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Incivility and bullying in healthcare can impact care delivery and quality. There are challenges in research to making a direct link between the behaviors and patient outcomes. One way to address the challenges is through the creation of bullying vignettes that induce mood changes that reflect a feeling of being bullied. The purpose of this study was to develop workplace bullying textual vignettes and to test content validity. Cognitive interviewing was used by engaging content experts to rate 21 author-created vignettes for relevance, realism, and severity. Eleven vignettes were identified and have potential use in research, education, and practice.

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... Organizational bullying includes organizational cultural bullying, bully processing, and senior team bullying (from senior peers' tactics) [44,45]. Leymann [46] introduced the concept of organizational bullying, which has been adopted in different sectors and countries with different styles [44,47,48]. A toxic workplace environment and bullying create and accelerate work depression, stress, low levels of work engagement, a high ratio of absenteeism, a lack of work performance, and work destruction [49]. ...
... Liu and Chang argued that due to work depression, workers cannot sleep well and they have headaches, and these health problems decrease their productivity [110]. Devonish examined the operations of five wholesale and large-sized retail organizations in the small developing nation of Barbados located in the English-speaking Caribbean region, and the outcomes of his study indicate that work-related depression mediates the relationship between a toxic workplace environment and worker task productivity [48]. The findings of these studies support our study. ...
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This study determined how a toxic workplace environment can influence worker productivity, directly and indirectly, using work depression as a mediating variable. A toxic workplace environment with multiple dimensions (harassment, bullying, ostracism, and incivility) was used in this study. We used a questionnaire survey approach to evaluate the data. A total of 53 items were used in the questionnaire with a five-point Likert scale. The data were collected from 23 branches of five Chinese banks in the vicinity of Shanghai. The authors distributed 250 questionnaires among targeted employees (senior managers, middle managers, and administrative staff) and received 186 filled questionnaires, among which six were incomplete. Thus, the completed sample size of the research was 180, and the overall response rate was 72%. To estimate the proposed relationships in the research model, we used partial least-squares structural equation modeling (PLS-SEM 3.2). The outcomes of this study indicate that for direct and indirect relationships, a toxic workplace environment negatively influences worker productivity. Moreover, the outcomes of this study also show that work depression negatively impacts worker productivity. The study concludes with a discussion, limitations, and future research directions.
... Initially, this concept was introduced by Leymann Heinz in 1996 [49] and has been adopted in different organizations, industries, sectors, and countries [50]. As an indicator of a toxic workplace environment, bullying may result in job stressors, job burnout, buffering resources, negative work environment, work destruction, and low productivity [51,52]. ...
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Vignette-based methodologies are frequently used to examine judgments and decision-making processes, including clinical judgments made by health professionals. Concerns are sometimes raised that vignettes do not accurately reflect “real world” phenomena, and that this affects the validity of results and conclusions of these studies. This article provides an overview of the defining features, design variations, strengths, and weaknesses of vignette studies as a way of examining how health professionals form clinical judgments (e.g., assigning diagnoses, selecting treatments). As a “hybrid” of traditional survey and experimental methods, vignette studies can offer aspects of both the high internal validity of experiments and the high external validity of survey research in order to disentangle multiple predictors of clinician behavior. When vignette studies are well designed to test specific questions about judgments and decision-making, they can be highly generalizable to “real life” behavior, while overcoming the ethical, practical, and scientific limitations associated with alternative methods (e.g., observation, self-report, standardized patients, archival analysis). We conclude with methodological recommendations and a description of how vignette methodologies are being used to investigate clinicians’ diagnostic decisions in case-controlled field studies for the ICD-11 classification of mental and behavioural disorders, and how these studies illustrate the preceding concepts and recommendations
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Purpose: The purpose of this pilot study was to explore rural nurses’ perceptions regarding disruptive behavior and its impacts on interdisciplinary relationships, patient safety, and patient outcomes. Methods: Montana nurses working at either of two rural facilities, one a small hospital and the other a critical access facility, participated in the study. The study replicated a larger study conducted by Rosenstein and O’Daniel (2005) in the VHA West Coast hospital network. A questionnaire was sent to nurses electronically via their agency’s email system to assess perceptions of disruptive behavior and its effects on patient outcomes. Findings: Fifty-seven nurses participated in the study, yielding a 47.5% response rate. Disruptive behavior was reported to be displayed more often by nurses than physicians in this study. Nurses perceived that disruptive behavior is linked to adverse events, and may also have a negative impact on patient safety and satisfaction. In addition, participants perceived a link between disruptive behavior and the psychological and behavioral variables impacting individual nurses. Finally, the majority of respondents indicated that their facility lacked appropriate reporting and counseling policies for addressing disruptive behavior. Conclusions: Like their VHA West Coast counterparts, nurses working in rural settings experience disruptive behavior and believe there is a link between disruptive behavior and negative patient outcomes. However, results from this pilot study suggest that disruptive behavior by nurses in rural settings is more prevalent than that of physicians, findings that contradict previous work. DOI: http://dx.doi.org/10.14574/ojrnhc.v14i1.300 Key words : Disruptive behavior, workplace incivility, patient outcomes, patient safety, rural nursing
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Workplace bullying is strongly associated with negative nursing outcomes, such as work dissatisfaction, turnover, and intent to leave; however, results of studies examining associations with specific patient safety outcomes are limited or nonspecific. This integrative review explores and synthesizes the published articles that address the impact of workplace nurse bullying on patient safety.
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In this article we introduce the concept of workplace incivility and explain how incivility can potentially spiral into increasingly intense aggressive behaviors. To gain an understanding of the mechanisms that underlie an "incivility spiral," we examine what happens at key points: the starting and tipping points. Furthermore, we describe several factors that can facilitate the occurrence and escalation of an incivility spiral and the secondary spirals that can result. We offer research propositions and discuss implications of workplace incivility for researchers and practitioners.
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A series of 48 vignettes of bullying was constructed by crossing (a) four kinds of social contact (physical aggression, verbal aggression, relational aggression, and non-aggression) with (b) male and female bullies, (c) male and female and victims, and (d) reaction of the victim (aggressive, passive, and no reaction). Teachers rated vignettes for seriousness. Physical aggression was perceived as more serious than any other kind of bullying, and vignettes that depicted female bullies and male victims were perceived as least serious across all kinds of bullying. Results are discussed in terms of applied implications for teachers in school settings and directions for future research.
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When will bystanders of workplace mobbing show antisocial or prosocial behaviour toward the victim? Results of a 2 × 2 vignette study (N = 177) suggest that high perceived responsibility of the victim for the onset of the mobbing evokes anger and consequently antisocial bystander behaviour, whereas low perceived responsibility generates sympathy and consequently prosocial bystander behaviour. The results further indicate that bystanders will show more antisocial behaviour and less prosocial behaviour toward the victim when they anticipate stigma by association. The implications of these results for interventions seeking to influence bystanders' behaviour in the context of workplace mobbing and for further research on this bystander behaviour are discussed. Copyright © 2015 John Wiley & Sons, Ltd.
Inappropriate behaviors of healthcare workers can threaten the delivery of safe, quality care. The purpose of this research was to develop a research instrument specific to the construct of horizontal violence and conduct foundational psychometric testing of the newly developed instrument. The overall findings on the fit indices suggest that this model does adequately measure the underlying construct of horizontal violence. The instrument can be used as a way to determine the existence and extent of horizontal violence in practice settings and used to augment the study of the work environment, particularly in relation to healthy work environments.
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AimsThe aim of the study was to examine the relationship between bullying and burnout and the potential buffering effect psychological detachment might have on this relationship.Background There is evidence to suggest that bullying is relatively widespread in the nursing profession, with previous studies indicating that bullying is associated with higher levels of burnout. There is, however, limited research focusing on potential moderators of the relationship between bullying and burnout.DesignA cross-sectional quantitative study conducted with self-completed, anonymous questionnaires.Methods The study was conducted in 2011 with 762 Registered Nurses in Australia. Two hypotheses were tested with validated measures of bullying, psychological detachment and burnout. The hypotheses were tested using hierarchical regression.ResultsBullying is positively associated with burnout. Psychological detachment does not significantly moderate the relationship between bullying and burnout.Conclusion The results indicate that bullying exacts a strong negative toll on nurses. Ensuring there are workplace policies and practices in place in healthcare organizations to reduce the instances of bullying and proactively address it when it does occur would therefore seem crucial. Individuals may also lower their risk of burning out by psychologically detaching from work.
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In the present study, attitudes of elementary school teachers toward different types of bullying (verbal, physical, and relational) were investigated. Six written vignettes describing all types of bullying were given to 405 elementary school teachers (F = 218; M = 187). Results indicated that teachers perceived relational bullying, specifically, social exclusion, less serious than verbal and physical bullying. Unlike previous findings, however, the teachers considered verbal bullying behaviors more serious than physical bullying behaviors and were also more empathetic toward the victim physically bullied and the victim verbally bullied than the victim relationally bullied. Coherent with the findings of empathy, they were also more likely to intervene in verbal and physical bullying behaviors than relational bullying behaviors. Gender of the participant was a significant factor for all variables. The most rated intervention strategy was having a serious talk with the bully, regardless of the type of victimization. Multiple regression analysis illustrated that seriousness and empathy scores both predicted the need for intervention scores significantly in all types of bullying. The findings of this study highlight the importance of increasing teachers’ awareness and knowledge about all types of bullying, their consequences, and intervention skills to lessen bullying behaviors.
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The aim of this study was to investigate the impact of subtle forms of workplace mistreatment (bullying and incivility) on Canadian nurses' perceptions of patient safety risk and, ultimately, nurse-assessed quality and prevalence of adverse events. Workplace mistreatment is known to have detrimental effects on job performance and in nursing may threaten patient care quality. A total of 336 nurses from acute care settings across Ontario responded to a questionnaire that was mailed to their home address in early 2013, with a response rate of 52%. Bullying and incivility from nurses, physicians, and supervisors have significant direct and indirect effects on nurse-assessed adverse events (R = 0.03-0.06) and perceptions of patient care quality (R = 0.04-0.07), primarily through perceptions of increased patient safety risk. Bullying and workplace incivility have unfavorable effects on nurse-assessed patient quality through their effect on perceptions of patient safety risk.
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AIM:: The aim of this article is to examine the relationship between three types of bullying (person-related, work-related, and physically intimidating) with two types of outcomes (psychological/behavioral responses of nurses and medical errors). In addition, it investigates if the three types of bullying behaviors vary with age or gender of nurses and if the extent of bullying varies across different facilities in an institution. Nurses play an integral role in achieving safe and effective health care. To ensure nurses are functioning at their optimal level, health care organizations need to reduce negative components that impact nurses' job performance and their mental and physical health. Mitigating bullying from the workplace may be necessary to create and maintain a high-performing, caring, and safe hospital culture. Using an internal e-mail system, an e-mail requesting the participants to complete the questionnaire on Survey Monkey was sent to a sample of 1,078 nurses employed across three facilities at a university hospital system in Midwest. Two hundred forty-one completed questionnaires were received with a response rate of 23%. Bullying was measured utilizing the Negative Acts Questionnaire-Revised (NAQ-R). Outcomes (psychological/behavioral responses of nurses and medical errors) were measured using Rosenstein and O'Daniel's (2008) modified scales. Person-related bullying showed significant positive relationships with psychological/behavioral responses and medical errors. Work-related bullying showed a significant positive relationship with psychological/behavioral responses, but not with medical errors. Physically intimidating bullying did not show a significant relationship to either outcome. Whereas person-related bullying was found to be negatively associated with age of nurses, physically intimidating bullying was positively associated with age. Male nurses experienced higher work-related bullying than female nurses. Findings from this study suggest that bullying behaviors exist and affect psychological/behavioral responses of nurses such as stress and anxiety and medical errors. Health care organizations should identify bullying behaviors and implement bullying prevention strategies to reduce those behaviors and the adverse effects that they may have on psychological/behavioral responses of nurses and medical errors.
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Research on workplace bullying, which has just recently passed the 20 year mark, has grown significantly over this duration of time. We provide an extensive review of the extant literature, with a focus on the antecedents and consequences of workplace bullying. We organize our review of the extant literature by level of analysis, which allows us to understand workplace bullying from each major level of analysis, while simultaneously identifying those levels at which research has been sparse. We then develop a conceptual model based on our review that similarly depicts theoretical and/or empirical findings from the extant literature, but in a succinct manner. Based on our review and conceptual model, we identify and highlight a number of key avenues for future research that will help extend the current workplace bullying literature.
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Vignettes refer to stimuli, including text and images, which research participants are invited to respond. Drawing on a range of social science sources, this paper focuses on two substantive areas concerning the use of vignettes in research. Considered first is the development and construction of vignettes. This section is concerned with internal reliability; research topics; participants; and interest, relevance, realism and timing. Considered second are vignette interpretations and responses, in particular open and closed questioning; vignette perspectives; and difficulties with interpreting and responding to vignettes. Together these explorations contribute to the wider appreciation of vignette methodologies used within the social sciences. The paper concludes by outlining the limitations of using vignettes in social research.
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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.
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A growing body of research suggests that smoking portrayals in movies influence adolescent tobacco use. However, the mechanism for this influence remains unclear. The aim of this paper is to provide an overview of research on narrative transportation theory, particularly as applied to movies and smoking. We propose that this theory can provide a valuable framework for guiding research on the role of entertainment media in smoking and other addictive behaviors. We review empirical work on transportation theory and highlight the psychological mechanisms underlying transportation effects. ‘Transportation into narrative worlds’ refers to cognitive, emotional and imagery engagement into a narrative (including movies and entertainment media). We link this work with research on the effects of movie smoking. Research suggests that individuals who are more highly transported into narratives show greater attitude, belief and behavior change. Transportation effects work through reducing counterarguing, creating connections (identification and liking) with characters and increasing perceptions of realism and emotional involvement. We propose several future directions and research challenges for applying a transportation framework to the issue of entertainment media effects on smoking and tobacco disparities. Understanding factors contributing to transportation may provide a more nuanced view of who will be affected by movie smoking, and understanding the psychological processes underlying narrative persuasion may guide intervention efforts. Narrative transportation theory suggests that individuals' cognitive, emotional and imagery immersion in a narrative is a key mechanism of attitude, belief and behavior change. This theory provides a potentially generative and psychologically grounded framework for increasing knowledge about the boundary conditions and processes underlying the effects of entertainment media on tobacco use.
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Vie, T. L., Glasø, L. & Einarsen, S. (2012). How does it feel? Workplace bullying, emotions and musculoskeletal complaints. Scandinavian Journal of Psychology 53, 165–173. The present study examines experienced emotions among self-labelled victims of ongoing workplace bullying and tests whether emotions mediate the relationship between exposure to bullying and health in the form of musculoskeletal complaints. A total of 1,024 employees from a Norwegian public transport company participated in the study, in which 116 self-labelled victims were identified. Ten positive and 10 negative emotions were measured (PANAS). The results showed significant differences in emotional experiences between victims and non-victims regarding all 10 negative emotions and one out of 10 positive emotions. Victims felt less “interested” and more “afraid,”“upset,”“angry,”“guilty,”“nervous,”“hostile,”“frustrated,”“ashamed,”“scared” and “stressed” than did non-victims. Further, the results pointed to both positive and negative emotions as mediators of the relationship between exposure to bullying and musculoskeletal complaints. In particular the negative emotion “stress” acted as a significant mediator regarding this relationship. Hence, emotions seem to be central to understanding the detrimental effects of bullying on the victims’ health.
Article
Drawing on social identity theory and intergroup emotion theory (IET), we examined group processes underlying bullying behaviour. Children were randomly assigned to one of three groups: a perpetrator's group, a target's group, or a third party group. They then read a gender-consistent scenario in which the norm of the perpetrator's group (to be kind or unkind towards others) was manipulated, and an instance of cyberbullying between the perpetrator's group and a member of the target's group was described. It was found that group membership, group norms, and the proposed antecedents of the group-based emotions of pride, shame, and anger (but not guilt) influenced group-based emotions and action tendencies in ways predicted by social identity and IET. The results underline the importance of understanding group-level emotional reactions when it comes to tackling bullying, and show that being part of a group can be helpful in overcoming the negative effects of bullying.
Article
The arbitrary assertion of two of three experts does not establish content validity. Application of a two-stage process that incorporates rigorous instrument development practices and quantifies the aspects of content validity is required. In the first stage of this process, the content domain or dimensions are identified and items are generated to reflect the scope of the content domain of a cognitive variable or each of the dimensions of an affective variable. Once generated, the items are assembled in a usable, testable format. The instrument and domain or dimension specifications are then presented to a panel of experts, the size of which is an a priori decision, for their judgment of the items using a 4-point ordinal rating scale. Using the item evaluation, CVI calculations are applied to both the items and the entire instrument. The experts are asked, as a part of the content validity assessment, to identify areas of omission and to suggest areas of item improvement or modification. Admittedly, there are times when adherence to such rigor may not be feasible. When less stringent methods of determining validity are applied, it should not be said that content validity has been determined. Opponents of the process described in this article might argue that these applications and expectations exceed practical application and that this process is therefore too rigorous. Content validity, by its nature and definition, demands rigor in its assessment, and its assessment is, in fact, critical. Such a rigorous process for content validity determination is offered because content validity is an inexpendable form of validity which is rapidly losing credibility due to its less than standardized and rigorous assessments. Content validity, different from all other forms of validity, is crucial to the understanding of research findings and their practical or theoretical applications. It is worth the rigor.
Article
Vignettes are simulations of real events which can be used in research studies to elicit subject's knowledge, attitudes or opinions according to how they state they would behave in the hypothetical situation depicted. Advantages associated with the use of vignettes as research tools include: the ability to collect information simultaneously from large numbers of subjects, to manipulate a number of variables at once in a manner that would not be possible in observation studies, absence of observer effect and avoidance of the ethical dilemmas commonly encountered during observation. Difficulties include problems establishing reliability and validity, especially external validity. This paper considers the advantages and disadvantages associated with the use of vignettes as data collection tools, concluding with a check-list to help critique vignettes studies.
Article
Instrument content validity is often established through qualitative expert reviews, yet quantitative analysis of reviewer agreements is also advocated in the literature. Two quantitative approaches to content validity estimations were compared and contrasted using a newly developed instrument called the Osteoporosis Risk Assessment Tool (ORAT). Data obtained from a panel of eight expert judges were analyzed. A Content Validity Index (CVI) initially determined that only one item lacked interrater proportion agreement about its relevance to the instrument as a whole (CVI = 0.57). Concern that higher proportion agreement ratings might be due to random chance stimulated further analysis using a multirater kappa coefficient of agreement. An additional seven items had low kappas, ranging from 0.29 to 0.48 and indicating poor agreement among the experts. The findings supported the elimination or revision of eight items. Pros and cons to using both proportion agreement and kappa coefficient analysis are examined.
Article
Recent literature defines lateral violence as nurses covertly or overtly directing their dissatisfaction inward toward each other, toward themselves, and toward those less powerful than themselves. Newly licensed nurses are an identified group that is vulnerable to lateral violence during their socialization to nursing practice. The use of cognitive rehearsal, an applied cognitive-behavioral technique, was used as an intervention and the theoretical underpinning for this study. Twenty-six newly licensed nurses hired by a large acute care tertiary hospital in Boston, Massachusetts, participated in an exploratory descriptive study. They were taught about lateral violence in nursing practice and the use of cognitive rehearsal techniques as a shield from the negative effects of lateral violence on learning and socialization. Small laminated cueing cards with written visual cues for the appropriate responses to the most common forms of lateral violence were provided. One year later, videotaped focus groups designed to collect qualitative data about the applied intervention were conducted. Twenty-six newly licensed nurses in three different focus groups were videotaped responding to six open-ended questions designed to elicit information on their experience with lateral violence, use of cognitive rehearsal as an intervention, and the overall socialization process. Knowledge of lateral violence in nursing appeared to allow newly licensed nurses to depersonalize it, thus allowing them to ask questions and continue to learn. The learned cognitive responses helped them confront the lateral violence offender. Confrontation was described as difficult but resulted in the resolution of the lateral violence behavior. Overall, the retention rate in this study population was positively affected.
Article
Clinical vignette-based surveys have been used for more than 30 years to measure variation in physicians' approaches to the diagnosis and treatment of patients with similar health problems. Vignettes offer advantages over medical record reviews, analysis of claims data, and standardized patients. A vignette-based survey can be completed more quickly than a record review or standardized patient program. Research has shown that vignette-based surveys produce better measures of quality of care than medical record reviews when used to measure differential diagnosis, selection of tests, and treatment decisions. Although standardized patients are preferred when measuring communication and physical examination skills, vignettes are more cost-effective than standardized patients when assessing clinical physicians' decision making. Vignettes offer better opportunities to isolate physicians' decision making and to control case-mix variation than do analyses of claims data sets. Clinical vignette-based surveys are simple and economical tools that can be used to characterize physicians' practice variation.
Face-toface and online: An investigation of children's and adolescents' bullying behavior through the lens of moral emotions and judgments
  • L Conway
  • C Gomez-Garibello
  • V Tlawar
  • S Shariff
Conway, L., Gomez-Garibello, C., Tlawar, V., & Shariff, S. (2016). Face-toface and online: An investigation of children's and adolescents' bullying behavior through the lens of moral emotions and judgments. Journal of School Violence, 15(4), 503-522. doi:10.1080/15388220.2015.1112805
20 years of workplace bullying research: A review of the antecedents and consequences of bullying in the workplace. Aggression and Violence Behavior
  • A Samnani
  • P Singh
Samnani, A., & Singh, P. (2012). 20 years of workplace bullying research: A review of the antecedents and consequences of bullying in the workplace. Aggression and Violence Behavior, 17, 581-589. doi:10.1016/j.avb.2012.08.004