Seeing Students Squirm: Nursing Students' Experiences of Bullying Behaviors During Clinical Rotations

Prevalence, associated factors, and nursing practice-related outcomes of workplace violence towards nursing students in clinical practice: A systematic review and meta-analysis

OBJECTIVES

To estimate the prevalence of Workplace violence (WPV) among nursing students in clinical practice, and examine the associated factors and nursing practice-related outcomes.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS AND DATA SOURCES

A comprehensive literature search was performed in nine databases from inception to Mar 2023. Two researchers independently screened studies, extracted data and assessed the quality of included studies. The random-effects model was used to estimate the pooled prevalence of WPV. Separate analyses were conducted by WPV type and source.

RESULTS

57 studies involving 23,451 nursing students were identified. The overall prevalence of WPV experienced and witnessed by nursing students was 45.37 % and 53.76 %, respectively, and 13.73 % were unsure if they had WPV. Psychological violence was the most prevalent form of WPV, but the prevalence of WPV also varied by setting and source, with obstetrics and gynaecology (41.25 %) being the most common settings and patients and their relatives (50.80 %) being the most common sources. When exposed to WPV, 65 % of nursing students did nothing except keep quiet, and 74 % did not report it. Concerning the associated factors of WPV, there were few reports on patient-related factors, and the selected studies focused primarily on nursing student- and occupational-related factors. Regarding nursing practice-related outcomes, WPV had a predominantly negative impact on nursing students' professional practice, but it also had a certain motivating effect.

CONCLUSIONS

This meta-analysis estimates the global prevalence, associated factors, and nursing practice-related outcomes of WPV among nursing students. The findings confirm the high prevalence of WPV; therefore, schools and institutions should prioritize WPV education and training. The hospital should then formulate WPV laws and regulations, enhance the WPV reporting procedure, and protect the rights and interests of nursing students. Finally, hospital administrators should employ individualized intervention strategies for nursing students based on the variables that affect them.

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.

Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study

OBJECTIVE

To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme.

DESIGN

A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated.

SETTING AND PARTICIPANTS

To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study.

FINDINGS

Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

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

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

Evaluation and improvement of workplace vertical violence of nursing interns based on the Importance-Performance Analysis method

Purpose

To analyze the key factors related to workplace vertical violence among nursing interns in China and to propose strategies to improve the nursing practice environment.

Methods

A cross-sectional study was conducted using the Importance-Performance Analysis (IPA) method to analyze the key factors and significance of workplace vertical violence for nursing interns. The data were obtained by administering a workplace vertical violence survey, designed specifically for this study, to 120 nursing interns at a tertiary general hospital in Zhejiang Province, China.

Results

The results demonstrated that the variables "I was ordered to do something beyond my ability and lacked guidance (C3)," "Errors in work have been repeatedly emphasized, spread, or exaggerated (C8)," "I was unjustly criticized (C9)," "I was withheld or blocked information purposefully (C1)," and "I was belittled at work (C2)" were the most crucial variables for determining the presence of workplace vertical violence of nursing interns. Moreover, they are priority improvement variables.

Conclusion

Managers must prioritize the use of relevant resources during internships to minimize false reinforcement and unfair criticism. Efforts should focus on improving information sharing, emphasizing the role of nursing interns in clinical work, providing better guidance when arranging for nursing interns to do work that exceeds their capacity, reducing workplace vertical violence, and improving nursing intern practice environments.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review

AIMS

To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS.

BACKGROUND

WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser.

METHODS

A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings.

RESULTS

A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: 'Types of workplace violence', 'Perpetrators', 'Causes', 'Consequences' and 'Management of workplace violence'.

CONCLUSIONS

This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement.

RELATIVE TO CLINICAL PRACTICE

This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.

A Pilot Study to Examine the Effects of a Workplace Cyberbullying Cognitive Rehearsal Mobile Learning Program for Head Nurses: A Quasi-Experimental Study

This study aimed to (1) develop a version of the cognitive rehearsal program that is suitable for cyberbullying and (2) apply the m-learning method to evaluate its effectiveness among head nurses. This study was conducted in July 2021 and comprised 69 South Korean university hospital head nurses. It was evaluated using a nonequivalent control group pretest-posttest and a quasi-experimental design. The program was developed using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) step process, consisting of 10 scenarios. Variables with proven reliability were used in the program effect measurement. The differences between the experimental and control groups were examined using an independent t-test (perception) or the Mann-Whitney U test (symptom experience, knowledge, and turnover intention). The program positively affected and improved head nurses' knowledge and perception of workplace cyberbullying; however, it elevated their symptom experience and had no immediate impact on turnover intention. The developed program could be applied as a valuable educational strategy in the nursing field. Head nurses act as intermediaries between individuals and the organization. Therefore, they must respond with in-depth knowledge and perceptions of cyberbullying to fulfill their responsibilities of identifying, mediating, and managing cyberbullying among hospital team members.

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

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.

Psychological workplace violence and its influence on professional commitment among nursing interns in China: A multicenter cross-sectional study

Background

Psychological workplace violence (WPV) is the primary form of workplace violence suffered by nursing interns. Psychological WPV not only damages the physical and mental health of nursing interns, but also has a negative impact on their work quality and career choice.

Aim

To investigate the characteristics and types of psychological WPV suffered by nursing interns in China, analyze the influencing factors of psychological WPV among nursing interns, and explore the influence of psychological WPV on the professional commitment of nursing interns.

Methods

The subjects were 1,095 nursing interns from 14 medical colleges in Shandong Province. The data were collected electronically using the psychological WPV against nursing interns questionnaire and the professional commitment scale of nursing. The frequency and component ratio were used to describe the incidence and characteristics of psychological WPV. Binary logistic regression was used to analyze the influencing factors of psychological WPV, and linear regression investigated the influence of psychological WPV on the professional commitment of nursing interns.

Results

In the study, 45.0% (n = 493) of nursing interns suffered at least one incidence of psychological WPV during clinical practice, mainly discrimination and verbal abuse. Patients and their relatives were the main perpetrators of psychological WPV. Discrimination and lack of trust were the two main reasons behind psychological WPV. Furthermore, 75.9% of psychological WPV incidents were not effectively reported. Logistic regression showed that clinical internship duration, place of family residence, and hospital level were the influencing factors of psychological WPV among nursing interns. Linear regression results showed that psychological WPV had a negative effect on nursing interns' professional commitment.

Conclusion

Psychological WPV against nursing interns is highly prevalent in China, negatively impacting their professional commitment. It is suggested that colleges should introduce courses for nursing interns to understand and cope with psychological WPV before entering clinical practice, and hospitals should establish a mechanism to prevent, cope with, report, and deal with psychological WPV to effectively reduce the incidence of psychological WPV against nursing interns, improve their ability to cope with psychological WPV, and enhance their professional commitment.

Iranian nursing students' experiences of workplace violence: a qualitative study

BACKGROUND

Workplace violence against nursing students is a common phenomenon. This study aimed to investigate Iranian nursing students' experiences of workplace violence, including their reaction to violence and the consequences and the effects of such violence on the students.

METHODS

The study participants were undergraduate nursing students. The data were collected using semi-structured, in-depth face-to-face interviews. Data analysis was carried out with qualitative approach using conventional content analysis.

RESULTS

Four categories were extracted from the analysis of the interview transcriptions: vertical violence, horizontal violence, reaction to violence and consequences of violence. Nurses were the major imposers of violence against students and psychological and verbal violations were the most of used forms of violence. The students reacted to violence in the forms of counteracting, reporting, disregarding and considering as commonplace.

CONCLUSIONS

Workplace violence is a common phenomenon experienced by nursing students in this study, which causes devastating individual, educational, and professional impacts. Action plans including providing safe environment and appropriate support from nurses and educators should be developed in clinical settings to intervene and to prevent workplace violence.

The impact of bullying on the mental health and academic achievement of nursing students

PURPOSE

This study aimed to determine the prevalence of bullying and identify the perpetrators of bullying among nursing students. Further, the impact of bullying on their mental health and academic achievement was also examined.

DESIGN AND METHODS

A cross-sectional correlational design was adopted. A total of 180 undergraduate nursing students completed an electronic questionnaire.

RESULTS

Approximately half of the participants had experienced at least one or more bullying behaviors on a daily or weekly basis during nursing education. Classmates were the most frequently reported perpetrators of bullying behaviors. Bullying experience was associated with poor psychological health and perceived stress. A lower grade point average emerged as a significant predictor of exposure to bullying behaviors.

PRACTICE IMPLICATIONS

There is a need to create policies that delineate the legal implications of bullying to protect students. Faculty members and clinical service providers should work together to reduce the prevalence and impact of negative acts against students.

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.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

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

PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Bullying in 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.

Self-reported violence by nursing students in the context of undergraduate studies

OBJECTIVES

to identify the characteristics of violence in the context of the teaching and learning of the undergraduate Nursing course, from the perspective of students.

METHODS

quantitative, cross-sectional study, developed with 208 undergraduate students in Nursing. The data was obtained through the application of a survey questionnaire and processed by descriptive and bivariate statistics.

RESULTS

of the participants, 69.2% (n = 144) have experienced some kind of violence. Violent acts of a psychological nature were the most frequent, but there were also reports of physical, sexual violence and deprivation or abandonment. Violence was practiced in a theoretical and practical learning environment. Teachers and classmates were the most frequent perpetrators. Most students had no reaction, told friends, family, and colleagues, or pretended that nothing happened in the face of the violent acts.

CONCLUSIONS

violence is present at various moments in the undergraduate Nursing course and can negatively impact the quality of training in the area.

Workplace Aggression: Exploring Experiences of Occupational Therapy Practitioners in Healthcare Settings

Workplace aggression (WPA) among healthcare workers is a pervasive and serious problem in the healthcare industry, yet there is a poor understanding of WPA in the profession of occupational therapy (OT). The authors employed a mixed method design using a Likert scale survey and focus groups from two different settings and locations to explore WPA experiences of OT practitioners working in healthcare settings. Participants for the focus groups totaled 14 and 109 surveys were returned. The findings revealed that 100% of the focus group participants and 67% of the survey respondents report exposure to specific types of WPA. Key underlying causes relate to the challenges occupational therapy practitioner's face in advocating their professional role and values in a predominant biomedical setting. These findings are important not only to increase awareness among practitioners, leaders, and educators but to further examine how occupational therapy's unique role in healthcare can be fully recognized.

Revisión de la literatura sobre la violencia y sus implicaciones en la formación en enfermería

Introducción: La violencia es un fenómeno social complejo, que se manifiesta en varios sectores de la sociedad contemporánea. Los actos violentos están presentes en los procesos de formación en diferentes áreas del conocimiento, como el pregrado en enfermería. Objetivo: Identificar la forma en que se presenta la violencia en el pregrado de enfermería y las posibles implicaciones para la formación de los estudiantes. Materiales y métodos: Se realizó una revisión integradora en la biblioteca virtual SciELO® , las bases de datos ERIC®, LILACS®, Web of Science®, MEDLINE®, CINAHL®, Scopus®  y Google Académico®, con la que se recuperaron 21 documentos para el período entre 2014 y 2018. Resultados: El análisis permitió organizar los resultados en cuatro categorías: caracterización de estudios y autores; comprensión y naturaleza de la violencia; espacios en los que ocurre la violencia y los principales perpetradores; y las consecuencias generadas por la violencia y las acciones para enfrentar el fenómeno. Discusión: Los actos violentos afectan las condiciones de vida de los involucrados, impactan negativamente el desarrollo de habilidades relacionadas con la interacción interpersonal y generan debilidades en la formación de futuros enfermeros. Conclusiones: La violencia es un fenómeno constante en el contexto del pregrado en enfermería, para lo que es necesario promover el fortalecimiento de una cultura de paz en este entorno. Como citar este artículo: Maffissoni, André Lucas; Sanes, Marina da Silva; Oliveira, Saionara Nunes; Martini, Jussara Gue; Lino, Monica Motta. Violência e suas implicações na formação em enfermagem: revisão da literatura. Revista Cuidarte. 2020; 11(2): e1064. http://dx.doi.org/10.15649/cuidarte.1064

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.

Exploring the Construct of Psychological Safety in Medical Education

PURPOSE

Psychological safety (PS) is recognized as key in health professions education. However, most studies exploring PS in medical education have focused on mistreatment, thus focusing on what PS is not. The authors set out to explicitly explore learners' concept of PS in the context of medical education to better understand and define PS and its educational consequences for medical students.

METHOD

This descriptive exploratory study was conducted in the context of a pilot peer-assisted learning (PAL) program. The program brought together residents and medical students for 16 semiformal learning sessions. Eight medical students from a PAL program were recruited for semistructured interviews to explore their experiences of PS. Transcripts were thematically analyzed using an inductive approach, and social ecological theory was integrated in the later stages of analysis.

RESULTS

Students described PS as not feeling judged. Having supportive relationships with peers and mentors improved PS. Students' sense of PS appeared to free them to focus on learning in the present moment without considering the consequences for their image in the eyes of others. Feeling safe also seemed to facilitate relationship building with the mentors.

CONCLUSIONS

A sense of PS appears to free learners from constantly being self-conscious about projecting an image of competence. This enables learners to be present in the moment and concentrate on engaging with the learning task at hand. The authors propose that the term "educational safety" be used to describe a relational construct that can capture the essence of what constitutes PS for learners.

"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.

Adverse health events associated with clinical placement: A systematic review

OBJECTIVE

Clinical placement is a fundamental aspect of student learning and skill development across healthcare disciplines. However, participation in clinical placements can also present significant risk to students. This systematic literature review sought to examine the range of risks and hazards encountered by students across healthcare disciplines during their clinical placements.

DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines were utilised in conducting this exploratory systematic review.

DATA SOURCES

The CINAHL Complete, Medline Complete, and PsycINFO databases were searched. Reference lists of eligible records obtained via database searching were screened, and a supplementary key author search was conducted. Research published between 2013 and 2018 and conducted in the context of comparative international healthcare systems was the focus of this study.

REVIEW METHODS

Study titles and abstracts were screened, and the full text of potentially relevant records was perused. Records meeting key eligibility criteria by addressing risk posed to students in healthcare disciplines within a clinical placement context were included in the final synthesis.

RESULTS

The search identified 46 eligible records. The literature highlighted the worrying trend that students, most notably in the nursing discipline, can be exposed to a wide range of risks and adverse health events during clinical placement.

CONCLUSIONS

As risks in unpredictable clinical environments cannot be eradicated, this review demonstrated a critical need for educative action to enable students to competently and confidently manage risks, and to reduce occurrence of adverse health events.

Workplace Bullying Among Nurses: Developing a Model for Intervention

Workplace bullying is endemic to the nursing profession and it threatens nurses' health and ability to work safely. However, effective interventions to prevent workplace bullying are lacking. A sample of hospital nurses (n = 15) explored experiences of bullying and ideas for intervention via four focus groups in 2016. Four main themes emerged from the qualitative content analysis: (a) characteristics that define bullying behavior; (b) facilitators of bullying; (c) consequences of bullying; and (d) possible interventions. Although personal characteristics played a role, bullying was primarily facilitated by workplace and organizational factors that hindered the establishment of collegiality and team trust among nurses. Findings have informed a conceptual model for prevention of nurse-to-nurse bullying with ethical leadership and communication, trust, and social cohesion in work teams as key elements.

Nursing students' experiences with faculty incivility in the clinical education context: a qualitative systematic review and meta-synthesis

OBJECTIVE

The aim of this study is to synthesise evidence for the experiences and perceptions of incivility during clinical education of nursing students.

DESIGN

We used a meta-aggregation approach to conduct a systematic review of qualitative studies.

DATA SOURCES

Published and unpublished papers from 1990 until 13 January 2018 were searched using electronic databases, including CINAHL, PubMed (MEDLINE), ProQuest Central, ProQuest Education Journals, ProQuest XML-Dissertations and Theses, Web of Science, Embase, EBSCO Discovery Service and PsycINFO. The search for unpublished studies included the Open Grey collection, conference proceedings and the Deep Blue Library.

ELIGIBILITY CRITERIA

We included qualitative studies that focused on nursing students' perceptions and experiences of incivility from faculty during their clinical education.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently appraised the methodological quality and extracted relevant data from each included study. Meta-aggregation was used to synthesise the data.

RESULTS

A total of 3397 studies was returned from the search strategies. Eighteen studies fulfilled the inclusion criteria and were included in the meta-synthesis. Six synthesised findings were identified, covering features of incivility, manifestations of incivility, contributing factors, impacts on students, coping strategies and suggestions.

CONCLUSIONS

The results showed experiences of incivility during clinical education. However, the confidence was low for all synthesised findings. We suggest that nursing students should try to cope positively with incivility. Nurse managers and clinical preceptors should be aware of the prevalence and impact of incivility and implement policies and strategies to reduce incivility towards nursing students. Hospitals and universities should have an immediate response person or system to help nursing students confronting incivility and create an open communication environment.

“Mutual Respect Would be a Good Starting Point:” Students’ Perspectives on Incivility in Nursing Education

Background

Studies indicate that incivility is common in nursing education and perpetuated by both students and faculty. Academic incivility negatively affects the well-being of those involved, interferes with the teaching–learning process, and is antithetical to nursing as a caring profession. An understanding of academic incivility is essential to establish best practices to address this problem.

Purpose

The purpose of this study was to examine incivility in nursing academia from the perspective of baccalaureate nursing students.

Methods

The study was conducted using a cross-sectional design, with a mixed method questionnaire administered to 380 students. The quantitative data were analyzed descriptively and qualitative data through content analysis.

Results

The majority of students thought incivility is a mild to moderate problem in nursing education. They thought that students contribute to incivility by not taking responsibility (being unprepared and being disinterested) for their education and by not being professional (being disrespectful and being uncaring) and faculty contribute by not being good teachers (being authoritarian, treating students unfairly, having ineffective teaching methods) and not being professional (being disrespectful, lacking compassion).

Conclusion

Until evidence is available for effective measures to address incivility, nursing schools should consider adopting strategies for solutions as suggested by the students in this study.

Incivility in nursing education: An intervention

Incivility in nursing education is an unfortunate phenomenon affecting nursing students in all aspects of their educational experience. Students and their instructors are often ill equipped to deal with academic incivility and their lack of ability to handle such behaviors has proven detrimental to the future of the nursing profession. Nursing instructors need tools to help educate nursing students on how to recognize uncivil behaviors within themselves as well as others and ways to combat it. This research project addressed these aspects of academic incivility and implemented an e-learning module that was developed to educate students on incivility. The data was collected through a pre-test, post-test model with resulting statistical analysis using the McNemar's test. Results showed the nursing students obtained increased self-efficacy in regards to their ability to define, detect, and combat academic incivility after viewing the e-learning module. In conclusion, the successful implementation of the e-learning module provides further incentive for schools of nursing to consider implementing incivility education in their curriculums.

Nursing Instructor Incivility Toward Students

: This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. In this article, the author discusses instructor incivility toward students, the possible reasons for this behavior, the outcomes of instructor incivility, and suggestions for remediation.

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.].

Nursing curriculum and bullying: An integrative literature review

OBJECTIVES

The purpose of this integrative review was to identify and synthesize key concepts that inform curriculum which increase nursing students' competence, skills and strategies when addressing bullying. Specifically, the authors sought to examine the concepts informing educational interventions, skills, and strategies, which addressed the bullying of nursing students.

DESIGN

Integrative literature review.

DATA SOURCES

A search of the electronic databases CINAHL, MEDLINE, ERIC, PsycINFO, Proquest, and PubMed was conducted in January 2016 using search terms such as 'bully' 'nursing student' 'education' and 'curriculum'.

REVIEW METHODS

Articles were screened for relevance and eligibility and extracted onto a table. Critical appraisal was conducted using multiple tools. Papers were analysed using constant comparison and concept mapping.

RESULTS

61 articles were included in the synthesis. Concepts identified included: empowerment, socialization, support, self-awareness, awareness about bullying, collaboration, communication, and self-efficacy. All concepts linked to empowerment. Social Cognitive Theory was used by many studies. Active teaching methods which gave students opportunities to practice skills were the most effective.

CONCLUSIONS

Empowered nursing students have the potential to address bullying more effectively and competently. Empowerment of nursing students is a powerful concept that educators must consider when developing curriculum and educational interventions to address bullying.

"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.