Abstract
Bullying has become a continual problem in healthcare that affects work productivity and leads to high nurse turnover. Bullying does not have devastating consequences on medical care alone as it transcends gender, experience level, and professions. To investigate the factors that lead to bullying reduction in healthcare, evidence-based research was done. The literature search was done from databases such as PubMed and Medline databases. Several search terms such as “bullying” + “interventions” + “healthcare” or “teaching” were used. Based on the review of literature, several recommendations emerge. Increasing awareness, educating people on bullying practice as well as teaching people how to respond to bullying is critical to avert the challenge. Furthermore, encouraging parental education is important to avoiding bullying practices. Bullying is a pervasive problem that should not be allowed to pervade organizations.
Introduction
Incivility, cyberbullying, and bullying have become widespread problems in nursing. Nurse bullying is a systemic challenge that begins before the commencement of nursing school and lasts throughout the career of a care practitioner. The majority of nurses and other people leave their first jobs due to the adverse behaviors of their colleagues. Additionally, bullying cultures in hospitals and other institutions lead to poor working environments and increased turnover, costing hospitals huge amounts of money. Addressing cyberbullying and bullying in nursing can help to alleviate all the problems that nurses face due to bullying to increase their confidence and safety of nurses (Edmonson & Zelonka, 2019). Industry stakeholders and nurses should collaborate to change the bullying culture that has pervaded healthcare systems for decades and comprehend that bullying should have no place in healthcare.
PICOT (Population, Intervention, Comparison, Outcome, Time) Question
In the high-stressed and high-acuity environment of a nurse, the incidence of bullying has a lasting negative impact on the nursing staff. Through the understanding of bullying among other people, nurses can develop critical skills to use in their work environments. Situations can easily become volatile and unbearable as tempers rise; however, nurses can develop skills needed to have critical discussions with their coworkers and avoid additional harmful and disruptive behaviors in patients. To reduce bullying behaviors and incivility, the subsequent PICOT question was established.
In the high-stressed and high-acuity healthcare environment, does education, awareness, social and communication skills, and empathy training influence bullying?
Evidence-Based Research
According to Moreno and Vaillancourt (2017), education plays a big role in addressing bullying in clinical settings. Healthcare providers (HCPs) are important to bullying intervention because they provide and support educational practices on the best strategies to reduce and avoid bullying. Many HCPs have huge chances to collaborate with families and schools to help the general public and youth to grow optimistic social relationships and also provide education and support to teachers, who can help in further educating the youth in bullying interventions (Moreno & Vaillancourt, 2017). Furthermore, according to Howard and Embree (2020), bullying can be reduced by educational interventions that increase awareness of incivility and improve the capability to reduce bullying frequency (Howard & Embree, 2020). HCPs should participate in creating and disseminating education resources to address cyberbullying and facilitate widespread knowledge.
Ferrara et al. (2018) acknowledge that the major practical step in tackling cyberbullying is increasing awareness among adults and children. Most parents are not aware of the ramifications of their children using the internet and mobile phones. Therefore, by understanding the dangers of online communications, adults can be more aware of the potential of victimization and the remedies that they can seek. Ultimately, providing information to youth, school personnel, and parents on the definition of cyberbullying and how to avoid being victimized in online platforms is the key to averting cyberbullying (Ferrara et al., 2018). Hutson et al. (2017) also highlight the importance of parental education on cyberbullying mitigation (Hutson et al., 2017). Parents play a big role in tackling cyberbullying since they interact with their children more.
According to Edmonson and Zelonka (2019), nurses experience bullying at their workplace, which shows how widespread bullying is. Several strategies help reduce nurse bullying, such as fostering a respectful working environment and committing to a zero-tolerance policy for bullies. Additionally, training leaders in clear collaboration and communication skills help address nurse bullying (Edmonson & Zelonka, 2019). Healthcare administration can take a systems approach to mitigate bullying behaviors by addressing such behaviors as soon as they happen (Rutherford et al., 2019). All these strategies can be used to reduce bullying in other workplaces; however, they do not apply to healthcare alone.
Empathy training can effectively help to address bullying when noticed. Teaching the public to view bullying incidences from the perspectives of the persons involved is a good way to reduce such events. Empathy enables people to relate to the situations that other people are experiencing (Silva et al., 2018). Therefore, when people relate to victims of bullying, they can understand the situation and intervene. For example, if an emphatic person witnesses a bullying incident on the street, they are likely to intervene and deescalate the situation (Jenkins & Nickerson, 2019). On the contrary, a non-emphatic person may opt to view the bullying incident and fail to resolve the situation.
Myers and Cowie (2019) examine the relational rehabilitation model for reducing bullying. The model involves various steps, such as ensuring the authority of the teacher. Teachers can create an authoritative learning style that emphasizes tolerance, acceptance, and warmth, countering a bully’s destructive power. Additionally, creating a supportive classroom and providing emotional and social learning to students can help reduce bullying (Myers & Cowie, 2019). Similar to the research conducted by Moreno and Vaillancourt (2017), teaching students social skills to communicate with their peers promotes warm and supportive interactions.
Guarini et al. (2019) examined a teacher-based program to improve coping strategies for cyberbullying. According to the study, social and communication skills play a bigger role in cyberbullying reduction (Guarini et al., 2019). Since bullying arises from face-to-face interactions most of the time, the improvement of social and communication skills could lead to better relationships among nurses or students (Wunnenberg, 2020). As a result, bullying and incivility reduce in the long term.
Search Methods and Barriers
A comprehensive literature search was done by targeting interventions of cyberbullying in the teaching and healthcare setting. The literature search was conducted from databases such as PubMed (U.S. National Library of Medicine, n.d. b) and Medline (U.S. National Library of Medicine, n.d. a). Several search terms such as “bullying” + “interventions” + “healthcare” or “teaching” were used. The main barrier to searching for evidence was finding recent research articles. The topic is widely researched, but articles within the last five years are few.
Evidence-Based Practice (EBP) Model and Nursing Theorists
The Johns Hopkins Nursing Evidence-Based Practice Model can be used to translate research into practice. The model was chosen because it simplifies the EBP method as well as cultivates an evidence-based care culture. Additionally, the model is clinician-focused and allows appropriate and rapid application of best research practices (Dang & Dearholt, 2018). Nursing theorists that can help to translate the research into practice are Nancy Roper, Winifred Logan, and Alisson Tierney. The theorists were chosen because they promote a holistic approach to healthcare and their research helps maintain a safe environment for patients.
Recommendations
Various recommendations which can be implemented in a work setting are proposed in the following points.
- Increasing the awareness and knowledge of bullying behaviors in healthcare by widespread advocacy.
- Educating patients and hospital staff on what bullying is and other details related to awareness.
- Teaching people and healthcare staff to view bullying from the perspectives of the people involved.
- Teaching people and healthcare staff appropriate and effective skills for communication in social settings.
- Encouraging parental education on critical cyberbullying concepts.
- Teaching people and nurses how to respond to bullying.
Conclusion
In conclusion, industry stakeholders and healthcare staff should work together to eradicate bullying behaviors in healthcare and must understand bullying has no place in healthcare systems. Healthcare stakeholders can address bullying by nurturing a respectful working environment and not tolerating bullies in the workplace. Major initiatives to reduce incivility and bullying in healthcare include increasing awareness, fostering bullying education, empathy training, and parent education. Bullying is a pervasive problem that should not be allowed to pervade organizations.
References
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