精神科护士工作场所受欺负状况调查

目的调查精神科护士工作场所受欺负的现状。方法使用中文版负性行为问卷对重庆市精神卫生中心的护士共150人进行调查。结果被调查者有13.4%在工作场受欺负,严重受欺负人群占3.2%。不同学历、职称、年龄、婚姻状况、工龄的护士NAQ-R评分比较差异有统计学意义(P0.05)。结论工作场所受欺负存在于精神科护士中,且受年龄、职称、学历等因素影响,应引起护理管理者的重视。     

Childhood bullying: implications for physicians

Childhood bullying has potentially serious implications for bullies and their targets. Bullying involves a pattern of repeated aggression, a deliberate intent to harm or disturb a victim despite the victim's apparent distress, and a real or perceived imbalance of power. Bullying can lead to serious academic, social, emotional, and legal problems. Studies of successful antibullying programs suggest that a comprehensive approach in schools can change student behaviors and attitudes, and increase adults' willingness to intervene. Efforts to prevent bullying must address individual, familial, and community risk factors, as well as promote an understanding of the severity of the problem. Parents, teachers, and health care professionals must become more adept at identifying possible victims and bullies. Physicians have important roles in identifying at-risk patients, screening for psychiatric comorbidities, counseling families about the problem, and advocating for bullying prevention in their communities.     

Management of bullying and bullying in management

Bullying can be defined as ‘the improper and frequent use of power to affect someone's life adversely’ (Patchett 1992) or simply coercion by fear (Adams, 1992a, Adams, 1992b).Bullying is thought to be a significant problem within the National Health Service (NHS) but this is based on anecdotal literature by Adams, 1992a, Adams, 1992b, Turnbull (1995) and Kline (1994). There is no clear evidence as to its exact prevalence. This is not least due to the nature of the problem that inhibits reports of the incidence of bullying.Bullying may manifest itself as a problem within a department as well as a misinformed management style.Recommendations are made to call for more awareness of the issue by research and the formation of written policies. Research based information may provide the impetus needed to introduce measures against bullying.     

Bullying and employee turnover among healthcare workers: a three-wave prospective study

hogh a., hoel h. & carneiro i.g. (2011) Journal of Nursing Management 19, 742–751
Bullying and employee turnover among healthcare workers: a three-wave prospective study Aim To investigate the risk of turnover among targets of bullying at work. Background Exposure to bullying seems to leave targets with intentions to leave their workplaces. However, it is uncertain to what extent they actually leave. Method Data were collected by questionnaires in a three-wave study among Danish healthcare workers at the time of graduation (T₁), 1 (T₂) and 2 years (T₃) later. We followed 2154 respondents who participated in all three waves. Results The first year after graduation, 9.2% reported being bullied at work, 1.8% frequently. Follow-up analyses showed a strong relationship between exposure to bullying at T₂ and turnover at T₃ [odds ratio (OR) for frequently bullied = 3.1]. The inclusion of push factors such as low social support and low sense of community, intention to leave and ill health did not change the relation between bullying and turnover significantly. Three reasons for quitting stood out among reasons given by the bullied respondents: poor leadership, being exposed to negative behaviour and health problems. Conclusion Bullying may be costly to an organization in terms of staff turnover and subsequent recruitment and training of replacements. Impact for Nursing Management Managers should regularly monitor the psychosocial work environment. To prevent bullying local policies and procedures should be developed, implemented and evaluated.     

Bullying and the nursing profession in Australia: An integrative review of the literature

BackgroundBullying in nursing remains unacceptable with reports of bullying and harassment increasing.AimThis article discusses the current state of knowledge about bullying in the nursing profession in Australia.MethodsThe review was informed by the approach described by Whittemore and Knafl. A literature search was conducted using thefollowing search terms: ‘nurse OR nursing OR nurses’ AND ‘bullying OR bully OR violence OR harassment’ AND ‘Australia’.FindingsThe findings highlight the many ways in which the experience of bullying in the nursing profession can be manifested and the implications for the profession as a whole.DiscussionThe culture, prevalence and impact of bullying described in this paper raises concerns for practitioners, educators and policy makers.ConclusionIn order to develop effective strategies for both nurses and organisations to address the problem of bullying in nursing in Australia, the contributing factors that allow the problem to persist must first be examined.     

Bullying among nurses and its relationship with burnout and organizational climate

Workplace bullying is one of the most common work‐related psychological problems. Bullying costs seem higher for organizations composed of health‐care workers who perform direct‐contact patients‐complex tasks. Only a few studies have been carried out among nurses in Italy and integrated models of bullying antecedents and consequences are particularly missing. The aim of this study was to develop a bullying model focused on the interaction between bullying and burnout in the setting of a climate–health relationship. Research involved 658 nurses who completed a survey on health, burnout, bullying and organizational climate. Structural equation modeling was used to test the hypothesis. Results suggest that workplace bullying partially mediates the relationship between organizational climate and burnout and that bullying does not affect health directly, but only indirectly, via the mediation of burnout. Our study demonstrates the key‐role of workplace bullying and burnout in the climate–health relationship in order to understand and to improve nurses’ health.     

Workplace aggression,psychological distress,and job satisfaction among Palestinian nurses: A cross-sectional study

BackgroundNurses can be exposed to aggressive behavior from patients, patient's relatives, colleagues and visitors.PurposeTo determine the prevalence of workplace aggression among Palestinian nurses in the Hebron district and to examine cross-sectional associations between exposure to workplace aggression and the occurrence of psychological distress and job satisfaction.MethodsOf 372 nurses eligible for the study, 343 were included (response rate of 92.2%). The sample comprised 62% females and 38% males. The participants responded to questions about their socio-demographic status, workplace aggression (WHO questionnaires), psychological distress (General Health Questionnaire, GHQ-30), and job satisfaction (Generic Job Satisfaction Scale).ResultsNinety-three (27.1%) of the respondents reported exposure to workplace aggression of any kind. Seventeen (5%) reported exposure to physical aggression, 83 (24.2%) reported exposure to verbal aggression, and 25 (7.3%) reported exposure to bullying. The patients and the patients' relatives were the main sources of physical and verbal aggression, whereas colleagues were the main source of bullying. Males reported a higher prevalence of bullying than females. Younger nurses reported a higher prevalence of exposure to physical aggression, verbal aggression and bullying. Verbal aggression was associated with more psychological distress. Bullying was associated with lower job satisfaction.ConclusionsMore than a quarter of the nurses reported that they had been subject to some sort of aggression at the workplace. Verbal aggression was associated with higher psychological distress. Workplace bullying was associated with lower job satisfaction. Increased awareness and preventive measures to address this problem among health care workers are warranted.     

Psychological consequences of bullying for hospital and aged care nurses

RODWELL J. & DEMIR D. (2012) Psychological consequences of bullying for hospital and aged care nurses. International Nursing Review Aim: This study examines the psychological consequences of workplace bullying by negative affectivity (NA) and demographics for hospital and aged care nurses. Introduction/Background: Nurses are particularly vulnerable to workplace bullying, with suggestions that oppressed group behaviours may play a role. Bullying is a potent stressor that can negatively impact psychological well‐being, which, with NA and demographics, may be important in understanding the consequences of nurse bullying. Such factors are yet to be examined together across different nursing contexts. Methods: A cross‐sectional survey was conducted across hospital and aged care nurses working within a medium to large Australian healthcare organization in October 2009. The sample comprised 233 (29.1%) hospital and 208 (43.8%) aged care nurses. Analyses of covariance were used to evaluate the data. Results: For hospital nurses, psychological distress was noted as an impact of bullying, while depression was the impact for aged care nurses. Full‐time aged care nurses reporting bullying had higher psychological distress scores, compared with part‐time workers in the same area. NA was a significant covariate across both outcomes in both contexts. Discussion/Conclusion: This study demonstrates that bullying has detrimental consequences for the mental health of nurses in both hospital and aged care contexts. The results support the suggestion that nurses are an oppressed group at high risk of bullying, confirm the intrinsic nature of NA to the bullying process, and highlight the importance of employment type for aged care nurses. Given the shortage of nurses, managers need to give higher priority to addressing workplace bullying and implementing zero tolerance policies.     

The Role of Workplace Bullying in Low Back Pain: A Study With Civil Servants From a Middle-Income Country

This is a cross-sectional study that analysed the association between workplace bullying and LBP. The participants were 894 judicial civil servants from Porto Alegre, southern Brazil. Workplace Bullying was measured by the Negative Acts Questionnaire (NAQ-r) and Low Back Pain by the Nordic Questionnaire for Musculoskeletal Symptoms (NQMS). Logistic Regression was used to analyse data and test hypotheses. The prevalence of LBP in the last 7 days was 50.1%, while the overall prevalence of Chronic LBP was 19.3%. Some psychosocial factors at work were strongly associated with both outcomes. Workplace bullying was strongly associated with LBP, even after adjustment for several covariates. The odds of LBP in the last 7 days among bullied workers was 1.89 (95% CI: 1.31-2.71) times higher, compared to non-bullied. Workplace bullying was also associated with chronic LBP after adjustment for sociodemographic, behavioural and some occupational factors (OR = 1.60; 95% CI: 1.05-2.44). Psychosocial factors at work, and particularly workplace bullying, were strong risk factors for LBP, in contrast to most individual factors, and dose-response patterns were showed. Positive associations between bullying and LBP raise hypotheses on causation, and the role of psychosocial factors at work are discussed. Further longitudinal studies should address these hypotheses, investigating causal paths, mechanisms and possible mediation.PerspectivesAs a psychosocial risk, workplace bullying may play a role in low back pain and can be focus of interventions to prevent LBP. Dose-response patterns on the association between workplace bullying and low back pain are discussed and hypotheses are raised. The paper addresses different ways of measuring and categorising bullying at work, in order to study the relationship between bullying and pain.     

Assessing the Prevalence and Predictors of Bullying Among Emergency Medical Service Providers

Background: Bullying as a stressor in the workplace has been evaluated in numerous settings. It has never been evaluated in the emergency medical service (EMS) environment where bullying can occur from many different sources. The Negative Acts Questionnaire-Revised (NAQ-R) is a 22-question validated tool for evaluating bullying. Our hypothesis was that we could identify a shortened version of the NAQ-R that identifies bullying as accurately as the full screening tool. Methods: This was a cross sectional study of EMS providers in our local EMS transport agency. The local EMS agency transports approximately 50,000 patients per year and is a paramedic level response system. Results on the NAQ-R were on a 5-point Likert scale for each of 22 different categories of bullying that were summed by adding each questions 1–5 response for the 22 questions. Respondents were also categorized as victims or non-victims of bullying based on being positive for any of the 22 types of bullying at least once a week. We performed a binomial decision tree analysis and a cross-validation. Results: Data were collected from 153 providers. Mean age was 33?±?10 years and 50% were male. Total years in EMS were 8?±?8 years. NAQ-R summed results in our group ranged between 22 and 88, with an average of 40?±?15. A NAQ-R score of 33 or less was 91% accurate in identifying non-victims and a score of 45 or more was 94% accurate in identifying victims. The majority at 51% (77/152) of respondents were victims of one or more types of bullying. A combination of five questions was 94% accurate in identifying a victim of bullying among EMS providers. Cross validation resulted in a misclassification risk estimate of 0.12?±?.03. Conclusion: NAQ-R bullying scores in EMS are similar or higher than numbers in other fields. Five questions on the NAQ-R were 94% accurate in identifying victims of bullying in EMS providers.     

Bullying,Mentoring, and Patient Care

The literature suggests that acts of bullying are a root cause of new nurses leaving their units or the profession entirely and have the potential to worsen the nursing shortage. As an effective way to address bullying in the perioperative setting, mentoring benefits the nursing profession. Mentoring can have a direct influence on nurses’ longevity in a health care organization, thereby strengthening the nursing workforce. Magnet-designated hospitals support the importance of mentor-mentee relationships for positive employee retention and positive recruitment outcomes. One of the most important tasks that a mentor should undertake is that of a role model. Establishing a culture of mentoring requires authentic leadership, genuine caring and respect for employees, and open communication. The entire nursing profession benefits from a culture of mentoring, as do the patients and families who receive care.     

Factors associated with 'stress of conscience' in healthcare

Aim: The main purpose of this study was to examine factors related to ‘stress of conscience’ i.e. stress related to a troubled conscience in healthcare. Methods: A series of questionnaires was completed by 423 healthcare employees in northern Sweden as part of this cross‐sectional study. The series of questionnaires comprised the ‘Stress of Conscience Questionnaire’, ‘Perception of Conscience Questionnaire’, ‘Revised Moral Sensitivity Questionnaire’, Social Interactions Scale, Resilience Scale and a Personal/Work Demographic form. Results: Nonautomatic stepwise regression analysis with forward inclusion resulted in a model that explained approximately 39.6% of the total variation in stress of conscience. Individual items associated with stress of conscience were; perceiving that conscience warns us against hurting others while at the same time not being able to follow one’s conscience at work and having to deaden one’s conscience to keep working in healthcare. In addition moral sensitivity items belonging to the factor ‘sense of moral burden’ were; one’s ability to sense patient’s needs means that one is doing more than one has strength for, having difficulty to deal with feelings aroused when a patient is suffering and one’s ability to sense patient’s needs means feeling inadequate all added significantly to the model. In addition, deficient social support from superiors, low levels of resilience and working in internal medicine wards were all associated with stress of conscience. Conclusion: Healthcare employees seem to experience stress of conscience in their everyday practise. Particular contributing factors are not being able to follow one’s conscience at work, and the ‘negative’ dimension of moral sensitivity – moral burden – which is an inability to deal with moral problems. Thus, in order for conscience and moral sensitivity to become an asset instead of a burden, healthcare employees need to be able to express their moral concerns.     

One-year prospective study on the effect of workplace bullying on long-term sickness absence

ortega a ., christensen k.b. , hogh a. , rugulies r. & borg v. (2011) Journal of Nursing Management 19, 752–759
One-year prospective study on the effect of workplace bullying on long-term sickness absence Aims To examine the effect of workplace bullying on long-term sickness absence using a prospective design. Background Although bullying has been identified as a serious problem in the health care sector, little attention has been given to the possible effect of workplace bullying on long-term sickness absence and its implications. Methods The sample consisted of 9949 employees (78.1% response rate) working in the elderly-care sector in 36 Danish municipalities. Long-term sickness absence was measured by linking a survey on work and health to the national register on social transfer payments. Results Among the 1171 employees that were bullied at work in the past 12 months, 1.8% were frequently bullied and 7.3% were occasionally bullied. The risk of long-term sickness absence was higher for those frequently bullied even after adjusting for psychosocial work characteristics [rate ratio (RR) = 1.92, confidence interval (CI): 1.29–2.84; P < 0.05]. Conclusion This is the first prospective study that explored the effect of both frequent and occasional bullying on long-term sickness absence among health care employees. The effect of frequent bullying on long-term sickness absence was independent of the psychosocial work characteristics. Implications for Nursing Management Workplace bullying might impact negatively the quality of care and patients safety.     

Workplace Bullying in the OR: Results of a Descriptive Study

This study describes the incidence of workplace bullying among perioperative RNs, surgical technologists, and unlicensed perioperative personnel in two academic medical centers. The study sought to determine whether the demographic variables of gender, ethnicity, hospital, years of experience on the unit, years in the profession, and job title predict the experience of workplace bullying; whether a relationship exists between workplace bullying and emotional exhaustion; and whether bullying is associated with perceptions of patient safety in the OR. The cross-sectional design included perioperative nurses, surgical technologists, and unlicensed perioperative personnel (N = 167). Fifty-nine percent of the study participants reported witnessing coworker bullying weekly, and 34% reported at least two bullying acts weekly. Having one’s opinion ignored is the most common bullying act, with 28% of respondents experiencing being ignored. Differences in the experience of bullying can be found between hospitals and among ethnicities. Emotional exhaustion also was correlated with bullying. The participants did not perceive bullying as affecting patient safety.     

实习护生遭受欺凌行为现状及与领悟社会支持和职业认同的相关性研究

目的 调查实习护生遭受欺凌行为现状,分析实习护生遭受欺凌行为与社会支持、职业认同之间的相关性。方法 采用一般资料问卷、护生遭受欺凌行为量表、领悟社会支持量表和护生职业认同量表对260名实习护生进行问卷调查,并对结果进行分析。结果 实习护生遭受欺凌总均分为(7.642±8.378)分；实习护生遭受欺凌及各维度与领悟社会支持和职业认同均呈显著负相关(P<0.01)；控制了一般人口学变量后,欺凌和领悟社会支持能解释职业认同26.4%的变异,但领悟社会支持在实习护生遭遇欺凌与职业认同之间不存在调节效应。 结论 实习护生遭受欺凌行为现象普遍,减少实习护生欺凌行为的发生,给予实习护生更多社会支持,降低欺凌行为对实习护生的影响,有利于提高实习护生的职业认同水平。     

To stand back or step in? Exploring the responses of employees who observe workplace bullying

Bullying remains a pervasive problem in healthcare, and evidence suggests systems in place are not utilised due to perceptions of ineffectiveness and inequity. This study examines bystander responses to bullying and factors that influence decisions to intervene. We explore relationships between bystanders’ perceptions of psychological safety across three levels (organisation, supervisor and colleague) and reactions to witnessing bullying. We suggest psychological safety would be positively associated with the decision to intervene. Findings indicate the most pervasive reaction to witnessing incidents of bullying is to discuss with colleagues, a low‐involvement reaction. We find perceptions of supervisory and organisational safety/support are positively related to high‐involvement decisions such as formal reporting of the incidents, highlighting the importance of support from those in power. However, perceptions of collegial support may lead to low‐involvement responses, which risk reinforcing and underpinning dysfunctional organisational dynamics by providing informal social and emotional responses that may substitute more formal organisational responses to this persistent problem. This study highlights the importance of support from individuals in power if bystanders are to feel comfortable making high‐involvement interventions.     

Youth Bullying: Implications for Primary Care Providers

Bullying is a form of violence and has become a worldwide epidemic affecting children of all ages. Research has indicated that there are both physical and mental adverse health outcomes associated with childhood bullying that are exhibited both during the time the bullying is occurring and into adulthood. Primary care providers and clinic staff should be sensitive to subtle physical and emotional indicators and have policies and procedures in place to communicate any concerns. In addition, providers should have resources available to offer to children and families who have experienced bullying.