Judith A. Vessey

BULLYING OF STAFF REGISTERED NURSES IN THE WORKPLACE :A PRELIMINARY STUDY FOR DEVELOPING PERSONAL AND ORGANIZATIONAL STRATEGIES FOR THE TRANSFORMATION OF HOSTILE TO HEALTHY WORKPLACE ENVIRONMENTS

The primary purpose of this study was to validate the perceptions of frequency and patterns of bullying behavior experienced by registered nurses (RNs) across the United States. This study was completed to develop relevant and sensitive tailored interventions for the future. A 30-item anonymous electronic survey was used to identify the frequency, type, perpetrators, and personal and professional consequences of bullying. Findings from the overall population of 303 RN respondents (mean age of 49 years) indicated that 70% of the bullying was reported by a predominant group of staff RNs (n = 212), and it is this group that is the focus of this report. Of this group, bullying occurred (a) most frequently in medical-surgical (23%), critical care (18%), emergency (12%), operating room/Post Anesthesia Care Unit (9%), and obstetrical (7%) areas of care and (b) within the 5 years or less of employment on a unit (57%). Perpetrators included senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%) who publicly humiliated, isolated, excluded, or excessively criticized the staff nurses. Subsequent stress levels were reported as moderate or severe, with support found primarily with family, colleagues, and friends and not with an available workplace infrastructure of solution. Many left the workplace completely with or without jobs awaiting them. Bullying among U.S. nurses is a hidden problem with significant patient-directed quality performance and workforce implications. It is critical that innovative strategies be developed and implemented to address the root cause of this problem.

Use of Distraction with Children During an Acute Pain Experience

The purpose of this study was to investigate the effectiveness of a distraction technique in reducing a childs perceived pain and behavioral distress during an acute pain experience. A convenience sample of 100 children, ages 3 year 6 months through 12 years 11 months, scheduled for routine blood draws, was recruited and randomly assigned to an experimental or control group. During venipuncture, the control subjects received standard preparation, which consisted of being comforted by physical touch and soft voices, while experimental subjects were encouraged to use a kaleidoscope as a distraction technique. Results of the MANCOVA, with age as a covariate, indicated a significant difference between the groups. Univariate post hoc tests confirmed that the experimental group perceived less pain and demonstrated less behavioral distress than the control group.

Bullying, Harassment, and Horizontal Violence in the Nursing Workforce The State of the Science

In the complex health care workplace of nurses, intra/interprofessional ideals intersect with the expectations of patients, families, students, and coworkers in a context of managed care environments, academia, and other health care enterprises. Integral to quality assessment, management, and assurance is collegial and respectful communication. Decades of reported descriptive and anecdotal data on intra/inter professional and on client communication, describe the antithesis of these ideals. Specifically, increasing frequency and rates of persistent bullying, harassment, or horizontal violence (BHHV) have shown to yield detrimental effects on workplace satisfaction, workforce retention, and the psychological and physical health of nurses as well as implied effects on quality of patient care and risk of poor health outcomes. Persistent BHHV among nurses is a serious concern. In advancing the science of description and explanation to a level of prevention intervention, explanatory models from biology, developmental psychology, intra/interpersonal interactionism are described along with theoretical explanations for the prevalence of BHHV in nurse workplaces. Making the connection between explanatory models and creative solutions to address BHHV through multiple levels of behavioral influence such as individual, environmental, interpersonal, and cultural contexts is key to advancing the science of the relationship between professional behavior and client/family/community health care outcomes.

Teasing and Bullying Experiences of Middle School Students

BACKGROUND: In the United States, 9% to 15% of children experience chronic teasing and bullying that may be harmful. OBJECTIVE: The purpose was to explore teasing and bullying experiences of middle school students as part of the Child-Adolescent Teasing Scale (CATS) project. STUDY DESIGN: Seven focus groups were conducted with 11-to 14-year-old middle school students from Massachusetts, New Mexico, and Mississippi. Moderators used a semistructured interview guide to elicit views. Recorded sessions were transcribed; content analysis of verbatim accounts was used to identify sources of teasing and bullying. RESULTS: Sources of teasing and bullying were physical appearance, personal behavior, family and environment, and school relations. “Being different in any way” was the underlying theme. CONCLUSIONS: Teasing and bullying were universal and distressing, and were affected by context, frequency, and individually attributed meanings. Clinicians and school staff may use findings to identify children who might be at risk for psychological and physical harm.

Making Things Right: Nurses' Experiences with Workplace Bullying—A Grounded Theory

While bullying in the healthcare workplace has been recognized internationally, there is still a culture of silence in many institutions in the United States, perpetuating underreporting and insufficient and unproven interventions. The deliberate, repetitive, and aggressive behaviors of bullying can cause psychological and/or physical harm among professionals, disrupt nursing care, and threaten patient safety and quality outcomes. Much of the literature focuses on categories of bullying behaviors and nurse responses. This qualitative study reports on the experiences of nurses confronting workplace bullying. We collected data from the narratives of 99 nurses who completed an open-ended question embedded in an online survey in 2007. A constructivist grounded theory approach was used to analyze the data and shape a theory of how nurses make things right when confronted with bullying. In a four-step process, nurses place bullying in context, assess the situation, take action, and judge the outcomes of their actions. While many nurses do engage in a number of effective yet untested strategies, two additional concerns remain: inadequate support among nursing colleagues and silence and inaction by nurse administrators. Qualitative inquiry has the potential to guide researchers to a greater understanding of the complexities of bullying in the workplace.

Bibliotherapy: A Strategy to Help Students with Bullying.

Use of bibliotherapy to address childhood teasing and bullying is an innovative approach school nurses should consider as they work to promote a healthy school environment. Children’s books serve as a unique conduit of exchange between parents, teachers, and children. Bibliotherapy, using books to help people solve problems, involves three stages: identification, catharsis, and insight. These stages lend themselves well to coping with the sensitivities related to teasing and bullying. Salient research findings pertinent to teasing and bullying have made their way into the children’s literature and have been well received by children and their families over the course of the Child Adolescent Teasing in Schools (CATS) book review project and web site development. After exposure to a fictional story about teasing and bullying, children have shared their own nonfictional account of this often devastating experience and have come to develop successful coping strategies for dealing with the teasing and bullying that takes place in schools nationwide.

The Undergraduate Research Fellows Program: A Unique Model to Promote Engagement in Research

Well-educated nurses with research expertise are needed to advance evidence-based nursing practice. A primary goal of undergraduate nursing curricula is to create meaningful participatory experiences to help students develop a research skill set that articulates with rapid career advancement of gifted, young graduates interested in nursing research and faculty careers. Three research enrichment models-undergraduate honors programs, research assistant work-for-hire programs, and research work/mentorship programs-to be in conjunction with standard research content are reviewed. The development and implementation of one research work/mentorship program, the Boston College undergraduate research fellows program (UGRF), is explicated. This process included surveying previous UGRFs followed by creating a retreat and seminars to address specific research skill sets. The research skill sets included (a) how to develop a research team, (b) accurate data retrieval, (c) ethical considerations, (d) the research process, (e) data management, (f) successful writing of abstracts, and (g) creating effective poster presentations. Outcomes include evidence of involvement in research productivity and valuing of evidenced-based practice through the UGRF mentorship process with faculty partners.

SELF-MEDICATION WITH COMMON HOUSEHOLD MEDICINES BY YOUNG ADOLESCENTS

Our study examines the self-medication practices of children ages 10-14. We developed a questionnaire that addressed several aspects of such behavior. A convenience sample of subjects (n = 86) completed the questionnaires in school settings in a northeastern metropolitan area. The data showed that a vast majority of the adolescents (89%) have access to the medicine in their households: 36% of them medicated themselves the last time they had any medicine. Most of their medication choices were appropriate, except in the area of gastrointestinal problems. There is a need for further investigation of this issue and incorporating the findings into the practice of pediatric nurses.Our study examines the self-medication practices of children ages 10-14. We developed a questionnaire that addressed several aspects of such behavior. A convenience sample of subjects (n = 86) completed the questionnaires in school settings in a northeastern metropolitan area. The data showed that a vast majority of the adolescents (89%) have access to the medicine in their households: 36% of them medicated themselves the last time they had any medicine. Most of their medication choices were appropriate, except in the area of gastrointestinal problems. There is a need for further investigation of this issue and incorporating the findings into the practice of pediatric nurses.

Children's psychological responses to hospitalization.

The data-based literature addressing children’s psychological responses to hospitalization was reviewed using methods outlined by Cooper (1989). Using a developmental science perspective, early research was reviewed and a model of variables that contribute to children’s responses was constructed. This model consists of three major foci, including maturational and cognitive variables (developmental level, experience, coping style), ecological variables (family and hospital milieu), and biological variables (inborn factors and pathophysiology). Coping serves as the overarching framework for examining these variables and their contributions to children’s responses to hospitalization. A variety of theoretical perspectives from the social sciences have been used, with psychoanalytic and stress and adaptation theories predominating. The majority of the research used simple case study, descriptive, or pre- and post-test designs. Methodologic issues were common. Little qualitative work has been done. Future research directions call for studies to adopt new theoretical and empirical models that are methodologically rigorous and clinically relevant and that embrace the precepts of developmental science.

Measuring the Youth Bullying Experience: A Systematic Review of the Psychometric Properties of Available Instruments.

BACKGROUND Bullying is a significant problem in schools and measuring this concept remains problematic. The purposes of this study were to (1) identify the published self-report measures developed to assess youth bullying; (2) evaluate their psychometric properties and instrument characteristics; and (3) evaluate the quality of identified psychometric papers evaluating youth bullying measures. METHODS A systematic review of the literature was conducted using 4 electronic databases. Data extraction and appraisal of identified instruments were completed using a standardized method and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Thirty-one articles describing 27 self-report instruments were evaluated in our analysis. Quality assessments ranged from 18% to 91%, with 6 papers reaching or exceeding a quality score of 75%. Limited evidence supporting the reliability, validity, and responsiveness of existing youth bullying measures was identified. CONCLUSIONS Evidence supporting the psychometric soundness of the instruments identified was limited. Many measures were in early development and additional evaluation is necessary to validate their psychometric properties. A pool of instruments possesses acceptable initial psychometric dependability for selected assessment purposes. These findings have significant implications for assessing youth bullying and designing and evaluating school-based interventions.