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Time to stop making things worse: An imperative focus for healthcare student bullying research
Abstract
Student bullying in clinical practice remains a concern, and evidence regarding what works to specifically help the student appears rather piecemeal. At the same time, emergent literature indicates that some bullying interventions can be ineffective for behaviour change, or even deleterious to the staff which they target. Considering the potentially sizeable financial and personal costs associated with continued bullying and undertaking an intervention, it would seem sensible that any selected intervention method avoids those shown to be potentially ineffective or deleterious. Such avoidance would likely help to move the student bullying research forward, prevent further suffering and reduce the waste of valuable taxpayer resources.
... Bullying has been shown to have negative consequences in respect to patient outcomes and studies show that disruptive behaviors can lead to adverse events (Anderson, 2013;Rosenstein & O'Daniel, 2008). Incivility can lower physician morale (Askew, Schulter, Dick, Rego, Turner & Wilkinson, 2012), increase team dysfunction (Blakey, Anderson, Smith-Han, Wilkinson, Collins & Berryman, 2018) and is related to negative mental health outcomes (Frank, Carrera, Stratton, Bickel & Nora, 2006). Evidence of bullying is also seen globally (Ahmer, Yousafzai, Bhutto, Alam, Sarangzai, & Iqba, 2008;AlMulhim, Nasir et al., 2018;Lau, Li, Llewellyn & Cyna, 2017). ...
... From the nine articles identified in the review of literature, a number of studies were identified examining a variety of medical students' experiences with incivility. These studies employed varied terminology to describe negative experiences medical students experienced from others during their training and this includes mistreatment and harassment (Baldwin, Daugherty, & Eckenfels, 1991;Blakey et al., 2018;Frank et al., 2006;Mangus, Hawkins, & Miller, 1998), abuse (Moscarello, Margittai, & Rossi, 1994), adverse experiences (Wilkinson, Gill, Fitzjohn, Palmer, & Mulder, 2006), and bullying (Ahmer et al 2008;AlMuljim et al., 2018). Despite the lack of cohesive terminology, it is evident that uncivil and bullying behaviors are evident in medical schools. ...
Bullying and incivility negatively affect patient care, team interactions, and practitioner mental health. Prior research has highlighted the prevalence and outcomes of bullying for residents, physicians, and healthcare workers. This paper reviews research literature in order to understand the prevalence of bullying and incivility toward medical students.
Disruptive behaviors in health care can have a significant adverse effect on staff interactions that can negatively impact staff satisfaction, staff performance, and patient outcomes of care. Despite growing evidence of the ill effects of these types of behaviors many organizations are still having a difficult time in addressing these issues in an effective manner. Gaining a better understanding of the nature, causes, and impact of these behaviors is crucial to finding the right remedies for solution. Nobody intentionally starts the day planning to be disruptive; it's just that things get in the way. A combination of deep seated factors related to age and gender preferences, culture and ethnicity, life experiences, and other events that help shape values, attitudes and personalities, and more external factors related to training, environmental pressures, and personal issues all contribute to the mix. Early recognition, early intervention, and taking a pro-active supportive approach to improve individual behaviors will result in better relationships, less disruption, more satisfaction, and better outcomes of care.
Purpose
– Workplace mistreatment has a negative impact on the health and well-being of approximately 20 per cent of workers. Despite this, few interventions have been evaluated and published. The purpose of this paper is to address the question “what interventions designed to reduce workplace bullying or incivility are effective and what can be learnt from evaluated interventions for future practice?”
Design/methodology/approach
– A systematic review was undertaken in which 11 electronic databases were searched, yielding 5,364 records. Following screening on abstract and title, 31 papers were retained for detailed review and quality assessment. Subsequently, 12 interventions to address workplace bullying or incivility were critically appraised.
Findings
– The papers spanned a wide range of approaches to and assumptions about resolving the problem of bullying and/or incivility. Half the studies focused on changing individual behaviours or knowledge about bullying or incivility, and duration of intervention ranged from two hours to two years. Only four studies were controlled before-after studies. Only three studies were classed as “moderate” in terms of quality, two of which were effective and one of which was partially effective.
Originality/value
– A final synthesis of results of the review indicate that multi-component, organisational level interventions appear to have a positive effect on levels of incivility, and should be considered as a basis for developing interventions to address workplace bullying.
To study the types, causes, and consequences of academic health center (AHC) "elephants," which the authors define as obvious problems that impair performance but which the community collectively does not discuss or confront.
Between April and June 2010, the authors polled all the chairs of departments of medicine and of surgery at the then 127 U.S. medical-degree-granting medical schools, using a combination of Web and postal surveys.
Of the 254 chairs polled, 139 (55%) responded. Of 137 chairs, 95 (69%) reported that elephants in their organizations were common or widespread. The most common elephant reported was misalignment between goals and available resources. Chairs felt that the main reason faculty are silent is their perception that speaking up will be ignored and that the consequences of elephants include impaired organizational learning, flawed information resulting in poor decisions, and negative effects on morale. Chairs felt elephants were more problematic among deans and hospital leaders than in their own departments. Of 139 chairs, 87 (63%) said that elephants were discussed inappropriately, and of 137 chairs, 92 (67%) believed that creating a culture that dealt with elephants would be difficult. Chairs felt the best antidote for elephants was having senior leaders lead by example, yet 77 of 139 (55%) reported that the actions of top leaders fed, rather than dispelled, elephants.
AHC elephants are prevalent and detrimental to learning, organizational decision making, and morale, yet the academic medicine community, particularly its leadership, insufficiently confronts them.
Horizontal violence is a significant issue confronting the nursing profession both in Australia and internationally. The term horizontal violence is used to describe bullying and aggression involving inter-group conflict. Some evidence suggests that nursing students commonly experience this during clinical placement(s). Despite the current shortage of nurses and the fact that clinical placement experiences may influence whether students remain in the nursing profession, there has been little research undertaken on this topic. This study used a questionnaire to investigate 152 second and third year nursing student's experiences of horizontal violence (either directly experienced or witnessed). Analysis identified five major themes: humiliation and lack of respect; powerlessness and becoming invisible; hierarchical nature of horizontal violence; coping strategies; and future employment choices. More than half of the sample indicated that they had experienced or witnessed horizontal violence; importantly, most of these (51% of the total sample) also indicated that it would impact on their future career and/or their employment choices. Strategies are discussed that could be implemented to reduce the effect of horizontal violence, including giving a higher priority to debriefing within a supportive university environment, and teaching assertiveness and conflict resolution skills within the Bachelor of Nursing Degree.
Interventions addressing student bullying in the clinical workplace: A narrative review
- Gamble Blakey
- A Smithhan
- K Anderson
- L Collins
- E Berryman
- E Wilkinson
Gamble Blakey A, SmithHan K, Anderson L, Collins
E, Berryman E, Wilkinson
T. Interventions addressing
student bullying in the clinical workplace: A narrative
review. 2018 (In review).