Nursing curriculum and bullying: An integrative literature review

The effects of bullying behaviours among nursing students in Sierra Leone: a qualitative exploratory study

BACKGROUND

Bullying can have profound negative effects on nursing students who often contend with psychological trauma because of repeated acts of mistreatment. This study was done to explore the effects of bullying behaviours among nursing students with above average and below average academic performance in two nursing schools in Sierra Leone.

METHODS

A qualitative exploratory study involved six rounds of data collection and analysis over a one month period. 48 nursing students recruited from Njala University School of Nursing and Mattru School of Nursing participated in semi structured interviews. Recruitment was done using a purposive sampling method and students with higher than average and lower than average Grade point average (GPA) were selected to participate in the interviews. Interviews were audiotaped recorded and transcribed verbatim for analysis. An inductive approach with line-by-line coding to identify themes and subthemes was done for the first set of interviews, following this the researchers took a deductive approach to analysis to evaluate if subsequent themes were consistent with initial analysis.

RESULTS

Sensitization and apathy were the two broad themes regarding the effects of bullying behaviour demonstrated by students with higher than average and lower than average GPA respectively. Both groups of students had come to accept the inevitability of bullying as nursing students despite the distress it caused them. However, students with lower-than-average GPA also demonstrated resentment and a loss of interest in their studies because of the bullying they had encountered.

CONCLUSION

The findings of this study demonstrate that bullying negative affects nursing students regardless of their academic performance. There is an urgent need for policy makers to prioritise the deterrence of bullying of nursing students through implementation of strategies that protect students and punish perpetrators of abuse in nursing schools nationwide.

Experiences of bullying among nursing students during clinical practice: a scoping review of qualitative studies

Bullying in the clinical setting has become a significant issue for nursing students. The experience of bullying during clinical practice can negatively affect students' mental and physical health, as well as their professional development. Nursing students are often targets of verbal abuse, intimidation, and discrimination from various individuals in the clinical environment. This behavior not only harms individual students but also affects the quality of patient care. The aim of this study is to provide a deeper understanding of the phenomenon of bullying toward nursing students, identify research gaps, and offer recommendations for future research. This study employed a scoping review method, with articles sourced from four major databases: CINAHL, PubMed, Scopus, and Web of Science. The main keywords used included "bullying," "nursing students," "clinical practice," and "verbal violence." Inclusion criteria were studies with nurse participants, original research articles, and published within the last 10 years (2015-2024). Data were manually extracted using tables and analyzed through a qualitative descriptive approach. Eleven articles met the inclusion criteria. This scoping review focuses on the findings of an exploration of the experiences of bullying experienced by nursing students, identifies research gaps, and provides suggestions for future research. Findings showed that nursing students experience various forms of bullying, including verbal violence and intimidation, often triggered by power imbalances in interactions with clinical staff and mentors. The impact of bullying is not only detrimental to students' mental health, but also affects their academic performance and quality of learning. Research gaps found include a lack of studies on the direct relationship between bullying and clinical assessment outcomes, as well as a lack of understanding of effective strategies to address bullying. This study recommends the need for clearer anti-bullying policies and transparent reporting systems, as well as further research to explore the impact of bullying in the context of nursing culture and education system.

Bullying Behaviors and Stress (Acute and Perceived) among Undergraduate Nursing and Midwifery Students: The Moderating Role of Gender and Academic Majors

BACKGROUND

Nursing and midwifery professionals' well-being may be affected by various factors, including the bullying of new nurses.

PURPOSE

To analyze the relationship between bullying behaviors, perceived stress, and acute stress among undergraduate nursing and midwifery students in Saudi Arabia, as well as the moderating role of gender and academic majors in this relationship.

METHOD

A cross-sectional correlation design was used, and data were collected from 322 undergraduate nursing and midwifery students enrolled in four major nursing universities in Saudi Arabia.

RESULTS

Educational level, environment, and personal attacks had a significant negative impact on perceived and acute stress (social and non-social), while hostility toward academic achievement and direct negative behaviors had significant positive impacts on perceived and acute stress (social and non-social). Female nursing students reported a stronger impact of bullying behavior on their perceived stress, while male students reported a greater impact on social and non-social stress. Nursing students reported a stronger impact of bullying on perceived stress, while midwifery students reported a greater impact on social and non-social stress.

DISCUSSION

Nursing educators should raise awareness about the harmful effects of bullying and emphasize the importance of creating a safe, supportive learning environment.

Nursing students' experience of bullying and/or harassment during clinical placement

PROBLEM OR BACKGROUND

Bullying is a recognised problem in nursing. Nursing students are particularly vulnerable. Bullying and harassment of nursing students can be detrimental to both students and recipients of care.

AIM

This study aims to identify the incidence and nature of bullying and/or harassment experienced by nursing students in Sri Lanka.

METHODS

A cross-sectional survey consisting of eight demographic questions and 15 items specific to the experience of bullying and harassment was administered to nursing students online.

FINDINGS

A total of 656 students from 26 nursing education institutions in Sri Lanka participated. The majority were female with a mean age of 24.4 years. More than a quarter of respondents reported that they had experienced bullying and/or harassment while on clinical placement, with a further 16.7 % being unsure. Most bullying or harassment (55 %) occurred in hospitals with 29 % experienced in community settings. Registered nurses, including nurse managers and clinical facilitators were the most common perpetrators. Verbal abuse was the most frequent type of behaviour reported.

DISCUSSION

These findings support existing literature that indicates that bullying of nursing students is an international phenomenon. The context of this study provides clues as to how culture may influence the problem. There is a need to better understand bullying and harassment in the environments in which it occurs, in order to identify strategies that can bridge cultures and settings.

CONCLUSION

The incidence of bullying and harassment of nursing students in Sri Lanka is concerning. Further research is needed to identify and evaluate targeted strategies to help prevent negative outcomes in all nursing contexts.

Global prevalence of bullying and associated factors among nursing students during clinical practice: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis aims to estimate the global prevalence of bullying among nursing students during clinical practice and identify associated factors.

DESIGN

Systematic review and meta-analysis.

REVIEW METHODS AND DATA SOURCES

We conducted a comprehensive literature search across ten databases (PubMed, Cochrane, Web of Science, Embase, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG) from their inception to January 3, 2023. Two researchers independently screened potentially eligible studies, extracted data, and assessed study quality. Data were analyzed using random-effects or fixed-effects models. Subgroup analyses and meta-regression explored the influence of participant and study characteristics on bullying prevalence. Publication bias and sensitivity analyses were also performed.

RESULTS

We included 28 studies (N = 9511) from 13 countries on five continents. The pooled estimate of bullying prevalence among nursing students during clinical practice was 65.60 % (95 % CI 55. 75 to 74.27), with no evidence of publication bias (t = 1.51, p-value = 0.14). Subgroup and moderator analyses highlighted the impact of country, continent, publication year, and assessment tool on bullying prevalence.

CONCLUSION

Nursing students face a high prevalence of bullying during clinical practice. Addressing this issue in nursing education requires prioritizing associated factors, fostering a culture of safety, providing effective training, and promoting individual resilience. These actions can prevent and mitigate bullying, creating a supportive and empowering learning environment for future nurses.

Bullying behaviors and intention to drop-out among nursing students: the mediation roles of sense of belonging and major satisfaction

Bullying in academic settings has long-lasting implications on students' well-being and career prospects, particularly in fields like nursing that require a high level of interpersonal skills and emotional resilience. This study explored the relationships between experiences of bullying and intentions to drop out among Iranian nursing students, with major satisfaction and a sense of belonging serving as mediating factors. A cross-sectional research design was employed from April to June 2023. Undergraduate nursing students (n = 386) filled out a five-part questionnaire namely demographic and educational information, bullying behaviors in nursing education environments, the Belongingness scale, intention to drop out, and academic major satisfaction scale. The study confirmed that experiences of bullying positively correlated with intentions to drop out, negatively affected students' sense of belonging and major satisfaction, and established that course satisfaction and a sense of belonging acted as mediators between bullying and intentions to drop out. The findings show the urgent need for anti-bullying interventions targeting faculty behavior and educational strategies aimed at fostering a sense of belonging and course satisfaction among nursing students.

Exploring student perceptions of the learning environment in four health professions education programs

The desire to support student learning and professional development, in combination with accreditation requirements, necessitates the need to evaluate the learning environment of educational programs. The Health Education Learning Environment Survey (HELES) is a recently-developed global measure of the learning environment for health professions programs. This paper provides evidence of the applicability of the HELES for evaluating the learning environment across four health professions programs: medicine, nursing, occupational therapy and pharmaceutical sciences. Two consecutive years of HELES data were collected from each program at a single university (year 1 = 552 students; year 2 = 745 students) using an anonymous online survey. Reliability analyses across programs and administration years supported the reliability of the tool. Two-way factorial ANOVAs with program and administration year as the independent variables indicated statistically- and practically-significant differences across programs for four of the seven scales. Overall, these results support the use of the HELES to evaluate student perceptions of the learning environment multiple of health professions programs.

Nursing students' experiences of violence and aggression: A mixed-methods study

BACKGROUND

Violence and aggression cause significant problems for nursing staff and students working across healthcare.

OBJECTIVES

To identify the prevalence of aggression experienced by nursing students whilst on clinical placement in one UK city, and rates and experiences of reporting of aggression.

DESIGN

A convergent mixed method design, with mixing occurring at the objective and inference stages.

PARTICIPANTS

Preregistration nursing students who had completed at least one clinical placement.

METHODS

A cross-sectional survey and concurrent focus groups were conducted between May and December 2018. Students completed the 'Students' Experiences of Violence and Aggression Survey' (SEVAS) and were separately invited to participate in focus groups.

RESULTS

There were 129 responses to the survey and 36 students participated in five focus groups. Only about a third of non-physical aggression was reported and around half of the physical aggression and sexual harassment. Very few incidents were reported to the university. Themes from the focus groups encompassed ideas of the ubiquity of violence, that students did not know what they were doing, and issues of racism, bullying, and compassion.

CONCLUSIONS

Universities have a responsibility to students; this includes preparing them adequately to manage aggression, and ensuring reporting is easy to do and adequately dealt with. A majority of students who responded to the survey had experienced non-physical aggression in the past year (81%), over half had experienced physical aggression (56%) and more than one in three had experienced sexual harassment (40%).

Bullying in nursing students: A integrative literature review

The purpose of this integrative review was to analyse the current situation of bullying in nursing students through an exhaustive review of the last 10 years. As the sources of information, we used electronic databases, such as Medline, CINAHL, PubMed, Cochrane, and SciELO, using bullying, nursing students, and clinical environment as search terms. We based the methodology of the study in PRISMA checklist. Articles were selected for their relevance and suitability for the purpose, and they were constructed into a table. A critical appraisal was done using MMAT TOOL and AACOODS checklist. Papers were analysed using a constant comparison and a concept mapping. Finally, 30 articles were included. We analysed: prevalence, profile of the victim and perpetrator, type of violence, and bullying consequences. Bullying prevalence varied from 9-96% according to the author. Differences about the influence of sociodemographic variables were detected, there is no consensus about age, gender, or educational level. Bullying in nursing students is an important problem that affects all spheres of their life. Harassment also has consequences for the patient and for the health organization, so it is really important to take action regarding bullying and to act to victims, perpetrators, and health organizations. Regarding to implications for nursing practice, we found that some interventions were useful to reduce bullying, so it is important to participate in intervention programmes to eventually stop this problem. This study has revealed that more research on the efficacy of psychological intervention programmes to help students cope with bullying situations is essential.

Stepping out of the shadows: Creating a graphic novella to address bullying in nursing education

The prevalence of bullying in nursing and nursing education is of serious concern. Not only is bullying an issue at the interpersonal level, it is also pervasive at structural and institutional levels. Addressing bullying requires attention to all levels. In previous published work, we emphasized the importance of transparent and easily accessible processes and reporting mechanisms for students if or when they witness or experience bullying in nursing education. In this paper, we describe one of a number of education initiatives designed to inform stakeholders (students, faculty members, clinical instructors, registered nurses, clinical education leaders) about the prevalence of bullying, the nature of bullying, the consequences of bullying, and some strategies to address bullying in nursing education. We chose a creative approach in the form of a graphic novella (aka comic) because we believed that this medium would be visually appealing and user friendly and would therefore draw stakeholders, especially students, to the sensitive nature of the content embedded within it.

Midwifery students' experiences of bullying and workplace violence: A systematic review

BACKGROUND

Workplace violence directed at registered midwives in the maternity setting has been a recognised issue since the early 1990s. More recently it has become evident that midwifery students are also victims of bullying and harassment whilst on clinical placement. Due to the short and long-term impacts this has on students, it is likely to have a detrimental effect on the future and sustainability of the midwifery profession. As a basis for designing a response, it is important to understand what is currently known about this phenomenon.

AIM

To systematically review the literature to identify what is known about workplace violence and bullying experienced by midwifery students whilst on clinical placement.

METHOD

Reporting of this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was undertaken of all primary research that focussed upon workplace violence and bullying involving midwifery students whilst on clinical placement, published between January 1990 and December 2019. Pre-defined terms were used to search the following five databases: CINAHL, Web of Science, MEDLINE, Embase, supplemented with Google Scholar. Additional manual searches of reference lists were conducted. An assessment of the quality of each eligible study was then undertaken using an appropriate mixed methods appraisal tool (MMAT). Extracted data were then synthesised using thematic synthesis.

FINDINGS

Nine articles met the criteria for inclusion in the review. Studies were primarily qualitative, with some reporting descriptive statistics that do not enable key issues such as prevalence to be reliably addressed. The synthesis identified four main themes that related to workplace violence and bullying of midwifery students whilst on clinical placement. Results were clustered around the role of power in bullying, prevalence and impacts, the culture of compliance, and the victim's response.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

A broader understanding of the nature of workplace violence and bullying and how it manifests itself is beginning to emerge, but more and higher quality research is required to establish an empirical base on which to design interventions. Studies suggest that bullying is common and has significant impacts at both a personal and professional level.  This strongly reinforces a need for greater policy and organisational responses to bullying in the clinical education context, in order to break the bullying cycle and ensure the midwives of the future remain in the profession and sustain the workforce.

Interrupting the cycle of bullying witnessed or experienced by nursing students: An ethical and relational action framework

BACKGROUND

The prevalence of bullying experienced by nursing students continues to be a substantial concern for the profession, especially for nurse educators. It is also an issue in other health care professional programs.

OBJECTIVES

To explore how educational institutions address bullying experienced by nursing and other health care professional students, with the goal of creating a set of procedures for reporting bullying if students witness or experience it during their education.

DESIGN

Qualitative Description. Our central question was "What processes and resources do faculty members use when students disclose an experience related to bullying?"

SETTINGS

Educational institutions in Western Canada.

PARTICIPANTS

Nine faculty members and one staff member with a student service role from nursing and other health care profession programs.

METHODS

Semi-structured interviews.

RESULTS

We found significant variation in interviewees' conceptions of bullying and the policies, processes, and resources for addressing bullying within programs. We adopted an existing definition of bullying; designed a set of procedures focused on reporting mechanisms; and developed a guiding framework entitled Addressing Bullying in Nursing Education: An Ethical and Relational Action Framework.

CONCLUSIONS

Nursing and other health care professional programs should ensure they have 1) clear and transparent procedures to report bullying 2) education about bullying for students and faculty.

Incivility in nursing practice education in the operating room

BACKGROUND

Incivility toward nursing students has been identified as a contributor to negative experiences in clinical education and may cause a weakened learning environment, anxiety, depression and workplace violence. However, few data with regard to uncivilized behavior toward nursing students in the operating room are available. The operation room is a special place where the tempo is fast and the risk is high. Nursing students may have to face pressure from different people, such as anesthesiologists, surgeons, clinical instructors, and staff nurses.

OBJECTIVES

To explore uncivilized behavior toward nursing students in the operating room and to discuss the source of uncivilized behavior and the attitude of clinical instructors when it occurs.

METHOD

A total of 215 nursing students in the operating room of the Second XiangYa Hospital from January to December 2018 were investigated. The uncivilized behavior in clinical nursing education tool and self-designed questionnaire were used.

RESULTS

The incivility mean score was (4.6 ± 6.7). In all, 122 (56.7%) participants had experienced various degrees of uncivilized behavior in the operating room. There were significant differences in incivility toward students according to degree of education and age. The most frequent uncivilized behavior toward students was raising of the voice when speaking to students (41.9%), followed by inappropriate tone (36.7%), being embarrassed in front of others (36.3%), and snide remarks (34.4%). Surgeons (59%) were considered as the most important source of uncivil behaviors, followed by staff nurses (46.7%). When students experienced uncivilized behavior, 61.5% clinical instructors defended and comforted them, 23% comforted them privately, 13.1% ignored them, and 2.5% even criticized them together with the uncivil behavior actor.

CONCLUSION

Nursing managers and instructors should pay more attention to the incivility toward students and take actions to foster a healthy, civilized and respectful work environment in the operating room for students.

"You can't escape it": Bullying experiences of New Zealand nursing students on clinical placement

BACKGROUND

Bullying in nursing is not a new phenomenon and nursing students are not exempt from its effects, however there is limited literature that deals directly with bullying of nursing students within the clinical environment in New Zealand. Quality clinical placements are vital to facilitate the link between theory and practice whilst working in complex healthcare settings.

AIM

The purpose of this article is to present the experiences described by nursing students regarding the nature and extent of bullying during clinical placements.

DESIGN

This study employed a cross-sectional survey design using an electronic survey in which this paper focuses on the textual data provided by nursing students from across New Zealand. Data was analysed by coding and grouping into themes.

RESULTS

There were numerous uncivil behaviours students were subject to during clinical placements. The consequences of these behaviours had physical, psychological and financial implications for students, with some suggestions that they choose to leave the nursing profession.

CONCLUSIONS

Predominantly the practice setting is clearly not nurturing enough for nursing students; a situation unlikely to change in the near future. Hence academic institutions must be proactive in developing students' ability to address incivility in these environments and to educate their own staff on how to recognise and respond to bullying in the clinical arena.