to seek organizational-level solutions to prevent it.

METHODS

A cross-sectional survey was performed from 4 January to 10 February 2022, in six tertiary hospitals in mainland China. Demographic information, Paternalistic Leadership Scale, Organizational Climate Scale and Negative Acts Questionnaire-Revised were used in the survey. Descriptive statistics, Spearman correlation analyses and a structural equation model were used for data analysis.

RESULTS

A total of 5093 valid questionnaires were collected. Moral leadership and authoritarian leadership have both direct and indirect effects on WPB through the mediating effect of organizational climate. The former is negatively related to WPB and the latter is positively related to WPB. Benevolent leadership was only negatively associated with WPB via the mediating effect of organizational climate.

CONCLUSION

The three components of paternalistic leadership have different effects on WPB through the mediating effect of organizational climate. Nurse managers are recommended to strengthen moral leadership, balance benevolent leadership, reduce authoritarian leadership and strive to create a positive organizational climate in their efforts to mitigate WPB among nurses.

IMPACT

This study enhanced our comprehension of the relationship between different leadership styles and WPB. Greater emphasis should be placed on moral leadership in the promotion of nursing managers and nursing leadership training programs. Additionally, nursing managers should focus on establishing a positive organizational climate that helps to reduce WPB.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.

Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals

BACKGROUND

Unprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program "Ethos" implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for 'reflection' or 'recognition'. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos.

METHODS

A survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5-3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as 'extreme' (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics.

RESULTS

In total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32-41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message.

CONCLUSION

The Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.

A taste alteration-related scale assesses megestrol to improve chemotherapy-induced anorexia

PURPOSE

We evaluated the efficacy of megestrol in improving chemotherapy-related anorexia by analyzing the related scales of taste alteration.

METHODS

We conducted the current study on a group of advanced patients with cancer with two or more chemotherapy cycles. The chemotherapy-induced taste alteration scale (CiTAs) scale helped assess the megestrol effects on basic taste perception, aversive taste changes, unpleasant symptoms, and associated concerns. Furthermore, the Short Nutritional Assessment Questionnaire scale (SNAQ) helped measure the impact of megestrol on malnutrition likelihood in patients experiencing chemotherapy-induced anorexia. The World Health Organization Quality of Life (WHOQOL)-BREF Scale was used to evaluate the quality of life of participants, producing scores related to physical health, psychological well-being, environmental factors, and social relationships.

RESULTS

The CiTAs scale assessment indicated that administering megestrol significantly enhanced taste perception among advanced patients with cancer undergoing chemotherapy. Notably, the megestrol group patients showed significantly higher Short Nutritional Assessment Questionnaire (SNAQ) scores than the control group. The megestrol group patients also exhibited higher physiological (PHYS) scores than their control group counterparts. However, this distinction was not statistically significant. The study findings indicate that patients who received megestrol demonstrated significantly higher scores in psychological (PSYCH) and environmental(ENVIR) domains than the control group. Furthermore, megestrol administration was associated with significantly elevated SOCIL and ENVIR levels in patients.

CONCLUSION

The proficient efficacy evaluation of megestrol in enhancing appetite, mitigating malnutrition likelihood, and improving the quality of life of chemotherapy-induced anorexic patients can be achieved through taste-related scales.

Workplace Violence in the Pediatric Emergency Department: A National Survey of Physicians in the United States

OBJECTIVES

Previous work shows that health care workers, and particularly emergency department (ED) staff, are at an above average risk of workplace violence (WPV), defined as verbal threats or physical violence in the workplace. Previous data suggest that staff of a single pediatric ED frequently feel unsafe. The objective of this study was to conduct the first national survey study to assess the prevalence and incidence of WPV in the pediatric ED.

METHODS

In this cross-sectional survey study, a representative sample of US pediatric emergency medicine physicians were invited to participate in a national survey adapted from the previously validated Workplace Violence in the Health Sector questionnaire from the World Health Organization. The primary outcome measure was the proportion of physicians who have been exposed to WPV. Rates of exposure to violence, reporting habits, and physician perception of various violence prevention strategies were studied secondarily.

RESULTS

Surveys were completed by 207 (45%) invited participants, representing 31 US children's hospitals. The prevalence of WPV exposure was 96%. Physical violence with a weapon was witnessed by 20% of participants. Injuries requiring medical attention or time off work were experienced by 10% of participants. Half of participants never reported violent events. Security guards were welcome by 99%, armed law enforcement officers by 70%, and metal detectors by 81% of physicians. Self-arming was opposed by 85% of respondents.

CONCLUSIONS

Exposure to WPV is frequent among pediatric emergency medicine physicians with a prevalence similar to that of general emergency departments. Workplace violence remains underreported. This national survey contributes to the objective evaluation of individual- and systems-level violence prevention interventions.

Characteristics of faculty mentoring in the Robert Wood Johnson Foundation Future of Nursing Scholars Program

BACKGROUND

To address the need for faculty scientists, Robert Wood Johnson Foundation (RWJF) provided support for an accelerated PhD program: Future of Nursing Scholars (FNS).

PURPOSE

To describe the experience of faculty mentoring PhD students in the RWJF FNS program pursuing a 3-year accelerated PhD degree, including faculty members' support activities for students, time commitment, student productivity in manuscript dissemination, and challenges and opportunities for supporting students.

METHODS

Surveys were sent to faculty mentors of FNS to understand mentoring activities, strategies used, and mentee productivity.

FINDINGS

Of 93 faculty mentors, they reported most FNS students (n = 61, 65.6%) completed a manuscript format dissertation. FNS students required academic/dissertation mentoring, with frequent emotional support and positive reinforcement.

DISCUSSION AND CONCLUSION

Mentors reported providing more frequent mentoring and spent more time mentoring FNS students than with other PhD students. Alignment of the student's research to that of the faculty mentor was identified as valuable.

Psychometric qualities of measurement tools used to determine workplace horizontal violence: A rapid review

RATIONALE AIMS AND OBJECTIVES: Horizontal violence has been defined as aggressive or hostile behaviour directed at an individual or between colleagues from the same working group. Measuring the prevalence of horizontal violence requires valid measures. To date, there has not been a review of the psychometric properties of available measurement tools for horizontal violence.

METHOD

A rapid review of the MEDLINE and BUSINESS EBSCO databases was conducted to identify studies testing the validity of any measure of horizontal violence in any workplace setting. Title and abstract and full-text screening, data extraction and quality appraisal were completed by two researchers working independently. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) was used to determine the methodological quality of studies, including details of the psychometric properties of included papers.

RESULTS

Fourteen papers reporting 17 studies were included in the review. Seven measures of horizontal violence (Civility Norms Questionnaire Brief; Negative Acts Questionnaire-Revised; Inventory of Violence and Psychological Harassment; Leyman Inventory Psychological Terror Mobbing of Single Cases of Harassment in Employees Relations; Shortened Negative Acts Questionnaire-Revised; Uncivil Workplace Behaviour Questionnaire) were identified. Most included studies were methodologically robust. Six measures had strong psychometric properties except for the Mobbing of Single Cases of Harassment in Employees Relations (MSCH) where key information about psychometric properties was not reported.

CONCLUSIONS

We identified six measures of horizontal violence that had good psychometric properties. The Negative Acts Questionnaire-Revised has been most extensively tested in different settings but is not necessarily a more precise measure than others.

Bullying Among Medical Residents: Gender, Social Norms, and Reporting Behavior

INTRODUCTION

Bullying behavior in residency is common, with prevalence rates ranging from 10% to 48%. Negative acts adversely impact junior physicians. The aims of this study were to examine (a) gender differences in experiences of bullying and/or negative acts while working as a medical resident, (b) residents' perceptions of injunctive (ie, approval of) and descriptive (ie, behavior) norms related to reporting bullying behaviors, and (c) whether greater self-other differences predict greater engagement in reporting bullying behavior by others in the workplace.

METHODS

Self-report surveys were administered to family medicine, internal medicine, surgical, and emergency medicine residents (N=61).

RESULTS

Female residents reported experiencing significantly more bullying than males. Overall, resident physicians held inaccurate beliefs, and thought other residents reported bullying more often than they did. Finally, the degree of inaccuracy was associated with reporting bullying behavior.

CONCLUSION

These findings are an initial indication that normative interventions may be applicable with this population. In a field that struggles with high rates of burnout, finding ways to improve the culture of an organization may assist with addressing at least part of these systemic issues.