Bullying and Its Prevention Among Intensive Care Nurses

Assessment of Clinical Reasoning While Attending Critical Care Postsimulation Reflective Learning Conversation: A Scoping Review

BACKGROUND

The critical care environment is characterized with a high level of workload, complexity, and risk of committing practice mistakes. To avoid clinical errors, health care professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, health care professionals should get the chance to practice and be exposed to different patient experiences. To minimize safety risks to patients and health care professionals, clinical reasoning with a focus on reflective learning conversation opportunities can be practiced in simulated settings.

OBJECTIVES

To explore the most valid and reliable tools to assess clinical reasoning while attending adult critical care-related simulation-based courses in which reflective learning conversations are used.

METHODS

A scoping review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews. Eight electronic databases were searched, and full-text review was completed for 26 articles.

RESULTS

The search resulted in no studies conducted to measure clinical reasoning while attending adult critical care-related, simulation-based courses in which the reflective learning conversation method was embedded.

DISCUSSION

This highlights the need to evaluate current available clinical reasoning tools or develop new tools within the context of adult critical care simulation where reflective learning forms a key part of the simulation procedures.

Investigating Mobbing Syndrome's Incidence in the Working Environment of a Public and a Private Greek Hospital

To investigate the phenomenon of moral harassment (mobbing) as well as the effect of demographic and occupational characteristics of healthcare professionals working in a public provincial general hospital and a private hospital in Athens a cross-sectional survey was designed. The study was conducted from November to December 2021 through the application of the Leymann Inventory of Psychological Terror (LIPT) a widely recognized research tool for the quantitative investigation of ethical harassment in the workplace. 264 fully completed questionnaires were collected out of the 300 that were distributed in both hospitals (response rates: 92% for the public hospital and 83.3% for the private). It was observed that private hospital's employees were morally harassed to a greater extent and for a longer time than the employees of a public hospital. The levels of moral harassment were quite high, indicating the necessity of thorough audit by the management in both hospitals.

Types of Nursing Intervention to Reduce Impact of Bullying and Aggression on Nurses in the Workplace

The bullying of nurses in the workplace hurts the individuals and the work environment. Bullying can cause mental health problems, reduces the quality of nursing services, and reduces patient safety. The purpose of this study was to describe types of nursing interventions to reduce impact of bullying on nurses in the workplace. This study used the scoping review method to examine literature from the CINAHL, PubMed, and ProQuest databases. The keywords used in English are “bullying OR cyberbullying” AND “nurse” AND “workplace OR work-place” AND “nursing care OR nursing intervention”. The inclusion criteria were full text, randomized control trial or quasi-experiment design, English language, population of nurses, and the publication period of the last 10 years (2013–2022). We found nine articles that discussed nursing interventions designed to reduce the impact of bullying on nurses in the workplace. The sample in the study was in the range of 26–97 respondents. Most of the articles in this review used the quasi-experiment method. The study showed that nursing interventions to heal had negative effects on the bullying on nurses. There are three types of interventions employed to reduce the impact of bullying and aggression on nurses in the workplace, namely training programs, cognitive rehearsal programs, and education programs.

Using Behavioral Theory to Enhance Occupational Safety and Health: Applications to Health Care Workers

Work-related morbidity and mortality are persistent public health problems across all US industrial sectors, including health care. People employed in health care and social services are at high risk for experiencing injuries and illnesses related to their work. Social and behavioral science theories can be useful tools for designing interventions to prevent workplace injuries and illnesses and can provide a roadmap for investigating the multilevel factors that may hinder or promote worker safety and health. Specifically, individual-level behavioral change theories can be useful in evaluating the proximal, person-related antecedents (such as perceived behavioral control) that influence work safety outcomes. This article (1) provides a brief overview of widely used, individual-level behavior change theories and examples of their application to occupational safety and health (OSH)-related interventions that involve the health care community; (2) introduces an integrated theory of behavior change and its application to promoting the OSH of health care workers; and (3) discusses opportunities for application of individual-level behavior change theory to OSH research and practice activities involving health care workers. The use of behavioral science to consider the role of individual behaviors in promoting health and preventing disease and injury provides a necessary complement to structural approaches to protecting workers in the health care industry.

Addressing Bullying and Lateral Violence in the Workplace: A Quality Improvement Initiative

BACKGROUND

Bullying and lateral violence are pervasive in the nursing workforce and have profound psychosocial, physical, safety, and financial consequences for nurses, their patients, and the overall health care organization.

PROBLEM

Unit-based nursing leaders may be aware of bullying and lateral violence but be unsure of the best approaches to address it.

APPROACH

An iterative, multimodal quality improvement initiative was crafted on the basis of the available evidence and principles of transformational, adult learning. Six units were designed to foster didactic, affective, and psychomotor learning specific to bullying and lateral violence and their prevention. Each unit consisted of formal lecture content, practice exercises, and reflection.

OUTCOMES

This quality improvement project was well received by participants; a unit-based action plan resulted. Project materials are being reworked and new evidence integrated for deployment across the department.

CONCLUSIONS

This initiative has demonstrated the necessary properties and is appropriate for adoption by other nursing units.

Association Between Workplace Bullying Occurrence and Trauma Symptoms Among Healthcare Professionals in Cyprus

Workplace bullying/mobbing is an extreme work-related stressor, but also a severe hazard for physical, mental and psychological health in healthcare employees, including nurses. A range of trauma-related symptoms has been linked with bullying victimization. The aim of the study was the investigation of workplace bullying/mobbing-related trauma symptoms in Greek-Cypriot nurses working in emergency and critical care settings, as well as of potential correlations with demographic and occupational variables. A descriptive, cross-sectional correlational study was performed in a convenience sample of 113 nurses. A modified version of the Part B.CII of The Workplace Violence in the Health Sector-Country Case Studies Research Instrument (WVHS-CCSRI Part C.II-M) and the modified Secondary Traumatic Stress Scale (STSS-M) were used for the assessment of bullying/mobbing frequency and workplace bullying/mobbing-related trauma symptoms, respectively. A total of 46.9% of the sample reported experiences of both bullying/mobbing victimization and witnessing of bullying/mobbing to others (VWB subgroup), 21.2% reported solely bullying/mobbing victimization (SVB subgroup) and 10.6% reported witnessing of bullying/mobbing to others (SWB subgroup). A total of 22.3% did not experience or witness any bullying/mobbing at the workplace. Trauma symptoms intensity (STSS-M total score) was more severe in the participants a) with a high frequency of workplace bullying/mobbing experiences compared to those with a moderate frequency of such experiences (p = 0.018), b) of the VWB subgroup compared to those of the SWB subgroup (p = 0.019), c) employed in Emergency Departments compared to those employed in ICUs (p = 0.03), d) who had considered resigning due to bullying/mobbing experiences compared to those who had never considered resigning (p = 0.008), e) who had been punished for reporting a bullying/mobbing incident compared to those who had not (p = 0.001), and f) who considered the incident unimportant to be reported compared to those who avoided reporting due to other causes (p = 0.048). This data highlights the need to establish effective and safe procedures for bullying/mobbing reporting, aiming to support bulling/mobbing victims and witnesses, and further to protect their legal rights. Both victims and witnesses of workplace bullying/mobbing need to be assessed by mental health professionals for PTSD symptoms in order to have access to effective treatment.

Workplace bullying in the nursing profession: A cross-cultural scoping review

BACKGROUND

Globally, nurses are at high risk of exposure to workplace bullying, and there is a growing body of literature addressing bullying in the nursing profession. Yet, our understanding of cross-cultural variations in bullying among nurses is lacking. An analysis of what is currently known about bullying in different parts of the world is critical for our understanding of cross-cultural effects of bullying among nurses.

OBJECTIVES

We aimed to examine workplace bullying research among nurses with the focus on sources, antecedents, outcomes and coping responses from a cross-cultural perspective during the years 2001-2019.

DESIGN

This is a scoping review of published literature on workplace bullying among nurses.

DATA SOURCES

A literature search was conducted using the CINAHL, PubMed, PsychINFO and Web of Science databases. A total of 166 articles provided data from the following cultural clusters: Anglo, Latin Europe, Eastern Europe, Nordic Europe, Middle East, Latin America, Confucian Asia, Southern Asia and Sub-Saharan Africa.

PROCEDURE

Studies were identified through a database search. Relevant data were extracted using a narrative approach. Categories were thematically organized according to the study topics. Cultural differences regarding the variation in the perceptions of and responses to bullying were analysed in relation to the cultural dimensions: power distance, assertiveness, in-group collectivism and performance orientation.

RESULTS

Research was mostly conducted in the Anglo cluster. Antecedents and outcomes of bullying were the most often studied topics across all cultural clusters. Vertical bullying was most prevalent in higher power distance cultures, whereas horizontal bullying was either more or equally prevalent in lower power distance cultures. The risk of bullying decreased as nurses' length of service and age increased in most of the clusters. Individual antecedents were more frequently reported in high in-group collectivist cultures. Organizational antecedents such as lack of bullying prevention measures, unsupportive leadership and stressful work characteristics were frequently reported across different cultural clusters. Yet, an organizational culture that tolerates bullying was most commonly addressed in Anglo, a highly performance-oriented culture. Negative outcomes of bullying were very similar across the world. Nurses used emotion-focused coping strategies more frequently almost in all clusters; yet, there were reports of problem-focused coping strategies especially in relatively higher assertiveness cultures.

CONCLUSIONS

Analysis revealed both similarities and differences in the nurses' reports of bullying by world region. Cultural factors were found to be important for understanding the variation in the nurses' perceptions of and responses to bullying.

Standing up against workplace bullying behavior: Recommendations from newly licensed nurses

Objective

Workplace bullying exists in today's healthcare system and often targets newly licensed nurses. Experiences of workplace bullying behavior may negatively affect the nurses' physical and psychological health and impact job satisfaction and staff turnover rates at an organizational level. The purpose of this study was to explore strategies suggested by newly licensed nurses to prevent and intervene during incidents of workplace bullying behavior.

Methods

An exploratory qualitative design guided this study. Three open-ended questions asked included: What do you think could be done to prevent a future, similar incident of workplace bullying? If you or someone else attempted to the stop the bullying incident, please describe the actions taken. If you or someone else did not attempt to stop the bullying incident, please state what would need to happen for you to intervene on behalf of yourself or someone else. Surveys were distributed electronically to newly licensed nurses from three baccalaureate nursing programs who had participated in a workplace bullying education intervention study as students. A total of 79 responses were received. Responses to three open-ended questions about recent incidents of workplace bullying behavior were coded and analyzed. Then the Social-Ecological Model was used to organize results into individual, relationship, and organizational level strategies.

Results

Most respondents reported experiencing workplace bullying behaviors in the previous six months. Three domains of strategies were identified: Preventing Future Bullying Behavior, Stopping Incidents of Bullying Behavior, and Promoting Others to Act.

Conclusions

Results indicated newly licensed nurses desire to be supported by their peers and organization as well as strategies to intervene when bullying behaviors occur. Implications for clinical practice and education are presented.

An investigation into the relationships between bullying, discrimination, burnout and patient safety in nurses and midwives: is burnout a mediator?

Background

Bullying and discrimination may be indirectly associated with patient safety via their contribution to burnout, but research has yet to establish this.

Aims

The aims of this study were to investigate the relationships between workplace bullying, perceived discrimination, levels of burnout and patient safety perceptions in nurses and midwives and to assess whether bullying and discrimination were more frequently experienced by Black, Asian and minority ethnic than White nurses and midwives.

Methods

In total, 528 nurses and midwives were recruited from four hospitals in the United Kingdom to complete a cross-sectional survey between February and March 2017. The survey included items on bullying, discrimination, burnout and individual level and ward level patient safety perceptions. Data were analysed using path analysis.

Results

The results were reported according to the STROBE checklist. Bullying and discrimination were significantly associated with higher burnout. Higher burnout was in turn associated with poorer individual- and ward-level patient safety perceptions. Experiences of discrimination were three times more common among Black, Asian and minority ethnic than White nurses and midwives, but there was no significant difference in experiences of bullying.

Conclusions

Bullying and discrimination are indirectly associated with patient safety perceptions via their influence on burnout. Healthcare organisations seeking to improve patient care should implement strategies to reduce workplace bullying and discrimination.

Prevalence of bullying in the nursing workplace and determinant factors: a nationwide cross-sectional Polish study survey

OBJECTIVES

In the present study, we aimed to investigate the prevalence of bullying among Polish nurses, and to identify the most common negative acts, as well as individual and work-related risk factors for workplace bullying.

METHODS

Cross-sectional study designed using an online survey. The total study sample was 404 nurses, each having over 6 months of working experience. Data were collected using the Polish version of the Negative Act Questionnaire-Revised. Linear stepwise regression analysis and logistic regression analysis were performed to assess predictors of greater reporting of perceived workplace bullying RESULTS: Bullying was experienced by 65.84% of participants. Perceived workplace bullying was associated with sex (p=0.043), age (p=0.003), seniority (p=0.006), number of working hours per week (p=0.010) and position (p=0.029). Logistic regression analysis with the dependent variable of bullying according to Leymann's rigorous criteria revealed that the model could include four variables: age from 50 to 59, seniority of 11-15 years,>45 working hours per week and a bachelor's degree in nursing.

CONCLUSIONS

An alarming percentage of nurses were victims of bullying. Among all variables included in the regression model, the most significant predictors of perceived workplace bullying were age, seniority, work overtime and bachelor's degree education. Bullying prevention and improvement of well-being at work must be addressed as part of an overall strategy to deal with turnover.

Conceptual model for intensive care nurse work well-being: A qualitative secondary analysis

BACKGROUND

There had been little focus on the well-being of intensive care nurses until a recent programme of research found work well-being to be best described as a collection of elements, a multifaceted construct. Strengtheners of intensive care nurses' work well-being were found to extend across individual, relational, and organizational resources. Actions such as simplifying their lives, giving and receiving team support, and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners.

AIMS AND OBJECTIVES

To synthesize intensive care nurse perceptions of work well-being characteristics and strengtheners to identify opportunities for job crafting and redesign.

DESIGN

This was a qualitative secondary analysis.

METHODS

Intensive care nurse work well-being characteristics and strengtheners were explored using applied thematic analysis and pre-design, open card-sort technique.

RESULTS

Five facets were identified in the analysis: (a) healthy, (b) authentic, (c) meaningful, (d) connected, and (e) innovative. These five facets were described from a theoretical perspective and illustrated as a conceptual model for intensive care nurse job crafting and redesign.

CONCLUSIONS

The proposed conceptual model contributes new knowledge to be explored in meaningful discussions about intensive care nurse work well-being and empirically investigated in terms of construct validity and theory development. Furthermore, the model provides practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being across a range of levels.

RELEVANCE TO CLINICAL PRACTICE

Opportunities for job crafting and redesign were identified and presented in a conceptual model of intensive care nurse work well-being. This model provides individual nurses, intensive care teams, health care organizations, and workers' well-being programme and policy developers practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being.

Mobbing perception among Intensive Care Unit nurses

AIM

to determine the perception of intensive care unit nursing staff on mobbing.

METHOD

qualitative approach study, Grounded Theory was used, 12intensive care unit nurses of 2public hospitals in our country during December 2017.

RESULTS

female sex predominated with an average age of 41.33 years old, mostly married, on night shift and trained a nursing technicians; 4categories emerged: general knowledge about mobbing, the origin of mobbing and its main actors, experiences of mobbing as a victim and as a spectator and the implications of mobbing in working life.

DISCUSSION

issues of workplace harassment are sensitive for most health workers, since they deal with private situations and lack of support from superiors when they have been victims of harassment. The evidence shows that one of the reasons why mobbing can be perceived in different ways is because little is known about the real concept, it can be associated with multiple forms of violence and there is heterogeneity in the use of the term.

CONCLUSION

the majority of intensive care unit nursing staff have been victims and witnesses of mobbing behaviour, with negative repercussions on their job satisfaction and performance; It is also the cause of constant staff turnover.

Bullying in the nursing work environment: integrative review

OBJECTIVE

To evaluate the studies that approach bullying in the nursing practice environment.

METHOD

Integrative review, conducted between April and December 2018, by combining the descriptors "bullying/bullying" AND "nursing/nursing/nurse" AND "workplace/workplace". We identified 224 studies of which 38 met the inclusion criteria.

RESULTS

The studies on nursing bullying presented three main approaches related to the prevalence in nursing practice, the repercussions for health and professional development, and the construction of theoretical models for bullying and nursing work environment variables.

CONCLUSION

Bullying is a negative behavior present in the nursing practice environment and has a direct impact on professional performance, impairing general health and professional performance. Despite being a behavior with recognized negative potential in the work environment, few studies propose effective actions to prevent or control this phenomenon in health institutions.

Disruptive behaviors among nurses in Israel - association with listening, wellbeing and feeling as a victim: a cross-sectional study

OBJECTIVES

To examine the association between listening and disruptive behaviors and the association between disruptive behavior and the wellbeing of the nurse. To test whether constructive and destructive listening has an incremental validity.

METHODS

A structured questionnaire survey that measured the (constructive & destructive) listening climate at work, exposure to disruptive behaviors, well-being and feeling as a victim. We presented this survey using the Qualtrics software.

RESULTS

Of the final sample of 567 respondents who reported that they were nurses, MAge = 38.41, 67% indicated that they were exposed to some form of disruptive behavior. Experiencing listening in the ward was associated with low levels of exposure to disruptive behaviors; exposure to disruptive behaviors, in turn, predicted reduction in the nurses' wellbeing; the reduction in wellbeing was especially pronounced among nurses who felt like a victim. Each of the facets of the listening measure-constructive listening and destructive listening-had incremental validity in predicting exposure to disruptive behaviors. Finally, the effect of exposure to disruptive behavior on wellbeing was curvilinear.

CONCLUSIONS

Disruptive behavior is a major challenge to the workplace well-being for nurses. The victim mentality has an adverse impact on nurses. Preventive efforts aimed at reducing disruptive behaviors among nurses and decreasing their sense of victimization are crucial for the well-being of nurses.

Effects of a smartphone application for cognitive rehearsal intervention on workplace bullying and turnover intention among nurses

BACKGROUND

Bullying in nursing workplaces has been considered a serious problem that increases nurse turnover.

AIM

To develop a cognitive rehearsal intervention for workplace bullying and examine its effects on nurses' bullying experiences and turnover intentions.

METHODS

We developed a smartphone application to cognitively train nurses to handle bullying situations in the workplace. This application included common bullying situations and appropriate non-violent communication scenarios. A cluster quasi-randomized trial was performed with 72 hospital nurses working in a university hospital in South Korea from November 2016 to January 2017. We measured workplace bullying experiences and turnover intention before intervention and 4 and 8 weeks after intervention in both intervention and control groups.

RESULTS

The cognitive rehearsal intervention developed in this study was effective for decreasing nurses' person-related bullying, work-related bullying experiences, and turnover intention. However, it had no effects on intimidation-related bullying experiences.

CONCLUSIONS

The smartphone application-based cognitive rehearsal intervention can serve as a personal coping measure for person-related and work-related bullying among nurses. It is recommended that the intervention developed in this study be applied as a strategy to reduce nurse turnover.

Workplace bullying and its preventive measures and productivity among emergency department nurses

BACKGROUND

Workplace bullying has adverse effects on nurses' productivity and emotional well-being and increases nurses' desire to leave their jobs. Bullying is a common phenomenon that has been reported worldwide. Emergency Department (ED) nurses are particularly exposed to bullying as a result of their job stressors and demands.

PURPOSES

To examine the prevalence of bullying and the impact of preventive measures on productivity among Jordanian ED nurses; and to examine bullying in relation to personal and organizational factors.

METHODS

We surveyed ED nurses in five hospitals in Amman, Jordan - two government hospitals and three private hospitals. The eligibility criteria for the study, met by 134 persons, were having at least an associate degree and having worked in the ED for at least six months. We used a four-part questionnaire that included demographic data, the Negative Acts Questionnaire, questions on prevention of bullying, and a health and productivity survey. Data analysis included descriptive and inferential statistics.

RESULTS

A total of 120 ED nurses joined the study, an 89.6% response rate. The majority of participants were male (65%) and their mean age was 29.4 years. Ninety percent of the participants reported being bullied. Nurses with less experience in the ED were exposed to more bullying compared to other nurses. Of nurses who reported being bullied, 61.7% reported associated decreased productivity, including the ability to respond to cognitive demands, provide support, appropriate communication, safe care, and competent care. The overall mean score for the prevention of bullying questionnaire was 94.51 out of 168 (SD = 23.43). Drilling down, the highest mean score was for the "Individual sub-scale", and the highest item mean score was for "I know the process of how to report bullying".

CONCLUSION

Bullying is prevalent among ED nurses in Jordan; it has significantly influenced the nurses' perception of their productivity and the quality of care they provide. Although nurses reported adopting measures to prevent bullying, they were insufficient to address this widespread problem.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Bullying is a common occurrence in nursing practice in Jordan, as in other places. It has a detrimental effect on the quality of health care. Accordingly, interventions, which we describe, should be undertaken to minimize the incidence and impact of bullying.

Workplace bullying and its preventive measures and productivity among emergency department nurses

BACKGROUND

Workplace bullying has adverse effects on nurses' productivity and emotional well-being and increases nurses' desire to leave their jobs. Bullying is a common phenomenon that has been reported worldwide. Emergency Department (ED) nurses are particularly exposed to bullying as a result of their job stressors and demands.

PURPOSES

To examine the prevalence of bullying and the impact of preventive measures on productivity among Jordanian ED nurses; and to examine bullying in relation to personal and organizational factors.

METHODS

We surveyed ED nurses in five hospitals in Amman, Jordan - two government hospitals and three private hospitals. The eligibility criteria for the study, met by 134 persons, were having at least an associate degree and having worked in the ED for at least six months. We used a four-part questionnaire that included demographic data, the Negative Acts Questionnaire, questions on prevention of bullying, and a health and productivity survey. Data analysis included descriptive and inferential statistics.

RESULTS

A total of 120 ED nurses joined the study, an 89.6% response rate. The majority of participants were male (65%) and their mean age was 29.4 years. Ninety percent of the participants reported being bullied. Nurses with less experience in the ED were exposed to more bullying compared to other nurses. Of nurses who reported being bullied, 61.7% reported associated decreased productivity, including the ability to respond to cognitive demands, provide support, appropriate communication, safe care, and competent care. The overall mean score for the prevention of bullying questionnaire was 94.51 out of 168 (SD = 23.43). Drilling down, the highest mean score was for the "Individual sub-scale", and the highest item mean score was for "I know the process of how to report bullying".

CONCLUSION

Bullying is prevalent among ED nurses in Jordan; it has significantly influenced the nurses' perception of their productivity and the quality of care they provide. Although nurses reported adopting measures to prevent bullying, they were insufficient to address this widespread problem.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Bullying is a common occurrence in nursing practice in Jordan, as in other places. It has a detrimental effect on the quality of health care. Accordingly, interventions, which we describe, should be undertaken to minimize the incidence and impact of bullying.

Workplace Bullying of Urology Residents: Implications for the Patient and Provider

OBJECTIVE

To elucidate whether urology residents in the United States feel bullied by nurses, how respected they feel at work, and whether this impacts personal and patient care.

METHODS

We distributed an Institutional Review Board-approved online, validated, revised Negative Acts Questionnaire to US urology residents in their first year or above. We evaluated bullying through scoring work (total range 5-25), person (total range 9-45), and physical intimidation (total range 3-15) related bullying domains. We also solicited how respected residents feel by different staff on a Likert scale and the perceived personal and professional impact of bullying. Bullying domains were assessed with descriptive statistics and mean total bullying scores (MTBS) and demographics compared.

RESULTS

We received 102 responses (82% MD, 18% DO). One resident reported never experiencing bullying. Overall average MTBS was 28.9 ± 0.9 (17-68). 98.0%, 82.4%, and 77.5% of residents reported at least 1 incident of work, person, and physical intimidation-related bullying, respectively. DO residents reported higher MTBS than MD residents (33.7 ± 2.2vs 27.8 ± 1.0, P = .015). Higher MTBS scores were seen in residents who feared retaliation and considered transferring programs, while lower scores were seen where the resident-nurse relationship was nurtured.

CONCLUSION

Ninety percent of residents perceived some degree of bullying and report a negative impact on personal performance and patient outcomes.

Horizontal violence among nurses: Experiences, responses, and job performance

Horizontal violence (HV), or nonphysical intergroup conflict expressed in overt and covert behaviors of hostility, is pervasive in nursing and has been discussed in the literature for more than two decades. It is costly and has potentially devastating effects including high nurse turnover rates, increased illness, decreased productivity, and decreased quality of patient care. Recognizing how these behaviors are established and sustained is necessary if nurses are to overcome these types of behaviors. This mixed methods study used an online survey to examine 76 hospital nurses' experiences and responses to episodes of HV as well as its effects on job performance. Seven of these nurses answered more in-depth questions during a follow-up interview. Nurses in this study recognize HV as a phenomenon that occurred early in their careers as novice nurses. The literature suggests that these behaviors are evident during nursing education. The academic environment is an ideal place to teach the skills necessary to respond appropriately to HV with peer support being essential. Nurses also reported that manager and staff support and workplace education were the most helpful in reducing HV. Increased workload and stress and HV being accepted practice on the unit were factors identified as most important in promoting HV. Further, nurses cited reasons why they continue in their jobs after episodes of HV. Intervention studies are needed to test effective ways of reducing this very difficult behavior among nurses in the workplace.

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review

INTRODUCTION

The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role.

OBJECTIVES

To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses.

REVIEW METHODS

A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings.

DATA SOURCES

The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment.

RESULTS

Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,⁷¹ a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,⁷² and the Mixed Methods Appraisal Tool for mixed-method studies.⁷³ The critical review guidelines by Shenton⁷⁴ and Polit and Beck⁷⁵ were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'.

CONCLUSION

Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.

Intensive care nurse conceptions of well-being: a prototype analysis

BACKGROUND

Accurately conceptualizing intensive care nurse work well-being is fundamental for successful engagement with workplace well-being interventions. Little is currently known about intensive care nurse work well-being.

AIMS

The study aimed to identify intensive care nurses' conceptions of work well-being and ascertain whether the term 'work well-being' is prototypically organized.

METHODS

Three linked studies conceptualize intensive care nurse well-being. For study one, participants listed key features of work well-being as free-text responses. Study two measured whether there was prototypical organization of these responses. Study three sought to confirm the prototypical organization of the term 'work well-being' through narrative ratings.

RESULTS

A total of 82 New Zealand intensive care nurses were randomly allocated to the three studies; 65 participated. In study one (n = 23), the most frequently endorsed elements included: workload (n = 14), job satisfaction (n = 13) and support (n = 13). In study two (n = 25), the highest rated elements included: feeling valued, respect, support, work-life balance and workplace culture. Elements of support, work-life balance and workload were in the top five most frequently endorsed elements and were also rated in the top 12 most central. Overall, the ratings of centrality and number of endorsements were positively correlated (r = 0.35, P < 0.05). In study three (n = 17), nine participants selected the same rating across both narratives with no differentiation on the 11-point scale and were excluded from analysis. The mean score for the central narrative was 7.88 and for the peripheral narrative was 7.38. Confirmatory analyses did not reach statistical significance.

CONCLUSIONS

Unique conceptions of work well-being were identified. Workload and work-life balance were central characteristics. Feeling valued and experiencing respect and support were considered most important.

RELEVANCE TO CLINICAL PRACTICE

Intensive care nurse conceptions of work well-being are fundamental for future measures of work well-being and future interventional studies and initiatives.

Education as an Intervention Toward Recognizing and Eliminating Incivility

Incivility in nursing is a pervasive and evasive problem that many nurses do not easily recognize or may simply shrug off as "normal." However, incivility produces a hostile work environment and can jeopardize safety. A study was conducted to (a) determine nurses' ability to recognize incivility in nursing after an online educational intervention on incivility, (b) ascertain the effectiveness of online education toward assisting nurses with understanding how to ward off this behavior, and (c) determine the types and effects of incivility participants experienced. Findings suggest that education on incivility may assist nurses with identifying uncivil behaviors exhibited by nurse peers and help them understand strategies to combat it. The types of incivility reported by participants were similar to findings of other studies; effects included unsafe behaviors and somatic consequences.

Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study

Background:

Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future.

Methods:

We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey.

Results:

We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse–patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels.

Conclusion:

As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.

"Nurses Eat Their Young": A Novel Bullying Educational Program for Student Nurses

Bullying is a known and ongoing problem against nurses. Interventions are needed to prepare nursing students to prevent and mitigate the bullying they will experience in their nursing practice. The purpose of this article is to describe the development process and utility of one such intervention for use by nursing faculty with nursing students prior to their students' entry into the profession. The educational program was critiqued by an advisory board and deemed to be relevant, clear, simple, and non-ambiguous indicating the program to have adequate content validity. The program then was pilot tested on five university campuses. Faculty members who implemented the educational program discussed (1) the program having value to faculty members and students, (2) challenges to continued program adoption, and (3) recommendations for program delivery. The proposed multicomponent, multiyear bullying educational program has the potential to positively influence nursing education and ultimately nursing practice. Findings from the pilot implementation of the program indicate the need to incorporate the program into additional nursing courses beginning during the sophomore year of the nursing curricula.

Nurse Bullying: Impact on Nurses’ Health

Workplace bullying has been experienced by 27% to 80% of nurses who have participated in studies. Bullying behaviors negatively impact the health of nurses. This study examined whether nurses’ resilience had an impact on the effects of bullying on the nurse’s health. This cross-sectional descriptive study surveyed licensed registered nurses in one state. The sample ( N = 345) was predominately female (89%) and Caucasian (84%), with an average age of 46.6 years. In this sample, 40% of nurses were bullied. Higher incidence of bullying was associated with lower physical health scores ( p = .002) and lower mental health scores ( p = .036). Nurses who are bullied at work experience lower physical and mental health, which can decrease the nurses’ quality of life and impede their ability to deliver safe, effective patient care.