Nursing Students’ Experience of Bullying: Prevalence, Impact, and Interventions

Relationship between emotional intelligence and academic support perception among nursing interns: The moderating role of bullying behaviors in nursing education

AIM

This study aims to investigate the status of academic support perception among nursing interns and explore the correlation between academic support perception, emotional intelligence, and bullying behaviors in nursing education, especially the moderating role of bullying behavior on the relationship between emotional intelligence and academic support perception.

BACKGROUND

Academic support perception is closely related to the nursing interns' mental health and academic performance. To some extent, it can reflect nursing interns' satisfaction and happiness during their internship, affecting their motivation to continue their studies. However, little is known about the nursing interns' academic support perception in China.

METHODS

A total of 1020 nursing interns participated in this study. A sociodemographic information questionnaire, Bullying Behaviors in Nursing Education Scale, Wong and Law's Emotional Intelligence Scale, and Academic Support in the Practicum Scale were used to collect data.

FINDINGS

Bullying behaviors and emotional intelligence were significantly associated with nursing interns' academic support perception. In addition, bullying behaviors in nursing education moderated the association between emotional intelligence and academic support perception.

DISCUSSION

Nursing interns who possess high emotional intelligence and experience less bullying in nursing education tend to perceive higher academic support in clinical practice. The positive effects of emotional intelligence on nursing interns' academic support perceptions are contingent on the level of bullying behavior experienced in nursing education. Less bullying behaviors in nursing education enhance the impact of emotional intelligence on academic support perception.

CONCLUSION AND IMPLICATIONS FOR NURSING

Strategies should be created to promote emotional intelligence and decrease bullying behaviors in nursing education to improve the perception of academic support among nursing interns.

Human rights among Korean dental hygiene students in hospital clinical practice

BACKGROUND

The human rights of dental hygiene students should be guaranteed during practice at medical institutions for their mental and physical health as well as professionalism, for patient safety. Safe and well guaranteed clinicians can perform their work in a more stable way. This study investigated the human rights circumstances of dental hygiene students during their hospital clinical practice at dental institutions.

METHODS

This study used a cross-sectional survey design. Convenience sampling was conducted on 121 third- and fourth-year dental hygiene students from universities in Seoul, Gyeonggi, and Gangwon. The survey used the Human Rights Indicators for Dental Hygiene Students to investigate the rights to safety, equality, and personality to understand participants' experiences of guaranteed fundamental rights. Data were collected from October 31 to November 8, 2019. A chi-square test was used to assess differences in experience according to general characteristics.

RESULTS

During dental hygiene practice at dental institutions, less than 50% of students felt safe. When human rights violations occurred in dental institutions, only 42.4% of students received guidance on response measures from their universities. While 72.1% of students who practiced at dental university hospitals were given information on first aid supplies (facilities) within dental institutions, only approximately 45% of students who practiced at lower-scale dental institutions were given this information (p < 0.05). Regarding equality rights, only 52.5% of trainees reported that they had received equal treatment from healthcare workers during hospital clinical practice.

CONCLUSIONS

During dental practice at dental institutions, Korean dental hygiene students confirmed that human rights (including safety rights, equality rights, and personality rights) were guaranteed to varying degrees. Dental hygiene students' rights during hospital clinical practice in dental institutions should be guaranteed across institutions regardless of their scale. This is necessary for dental hygiene students' human rights and safe policies and guidelines in dental institution clinical practice and regular monitoring systems.

Interventions to prevent or manage workplace violence against student nurses during clinical placement: a systematic review protocol

OBJECTIVES

The objective of this review is to investigate the effectiveness of workplace violence management or prevention interventions, including strategies, protocols, and policies, to address violence against, and provide support to, registered nursing students (RNS) following incidents of violence during clinical placement.

INTRODUCTION

Workplace violence is a global issue that affects victims' physical and mental health. RNS are especially vulnerable to workplace violence because of their limited work experience and confidence. These students often feel shocked and unprepared when experiencing workplace violence due to limited education and support provided by educational institutions or clinical sites. Workplace violence can lead to anxiety, decreased confidence, and professional attrition. There is a need to systematically synthesize the evidence on workplace violence management and prevention to support nursing students during clinical placement.

INCLUSION CRITERIA

The review will consider studies assessing the effectiveness of interventions to address workplace violence or improve support for RNS. Studies that report on educational interventions or pre-clinical placement strategies and measure the preparedness of students will also be considered. Study designs will be limited to quantitative methods that evaluate intervention effectiveness.

METHODS

Databases to be searched include MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection, Scopus, Embase (Ovid), Cochrane Central, ERIC (ProQuest), ProQuest Central, ProQuest Social Science Premium Collection, and ProQuest Dissertations and Theses Global. Two independent reviewers will screen, review, appraise, and extract data from eligible articles. For data synthesis, studies will be pooled using JBI SUMARI. The GRADE approach for grading the certainty of evidence will be followed and a Summary of Findings will be created.

REVIEW REGISTRATION

PROSPERO CRD42022377318.

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.

A Scoping Review of Assertiveness Therapy for Reducing Bullying Behavior and Its Impacts Among Adolescents

Bullying is a global problem in adolescents which has increased every year. One of the factors in the occurrence of bullying is the ability of interpersonal skills. This ability can build good relationships with assertive between adolescents and can prevent bullying. The purpose of this study is to describe assertiveness therapy for reducing bullying behavior and its impacts among adolescents. The method used in this study is scoping review. The search strategy used is PRISMA Extension for Scoping Reviews through three databases namely PubMed, CINAHL, and Scopus. The authors used inclusion criteria and exclusion criteria in the selection of articles. The major keywords used in the article search were bullying, assertiveness therapy, and adolescents. Data analysis used descriptive qualitative. The results showed that there were 10 articles that discussed assertive therapy. All articles show that assertiveness therapy can reduce bullying behavior and its impact significantly, such as reducing the impact of anxiety and increasing self-esteem. Assertiveness therapy methods carried out in the form of education, games, and role play. Education is carried out online and offline. Educational media is provided directly and through media such as educational videos which can be accessed at any time. Gender and cultural approaches are important aspects in the implementation of assertive therapy. Assertive therapy can improve interpersonal skills, social skills, empathy and assertiveness so that it can reduce bullying behavior and its impacts in adolescents. Then, this data becomes the basis for nurses to carry out assertive therapy as an effort to prevent and reduce bullying behavior in adolescents.

The mediating role of academic support perception in the relationship between emotional intelligence and bullying behaviours in clinical practice: A cross-sectional study

BACKGROUND

Bullying behaviours experienced by nursing interns in clinical practice are a considerable and serious concern. Understanding the factors that influence such behaviours in clinical practice is crucial for developing effective preventive measures and fostering a supportive learning environment.

PURPOSE

This study aims to investigate the prevalence and influencing factors of bullying behaviours experienced by nursing interns and examine the mediating role of academic support perception in the relationship between emotional intelligence and bullying behaviours in clinical practice.

METHODS

This is a cross-sectional study that used convenience sampling. A socio-demographic information questionnaire, Bullying Behaviours in Nursing Education Scale, Wong and Law's Emotional Intelligence Scale, and Academic Support in the Practicum Scale were used to collect data from nursing interns (n = 813) at seven tertiary hospitals in Changsha, China. Binary logistic regression and mediating analyses were used to explore the factors influencing bullying behaviours in nursing practice and examine the potential mediating role of academic support perception.

RESULTS

The prevalence of bullying behaviours in clinical practice among 813 nursing interns was 82.7 %. Binary logistic regression analyses indicated that attitude toward the nursing profession, emotional intelligence, and academic support perception were significantly associated with bullying behaviours in clinical practice. Academic support perception (β = 0.375, p < 0.001) played a significant mediating role in the relationship between emotional intelligence and bullying behaviours in clinical practice, accounting for 55.7 % of the total effect.

CONCLUSION

Nursing educators and administrators should recognise that improving emotional intelligence and enhancing academic support perception among nursing interns can reduce the occurrence of bullying behaviours in clinical practice.

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.

Experience of verbal violence among Chinese nursing students in clinical practice: a qualitative study

BACKGROUND

Workplace violence is prevalent in the nursing profession, and as a relatively junior link of the professional hierarchy, nursing students are not immune to it. Among these, verbal violence may have more serious consequences for the victims than physical violence, but the literature on verbal violence among nursing students in Chinese clinical settings is limited.

AIMS

To explore the verbal violence experience among Chinese nursing students in clinical practice, and the strategies used by nursing students to cope with violence.

DESIGN

A descriptive qualitative study.

METHODS

From January 2022 to June 2022, semi-structured interviews were conducted with 21 nursing students in clinical practice by purposive snowball sampling. Nvivo12 software and inductive content analysis were used for data analysis. This paper followed the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Through data analysis, three themes were defined:(1) Multiform verbal violence; (2) Hurting and impacting and (3) Struggling or Coping. The findings indicated that nursing students were subjected to multiple forms of verbal violence in clinical practice, not only from patients and caregivers, but also from peers such as clinical tutors and doctors, which not only harmed students' personal health and well-being, but may also contribute to the nursing industry's future loss of human resources. Seeking emotional support from others and forcing themselves to grow up were the most commonly used coping strategies.

CONCLUSION

Nursing educators and nursing managers need to pay attention to verbal violence in the clinical environment, and actively develop the ability of nursing students to deal with uncivilized behavior. Establishing relevant courses and training such as communication, resilience, and violence prevention, establishing a stricter clinical mentor appointment system, and teaching assessment system may be strategies to help nursing students better perform clinical practice.

Development and Evaluation of a Workplace Bullying Cognitive Rehearsal-Based Nursing Simulation Education Program: A Mixed-Methods Study

Bullying makes learning difficult for nursing students, and using real-life scenarios during training can improve the understanding of workplace bullying. Thus, to mitigate bullying experienced by nurses, this study developed and evaluated a cognitive rehearsal education program that constituted training nursing students through role-play simulations. A mixed-method research design was used to evaluate 39 nursing students from two universities. A quasi-experimental research design was applied to assess symptoms, knowledge, and perceptions of bullying, and a focus group interview was conducted with six participants. Quantitative analyses revealed that the program improved participants' knowledge and perceptions but not their symptoms. The focus group interview revealed that the program improved participants' coping skills and desire for education. This program could be effective in raising awareness of workplace bullying and increasing relevant coping skills. It can be further developed as part of an overall strategy to manage workplace bullying and its consequences in hospital settings.

Domains of competence in midwifery students: a basis for developing a competence assessment tool for iranian undergraduate midwifery students

BACKGROUND

Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students.

METHODS

Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps proposed by Zhang & Wildemuth.

RESULTS

Twenty-four people participated in this study, including seven midwifery students, seven midwives, nine midwifery and reproductive and sexual health faculty members, and one obstetrician. The participants were aged 20-56 years and their mean age was 39.75 years. Their level of education varied from midwifery student to PhD. The mean work experience of the participants was 13.62 years and the mean duration of the interviews was 48 min. The analysis of the data obtained from the experiences of the participants led to the formation of the four categories of ethical and professional function in midwifery, holistic midwifery care, effective interaction, and personal and professional development, along with ten subcategories.

CONCLUSION

The findings of the present study showed that clinical competence in midwifery students involves different domains that correspond well overall to the general definitions of clinical competence in different sources. These findings can be used as a basis for the design and psychometric assessment of a clinical competence assessment tool for undergraduate midwifery students.

Student perspectives on potential sources of trauma exposure during nursing school

Adverse effects of events experienced by nursing students as harmful during nursing school have included moral distress, prolonged grief reactions, secondary traumatic stress, and anxiety and depression during nursing school. Nursing student perceptions of potential sources of trauma exposure also known as potentially traumatic events (PTEs) during nursing school are lacking in the literature. The purpose of this study was to describe nursing students' perceptions of potential sources of trauma exposure during nursing school at one private school of nursing. Four online, synchronous focus groups with undergraduate nursing students were conducted in April 2020. Four themes emerged from analysis of focus group transcripts related to potential sources of trauma exposure: Individual-oriented interpersonal sources, nursing student-oriented interpersonal sources, nursing student-oriented institutional and organizational sources, and individual-oriented community sources. Participants focused on nursing student-oriented, interpersonal, and institutional and organizational potential sources of trauma exposure, while minimizing individual-oriented, community, and macro-level potential sources of student trauma exposure during nursing school. Findings advance discussions of organizational, systems, and community PTEs in nursing education. Trauma-informed educational and healthcare systems that promote the academic and career success of nursing students should be considered in PTE prevention efforts.

Nurse leaders' experiences of upwards violence in the workplace: a qualitative systematic review

OBJECTIVE

The objective of this review was to synthesize the qualitative literature on the experience of upwards violence in nursing workplaces directed towards nurse leaders who have authority over those who direct the violence towards them.

INTRODUCTION

Workplace violence has impacted nursing work life for decades. It has been studied mostly from a downwards and lateral perspective and less often from an upwards direction towards individuals in leadership positions. Little is known about the experiences of nurse leaders or the potential consequences of workplace violence, including what impact upwards violence has on leadership ability and sustainability.

INCLUSION CRITERIA

This review considered qualitative studies that included nurse leaders who experienced upwards violence in nursing workplaces from nurses they supervise. Nurse leaders were registered nurses or advanced practice nurses employed in a position where they supervised other nursing personnel (eg, registered nurses, licensed practical nurses, nurse practitioners, student nurses). The positions held by nurse leaders included all roles (eg, nurse manager, clinical nurse specialist, nurse practitioner, nursing professor) where the position included supervising other nursing personnel.

METHODS

The search strategy aimed to find both published and unpublished studies in English from 2000. The search was first conducted in January 2019 and rerun in June 2020. The databases searched included CINAHL, MEDLINE, PsycINFO, and Embase. To ensure full coverage, databases not specific to the nursing profession, but with potential content on upwards violence, were also searched for examples of upwards violence against nurse leaders. These databases were ABI/INFORM, Sociological Abstracts, LexisNexis Academic, Scopus, and Web of Science. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, OpenGrey Repository, Health Business Elite, and Factiva. Papers meeting the inclusion criteria were appraised by two independent reviewers for methodological quality using the JBI critical appraisal checklist for qualitative research. Data extraction was conducted according to the standardized data extraction tool from JBI. The qualitative research findings were pooled using the JBI method of meta-aggregation.

RESULTS

Six papers were included in the review yielding a total of 50 findings and nine categories. The categories were aggregated to form three synthesized findings: i) Physical, psychological, financial, and quality-of-work toll of upwards bullying: paying a high price; ii) Coping with violence alone; and iii) What happened to me? My take on the violence. The ConQual scores were low to moderate.

CONCLUSION

The synthesized findings reveal that nurse leaders' experiences of upwards workplace violence is a troublesome problem that leads to a negative impact on physical and psychological health, and creates a cost in terms of time, money, and efficacy of the workplace.

Incivility in practice - incidence and experiences of nursing students in eastern Canada: A descriptive quantitative study

BACKGROUND

Incivility within nursing is professionally unacceptable. Little research exists regarding student nurses' experiences with incivility from healthcare professionals and others within the clinical environment and particularly within a Canadian context.

AIM

To describe the incidence and perceptions of incivility experienced by undergraduate nursing students from healthcare professionals and others within clinical practice.

METHOD

This descriptive study used an electronic survey and was conducted at an eastern Canadian university. Descriptive statistics were applied.

RESULTS

Of 650 nursing students invited to participate in the study, 260 surveys were fully completed. Of these, 70% of respondents indicated experiencing incivility, mostly in acute care settings. Registered nurses and licensed practical nurses were the major offenders. Discourteous gestures and condescending remarks were the most frequently experienced uncivil acts, resulting in feelings of high anxiety and inadequacy. Participants coped by avoiding communication with the perpetrator. Incivility was rarely reported because of a belief it would be fruitless to do so, lack of awareness of policies and fear of retaliation.

CONCLUSIONS

Nursing students experience incivility frequently in clinical practice with serious consequences. Recommendations arising from this study encourage educators and healthcare leaders to collaborate to review, implement and evaluate curricula, policies and processes to address incivility.

Bullying in the clinical setting: Lived experiences of nursing students in the Central Region of Ghana

INTRODUCTION

Nursing students are confronted with bullies in the classroom and during clinical placement. Acquisition of the necessary psychomotor skills intended during clinical placements may be impeded when workplace bullies intimidate students. This study aimed to describe the various bullying behaviours experienced by nursing students and their effects during clinical placement in the Central Region of Ghana.

METHODS

A qualitative phenomenological descriptive approach using a semi-structured interview guide was employed to collect data from nursing students in focus groups. Overall, six (6) focus groups were used, with five (5) students in each group comprising males and females. The sample size was based on data saturation and was saturated on the six focus group discussions giving a sample size of 30. Purposive sampling was used to select students who had been on the ward at least three clinical placements and had experienced bullying in the clinical setting. In-depth interviews were conducted, recorded, transcribed verbatim and analysed using content analysis.

RESULTS

The study revealed that nursing students had experienced bullying practices such as shouting, isolation, humiliation and being assigned tasks below their competency level. In addition, findings showed that bullying led to a loss of confidence and caused stress and anxiety in nursing students.

CONCLUSION

Therefore, it is recommended that nursing students are mentored holistically in a caring and accepting environment where they will be supported to achieve their learning goals, build their confidence, and develop their personal and professional identity.

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.

Cyberbullying, student nurses' ethical awareness and the Covid-19 pandemic

BACKGROUND

The global COVID-19 pandemic has increased cyber communication, causing nursing students' clinical practice to be held in cyberspace. Thus, it is essential to ensure that nursing students develop comprehensive cyber ethics awareness. Moreover, cyberbullying is becoming more widespread and is an increasingly relevant new concept.

OBJECTIVES

This study aimed to assess the experiences of cyberbullying among nursing students during clinical practice and determine the effects of cyberbullying victimization and cyber environments on their cyber ethics awareness.

RESEARCH DESIGN

Data for this descriptive cross-sectional study were collected in July 2020 using a self-reported questionnaire and analyzed using hierarchical regression.

PARTICIPANTS AND RESEARCH CONTEXT

The study included data from 291 nursing students with more than 6 months of clinical experience who were enrolled in two nursing universities in two cities in South Korea.

ETHICAL CONSIDERATIONS

This study was conducted after obtaining approval from the Institutional Review Board of G University. Written, informed consent was obtained from all participants.

RESULTS

Cyberbullying victimization experiences during clinical practice were few. The most common cyberbullies of work- and person-related cyberbullying were nurses and classmates, respectively.

DISCUSSION

Cyber ethics awareness was affected by cyber anonymity and the perceived seriousness of cyberbullying; cyberbullying related to clinical practices was a new factor that significantly affected cyber ethics awareness.

CONCLUSIONS

Hospitals and nursing universities should develop a multi-dimensional, comprehensive, and effective nursing intervention education program to be integrated into the nursing curriculum to enhance cyber ethics awareness and reduce cyberbullying of nursing students.

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.

Lessons Learned: Raising Awareness of Civility and Incivility Using Semi-Virtual Reality Simulation

BACKGROUND

The purpose of our web-based, semi-virtual reality simulation was to raise baccalaureate nursing students' awareness of civility and incivility. Educators know civility in nursing is crucial to safe and effective patient care. However, nursing students have reported physiological and psychological distress after experiencing incivility. If nurse educators are unable to better promote civility, the quality of nursing education, and ultimately nursing practice, is threatened.

METHOD

We implemented an innovative civility-related, semi-virtual reality, simulation with senior-level nursing students. After attending a faculty-led discussion on the importance of civility and incivility, students participated in a web-based, semi-virtual reality simulation, followed by a synchronous debriefing session.

RESULTS

Students reported that the intervention raised their awareness of civility and incivility.

CONCLUSION

This article describes the intervention and shares the lessons learned in implementing it so nurse educators may replicate this innovative strategy to raise awareness of civility in nursing education. [J Nurs Educ. 2020;59(8):461-464.].

Effect of Korean nursing students' experience of incivility in clinical settings on critical thinking

Clinical experience is essential to helping nursing students to achieve and practice professional knowledge and skills. Published reports indicate nursing students often experience incivility during clinical practice. The purpose of this study was to investigate nursing student incivility experience during their clinical rotations and the relationship of these experiences with their critical thinking dispositions. A cross-sectional descriptive correlational study design was utilized. Data were collected from junior (n = 195) and senior (n = 180) students in a Bachelor of Science in Nursing (BSN) program in Seoul, Korea between October 15, 2017 and November 20, 2017 using a self-administered survey. Three instruments were used in the survey: six sociodemographic questions, the 13-item Korean version of Uncivil Behavior in Clinical Nursing Education (K-UBCNE) and the 27-item Yoon Critical Thinking Disposition (YCTD) tool. Data analysis revealed junior students reported significantly more incivility from nurses than the senior students (p = .038) during clinical learning experiences. Among YCTD subscales, the Prudence (p = .007) and Self-Confidence critical thinking (p = .007) scores from the senior nursing students were significantly higher than the junior students' scores. No significant relationship was found between experience of incivility and critical thinking disposition scores. Based on the study results, nursing educators, staff nurses, and administrators/managers in nursing should identify incivility toward nursing students during clinical practicums and especially toward junior nursing students. Additional investigation of the relationship between critical thinking and experiences of incivility is warranted, including longitudinal investigations and qualitative studies among junior nursing students to understand their personal experience of incivility in the clinical setting. Findings could inform the development of targeted programs to reduce clinical incivility.

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.

Emotions and feelings evoked in nursing students exposed to bullying behaviors in clinical settings

Background and objective

Though not fully integrated into the profession, student nurses have been exposed to and experienced bullying behaviors with limited skills to mitigate the effects of the behaviors. This qualitative study analyzed the emotions evoked due to exposure to bullying behaviors. Desired to address the question: "How do student nurses feel when they are the recipient of bullying-type behaviors?"

Methods

DESIGN: Qualitative descriptive design. SETTING: A nursing college at an urban university in the Midwestern United States; PARTICIPANTS: Matriculated students enrolled in a pre-licensure nursing program. METHODS: As part of a larger mixed informed pilot study, each participant was assigned to either the control or intervention group. Participants in the intervention group received an educational intervention focused on bullying two weeks prior to a scheduled clinical simulation. Participants in both groups each completed an individual clinical simulation during which they were exposed to bullying-type behaviors meant to replicate behaviors they may encounter in actual clinical settings. All participants were informed of their right to disenroll from the study at any point. For the health and safety of participants, individuals were provided with safeguards during the study as well as upon conclusion of their participation. Immediately following the simulation, participants completed an individual debrief interview during which they were asked to describe how the simulation made them feel. Responses were audio recorded and transcribed verbatim. Data were analyzed using a descriptive qualitative to generate thematic results.

Results

The three major themes developed included Past Bullying-like Behavior, Feelings Experienced during Simulation, and Perceptions of the Simulation. Participants reported experiencing negative emotions due to the bullying behavior exposure despite receiving an educational intervention. Harmful emotions, such as sadness, led participants to question their ability to perform simple tasks. Student nurses possess the skills and knowledge to perform routine tasks; however, when bullying behaviors target nursing students, the negative behaviors have the potential to adversely affect the whole student.

Conclusions

Further research is warranted to identify programs to aid students in overcoming the negative bullying behaviors in the clinical setting.

The Relationship Between Experiences of Lateral Violence and Career Choice Satisfaction Among Nursing Students

This article explores associate degree nursing students' experiences with lateral violence and its impact on career choice satisfaction. Lateral violence has been linked to decreased professional identity, increased errors, and poor self-esteem, leading to a negative culture and attrition. A nonexperimental, quantitative, cross-sectional, correlational design was used; 13.4 percent of respondents (n = 32) met the criteria for intermittent bullying. Analysis confirmed a significant negative correlation between experiences of lateral/vertical violence and career choice satisfaction (r = - .140, p < .05) even after controlling for affect and support. Improved efforts are needed to prevent lateral violence.

"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.

Responding to disruptive behaviors in nursing: A longitudinal, quasi-experimental investigation of training for nursing students

OBJECTIVES

The objective of this study was to determine the impact of a cognitive rehearsal intervention on nursing students' self-efficacy to respond effectively to disruptive behaviors.

DESIGN

This quantitative study was part of a longitudinal, quasi-experimental program of research.

SETTING

Interventions were conducted on site at facilities provided by participating pre-licensure nursing programs.

PARTICIPANTS

A total of 129 nursing students enrolled in their final academic year in three traditional format, pre-licensure nursing programs in the Midwestern United States were recruited to participate in this study.

METHODS

A cognitive rehearsal intervention was delivered to increase self-efficacy to respond to disruptive behaviors in the nursing workplace. Data were collected in writing immediately prior to and following the intervention. Three months later, data were collected in electronic format through a link sent by text message to their mobile phones. Study data were collected on the Self-efficacy to Respond to Disruptive Behaviors Survey, a 10-point Likert scale measuring self-efficacy and its dimensions: knowledge, previous behavioral engagement, affect, and motivation toward responding effectively to disruptive behaviors.

RESULTS

129 students completed the surveys at pre and post-test; 109 completed the survey three months later. Measures of overall self-efficacy and knowledge (p < 0.000), and both measures of situational self-efficacy (p = 0.002; p = 0.020) remained significantly increased three months after the intervention, compared to pre-test. Past behaviors increased on post-test but returned to baseline at the three-month follow-up. The intervention did not significantly impact affect scores. Changes in motivation toward effective responses were mixed between measurements immediately following the intervention and three months later.

CONCLUSION

Cognitive rehearsal interventions can increase self-efficacy to respond to disruptive behaviors with sustained effects up to three months later. Further research is needed to determine the effects of self-efficacy to respond once participants have entered the nursing workplace.

Faculty and Student Incivility in Undergraduate Nursing Education: An Integrative Review

BACKGROUND

Incivility is a critical issue in undergraduate nursing education. Uncivil acts in academia are increasing and have the potential to affect future nursing practice and patient safety outcomes.

METHOD

An integrative literature review was completed to describe faculty-to-student and student-to-faculty incivility in undergraduate nursing education.

RESULTS

Seventeen studies were included in the review. Four themes emerged from the data: (a) Detrimental to Health and Well-Being, (b) Disruption to the Teaching-Learning Environment, (c) Stress as a Catalyst, and (d) Incivility Incites Incivility.

CONCLUSION

The results support data that incivility has harmful physical and psychological effects on both faculty and students, and also disturbs the teaching-learning environment. Causes of un-civil acts have been highlighted to provide groundwork for schools of nursing to implement strategies for mitigating incivility. [J Nurs Educ. 2017;56(12):709-716.].

Status of Violence in a Selected Faculty: The Students’ Experience

The present study is aimed at examining the status of violence among the students of nursing, midwifery, and operating room. A self-reporting questionnaire with two sections of demographic characteristics and experience of violence was used. The data obtained were analyzed, using SPSS software. 58.7 percent of the students had a history of violence in the previous year. The maximum percentage of violence exposure belonged to the students of operating room (76.9%). The highest incidence of violence was verbal (76.4%), happened in patients’ rooms (32.9%) and was in the form of insult (75.1%). Accordingly, preventive actions are required to prevent and control violence and support students. Informing students about violence, communicative skills, reaction, and coping with violence during studying is necessary. Therefore, educational authorities and theoretical and clinical instructors should take appropriate measures in order to prevent violence and create supportive mechanisms for the students.

Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students' experiences during clinical placement in Australia and the UK

Bullying in health workplaces has a negative impact on nurses, their families, multidisciplinary teams, patient care and the profession. This paper compares the experiences of Australian and UK baccalaureate nursing students in relation to bullying and harassment during clinical placement. A secondary analysis was conducted on two primary cross-sectional studies of bullying experiences of Australian and UK nursing students. Data were collected using the Student Experience of Bullying during Clinical Placement (SEBDCP) questionnaire and analysed using descriptive and inferential statistics. The total sample was 833 Australian and 561 UK students. Australian nursing students experienced a higher rate of bullying (50.1%) than UK students (35.5%). Students identified other nurses as the main perpetrators (Aust 53%, UK 68%), although patients were the main source of physical acts of bullying. Few bullied students chose to report the episode/s. The main reason for non-reporting was fear of being victimised. Sadly, some students felt bullying and harassment was 'part of the job'. A culture of bullying in nursing persists internationally. Nursing students are vulnerable and can question their future in the 'caring' profession of nursing after experiencing and/or witnessing bullying during clinical placement. Bullying requires a zero tolerance approach. Education providers must develop clearer policies and implement procedures to protect students - the future nursing workforce.

Lateral Violence in Nursing: Implications and Strategies for Nurse Educators

Lateral violence among nurses persists as a prevalent problem, contributing to psychological distress, staff turnover, and attrition. Newly graduated nurses are at particular risk for being targets of lateral violence and experiencing its negative sequelae. Preparing student nurses to respond to lateral violence prior to entering the nursing may alter this scenario. A review of the literature was conducted to determine the potential for nursing faculty to change the cycle of lateral violence. Based on this review, we recommend 3 main strategies, specifically for nursing faculty, aimed at reducing incidences of lateral violence and preparing students to manage this phenomenon. First, curricular content can address integrating lateral violence content into simulation experiences and facilitating this knowledge into clinical experiences. Second, codes of conduct should guide behaviors for both students and faculty. Finally, as role models, faculty should be aware of their own behaviors, role model respectful communication, facilitate a courteous academic environment, and develop nurses capable of identifying and appropriately responding to lateral violence.