It's 'probably the teacher!' A strategic framework for clinical staff engagement in clinical student bullying intervention

Supporting Bystanders and Other Staff Exposed to Negative Workplace Behaviour: Developing and Testing the IMO Intervention Framework in the Clinical Workplace

BACKGROUND

Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or "stand up" to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke) are rarely acknowledged, and neither is the potential for considerable cognitive dissonance should they choose not to.

METHODS

Drawing on a substantial literature review, we developed an interventional program, initially with medical student bullying in mind, that generally employed a discourse for values cultivation. We implemented and evaluated this program through 6 cycles of action research methodology in 6 different departments of one tertiary teaching hospital. Data include individual interviews, discussions with key participants plus freehand comments from wider staff's workshop evaluations.

RESULTS

Alongside others, an early serendipitous finding was the "IMO" [Indirect, focus on Me, focus on Outcome] framework, intended for bystanders to student bullying. From using this framework, participants reported developing confidence in tackling negative behaviours, that interactions had better outcomes and that the workplace atmosphere felt more relaxed. It's use also significantly reduced cognitive dissonance. Encouragingly, participants went on to use IMO for staff-staff bullying incidents, and other common negative behaviours. We attribute IMO's utility to its memorability, simplicity and for catering to the many possible causes of bullying, including values issues, without perpetuating or creating conflict.

CONCLUSION

The IMO framework is offered as a widely usable framework for all staff in a clinical environment - a useful addition to popular frameworks used in the clinical workplace, ideas from which might also help these be further refined. Further evaluation would establish whether IMO invites long-term change and its utility in other contexts.

A Systematic Review of Negative Work Behavior: Toward an Integrated Definition

The objective of this systematic review was to identify the overlapping and unique aspects of the operationalizations of negative work behaviors (NWBs) to specify a new integrative definition of NWB. More specifically, we examined (1) how many operationalizations and conceptualizations of NWB can be identified, (2) whether these operationalizations can be categorized into facets, i. e., the nature of NWB, harm, actor types, and roles, with subcategories, (3) what the meaningful overlap in these operationalizations was, (4) whether the operationalizations tapped unique and meaningful elements, i.e., positive labels and dynamic processes, and (5) how the overlapping and unique elements of the operationalizations could be integrated into a new theory-based research model for NWB for future research. In the literature search based on the Prisma framework, Pubmed, PsycINFO, and Google Scholar, we identified k = 489 studies that met the inclusion criteria of our review. The results of these studies revealed 16 frequently studied NWB labels, e.g., bullying and aggression. Many of these could be categorized in the same way, namely, in terms of the type of behavior, type of harm, and type of actor involved in the NWB. In our new definition of NWB, we integrated the content of the overlapping and meaningful unique elements of the 16 labels.

Measuring exposure to bullying and harassment in health professional students in a clinical workplace environment: Evaluating the psychometric properties of the clinical workplace learning NAQ-R scale

Background: Instruments that measure exposure to bullying and harassment of students learning in a clinical workplace environment (CWE) that contain validity evidence are scarce. The aim of this study was to develop such a measure and provide some validity evidence for its use.Method: We took an instrument for detecting bullying of employees in the workplace, called the Negative Acts Questionnaire - Revised (NAQ-R). Items on the NAQ-R were adapted to align with our context of health professional students learning in a CWE and added two new factors of sexual and ethnic harassment. This new instrument, named the Clinical Workplace Learning NAQ-R, was distributed to 540 medical and nursing undergraduate students and we undertook a Confirmatory Factor Analysis (CFA) to investigate its construct validity and factorial structure.Results: The results provided support for the construct validity and factorial structure of the new scale comprising five factors: workplace learning-related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying (PIB), sexual harassment (SH), and ethnic harassment (EH). The reliability estimates for all factors ranged from 0.79 to 0.94.Conclusion: This study provides a tool to measure the exposure to bullying and harassment in health professional students learning in a CWE.