Running head: BULLYING IN NURSING 1

Bullying in Nursing

Name

Institutional Affiliation
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Abstract

This study intends to investigate the bullying problem in nursing, focusing on its prevalence,
underlying factors, and impact to address an educational nursing issue that endangers nurse
safety and the quality of patient care. This research aims to fill a knowledge gap by researching
the incidence of bullying among nurses and its impact on this group of professionals in various
healthcare settings. The research aims to incorporate the nursing profession with insights relating
to the topic to enable them to design more effective approaches for preventing bullying and
reacting to instances of bullying. The study will further provide more knowledge on bullying in
nursing for students and practitioners, adding to the existing literature. Key research questions of
the study are, what are the root reasons and contributing elements to bullying in the nursing
profession? And also, How does bullying affect the professional development and job happiness
of nurses and students? The study involves a mixed-methods design incorporating quantitative
and qualitative data collection methods. The study employs correlation and descriptive design for
the quantitative and qualitative methods. Various instruments are used for the study, including
surveys, questionnaires, discussion of the research topic with the participants, and interviews
with nursing students and practitioners. The research majors in implementing anti-bullying
studies and is supported by the Swanson Caring Model. Qualitative data are decoded and
analyzed using thematic and narrative analysis to identify—common themes, patterns, and
categories of data. Quantitative data analysis implies applying statistical and correlation parsing
methods. This research will provide a significant implication for both nursing practitioners and
students. The study will educate both the nursing profession and the general public on the nature
and scope of the problem. It allows the concerned stakeholders to advocate for creating new
laws, rules, and programs that foster an atmosphere conducive to learning and growth.

Key words: Bullying, Nursing

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Bullying in Nursing

Introduction

A significant amount of study on bullying in nursing has been carried out in recent years.

Remembering that bullying in nursing is not a recent phenomenon is essential. The nursing

literature has been discussing this problem for a considerable time now. Even though it has been

around for quite some time, it has only recently come to anyone's attention due to its destructive

impact on the quality of care being provided and the greater awareness of the problems

associated with harassment in the workplace. Occupational stress is A substantial contributor to

bullying within the nursing profession. Nurses' job is challenging since they must constantly deal

with the suffering of the patients and those who love them. As a result of the sensitive nature of

their line of work, nursing students and practitioners are more likely to experience mental and

physical tiredness, which may manifest in the form of irritability and mood swings. These

elements can make a hostile and violent work environment even worse.

Background

Workplace bullying is a significant issue that must be addressed in nursing. Even though

as many as 85 percent of nurses have been bullied while on the job, the incidence of bullying in

nursing is unknown (Crawford et al., 2019). The most common kind of violence in the workplace

is bullying, which can occur at any level and in any setting. Nurses can be affected by bullying.

Bullying in the workplace is significantly connected to high levels of job stress or conflict, a

demanding workload, and a lack of decision-making authority in the workplace. The low self-

esteem, lack of desire, and poor work ethic that can result from being bullied at work are all

problems that nurses face. The problems nurses face highlight how important it is to know about

the frequency of bullying in the nursing profession and its origins and repercussions. Indirect
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variables such as job satisfaction and intention to leave may be helpful in future research on

bullying in the workplace. When attempting to determine the prevalence of bullying in the

workplace among nurses, researchers need to consider the methodologies of the studies, the

socio-cultural aspects involved, and the organizational settings.

Forms of bullying

From the point of view of nurses, bullying can manifest itself in various ways, taking the

form of more senior nurses looking down on their junior colleagues, sabotaging their efforts, or

blocking them from advancing in their careers, all of which are unacceptable behaviors. Such

activities can result in feelings of inadequacy, discontent at work, and emotional distress. When

seasoned nurses are subjected to horizontal or lateral bullying by their peers, which can take the

form of intimidation, ostracism, or the propagation of disinformation, a toxic work environment

is worsened.

Even among nursing students, bullying is a problem that needs to be addressed. These

students risk being bullied in the clinical setting by various individuals, including preceptors,

experienced nurses, and other students. Examples include severe criticism, being humiliated in

public, being expected to meet high standards, and being denied opportunities to gain sound

knowledge. It is possible for nursing students who are bullied during their formative years in

school to develop low self-esteem, have difficulty concentrating, and eventually choose not to

pursue a career in nursing.

Prevention

To effectively counteract bullying among nurses and nursing students, it is critical to first

educate the general public, then build a culture of support, and finally make available

intervention and support services that are both efficient and effective. Educational activities to
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combat bullying in nursing can contribute to developing a culture that values respect,

professionalism, and support (Rutherford et al., 2019). Stakeholders can also consider assisting

other individuals in overcoming challenging circumstances by instructing them in the art of

effective communication, methods for conflict resolution, and assertive behavior.

Formal mentorship programs should be established to pair seasoned professionals with

less-experienced nurses or nursing students. These programs should be designed to foster

professional development. Mentoring may provide individuals with direction, support, and a

secure environment for open communication, all of which can assist individuals in overcoming

professional challenges and combating bullying tactics. Stakeholders can also establish resources

for registered nurses and students studying to become registered nurses, such as employee

assistance programs, counseling services, and peer support groups. People can obtain counsel, let

off steam, and connect with others who understand their challenges through these technologies,

which can provide a safe location for them to do so.

Leadership in the nursing profession that motivates others to perform at their highest

level is crucial, and managers should urge their employees to model this behavior for patients.

They need to demonstrate proper behavior by respecting one another and not tolerating any

bullying. Leaders who promote open communication can establish a secure channel through

which community members can report wrongdoing and ensure justice is served. The protection

of students and the prevention of bullying should be given the highest priority in schools. There

should be a surety that children have a secure and anonymous method to report bullying, then

conduct prompt investigations and take necessary action. The battle against bullying can be

considerably aided by the efforts of organizations representing nurses and other professionals.

They can develop anti-bullying policies, position statements, awareness campaigns, and teaching
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resources for students and instructors.

Effects of Bullying on Nursing

When bullying occurs in nursing, it is detrimental to both the patients and the nurses. Because it

makes it more difficult for medical personnel to interact with one another and work together

effectively, bullying substantially negatively affects the standard of treatment that patients

receive (Ma et al. 2021). When nurses leave their jobs due to bullying, the facilities in which

they work may experience financial and operational challenges. Nurses can endure stress, worry,

and depression due to bullying, eventually leading to burnout and a loss in job satisfaction.

Bullying in nursing can make victims less invested in their jobs, leading to substandard patient

treatment.

It is difficult for nurses to interact with one another and collaborate when they are forced

to work in an unfriendly atmosphere due to bullying. When nurses are subjected to bullying, they

may be reluctant to seek assistance, which can cause a breakdown in communication and, as a

result, inferior treatment for patients. The negative impacts that bullying has on the nursing

profession have contributed to the already acute nursing shortage. Since bullying is one of the

leading causes of experienced nurses leaving the workforce, it can severely impact patient care,

staff morale, and turnover rates.

Students and professionals in the nursing field are especially susceptible to the adverse

consequences of bullying on mental health, including feelings of stress, anxiety, melancholy, and

low self-esteem. When employees are bullied consistently, it may negatively impact their mental

health and the satisfaction they experience at work. Some physical symptoms of bullying include

but are not limited to, aches and pains in the head and stomach, difficulty sleeping, and an

increased risk of getting sick. Bullying is a form of chronic stress which can harm a person's
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immune system and general welfare.

Problem Statement

Bullying is the term used to describe the practice in which nursing practitioners or

nursing students are repeatedly subjected to cruel treatment by their superiors or peers. It should

be explored because of the harm it causes to workers' health, the satisfaction of their jobs, and

the advancement of their careers, in addition to the risk that it poses to the well-being and safety

of patients. Bullying must be acknowledged and appropriately addressed if nurses practice in an

environment that is both secure and wholesome, in which they are free to concentrate on their

patients' emotional and physical well-being.

When it comes to the issue of bullying, nursing students and professionals encounter a

distinct and varied set of obstacles. The primary educational problem of bullying among nurses

and nursing students is something the healthcare profession must address as soon as possible.

The prevalence of bullying practices within the nursing profession, such as intimidation, verbal

abuse, and exclusion, poses a significant risk to nurses' health and professional success. This

problem has far-reaching ramifications, influencing not only the practitioners and students for

whom it was intended but also the quality of education, teamwork, and therapy provided for

patients.

The prevalence of bullying in the nursing profession is concerning due to the numerous

challenges it causes its victims. Bullying has been associated with greater stress levels, worse job

satisfaction, and an overall decline in nurses' mental health. Patient care can deteriorate due to

poor teamwork, strained communications, and other bad outcomes of bullying. Nurses are

critical in ensuring patients receive high-quality care; doing everything possible to safeguard
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their well-being is necessary. Furthermore, by eliminating bullying incidents, healthcare

institutions can establish an environment that encourages nurses to collaborate and grow as

professionals.

To effectively combat this issue, it is essential to conduct research into the factors that

give rise to bullying, how it affects the population that is the subject of the bullying, and the

strategies that have proven successful in creating an atmosphere in nursing schools that is

characterized by mutual respect, cooperation, and support. The evaluation of the relevant

literature underlines how important it is to research this topic to preserve the mental and

emotional well-being of nurses and nursing students, improve the educational opportunities

available to them in an environment that is both supportive and secure, and ultimately improve

patient outcomes.

This study intends to investigate the bullying problem in nursing, focusing on its

prevalence, underlying factors, and impact to address an educational nursing issue that endangers

nurse safety and the quality of patient care. This research aims to fill a knowledge gap by

researching the incidence of bullying among nurses and its impact on this group of professionals

in various healthcare settings.

Research Questions

What are the root reasons and contributing elements to bullying in the nursing

profession?

How does bullying affect nurses' and students' professional development and job

happiness?

Purpose of the study

Research on bullying would be beneficial to nursing students as well as professionals

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already working in the field.

Students and working professionals in the nursing field can profit from a more in-depth

comprehension of bullying if they educate themselves on the issue and the myriad of forms it can

take. Because of this research, they can differentiate between bullying and, for example,

constructive criticism or a genuine professional challenge.

By gaining a deeper understanding of the variables that contribute to this problem, the

nursing profession can design more effective approaches for preventing bullying and reacting to

instances of bullying that do occur. Using insights gained from research on risk factors, triggers,

and patterns of behavior associated with bullying, targeted interventions can be adopted to

address and eliminate bullying in healthcare settings. These treatments can be used to address

and minimize bullying in healthcare settings.

Bullying could harm the treatment provided to patients. The findings of this study on

bullying in the nursing profession will illuminate the connection between toxic work

environments, low morale, and detrimental consequences on patients. By combating bullying and

cultivating an atmosphere that promotes open communication, teamwork, and collaboration,

healthcare providers can improve the quality of care they deliver to patients and the overall

safety of their facilities.

It is beneficial to nursing students and practicing nurses to research the consequences of

bullying in nursing. Consequently, ethics, respect, and the capacity to have productive

conversations in the workplace are all improved. Taking steps to stop bullying can help

individuals develop important qualities essential for professional success, such as resiliency,

assertiveness, and resolving conflicts.

The findings of this research on bullying in the nursing profession provide valuable
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insights into how company culture and leadership may build safe and supportive workplaces for

all employees. These studies looked at bullying in the nursing profession. It strongly emphasizes

the necessity of policies to avoid bullying, the involvement of leadership, and accountability

measures. This type of research can assist healthcare facilities in developing an atmosphere

where staff members value and support respectful interactions with one another to better care for

patients.
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Literature Review

Bullying among nursing students is a prevalent problem that affects their mental health

and academic achievements. Bullying can occur in clinical and educational environments,

involving intimidating, yelling, and treating unfairly. The issue of nurses bullying nursing

students has been a growing concern in recent years. Several studies have been conducted to

investigate the prevalence, impact, and interventions against bullying in nursing education. In

this critique, we will examine several studies to better understand the current research on the

topic.

Research Findings and Relevance

Effects of Bullying on Nursing

Abdelaziz and Abu (2022) conducted a study investigating bullying's effects on nursing

students' psychological well-being and academic success. The study used a cross-sectional

design and collected data from 480 nursing students in Egypt using a self-administered

questionnaire (Abdelaziz & Abu, 2022). The findings indicated that bullying significantly affects

nursing students' mental health and academic achievement. Specifically, students who

experienced bullying had higher levels of depression, anxiety, and stress, lower levels of

academic achievement, and less job satisfaction. The authors concluded that bullying prevention

programs should be developed and implemented to reduce the negative impact of bullying on

nursing students. The study is relevant to the project as it highlights bullying's detrimental effects

on nursing students' academic performance and psychological health. It also emphasizes the

importance of effectively developing and implementing bullying prevention programs to address

the problem.
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Ma et al. (2021) conducted extensive research to determine how work and personal-

related bullying affected the occupational commitment of nurses. The occupational dedication of

nurses can further be broken down into various subcategories exposed to the research. The

subcategories include emotional labor and exhaustion, which significantly affect the output of

nurses. The authors employed the cross-sectional design, and the model was tested using

structural equation modeling. Participants in the research were a sample of Chinese nurses. The

research findings show that bullying is work related to surface and deep acting. The study also

showed a negative relationship between deep acting and emotional exhaustion (Ma et al. 2021).

From the results, personal-related bullying was not related to surface acting or deep acting.

Emotional exhaustion, however, had a negative relationship with occupational commitment. It

can be concluded that bullying behaviors ought to be distinguished from work and personal-

related bullying.

Benmore et al. (2018) conducted research intending to identify the impact of bullying and

related behaviors on the National Health Service regarding costs, the safety of patients, and the

retention of staff. The authors try to provide a well-evaluated program to reduce bullying and

harassment in the sector (Benmore et al. 2017). The methodology employed in the study was the

Q-sort methodology which specifies the underlying program assumptions and the designers'

intention. The study's findings showed that there is a typology which is professionals, colleagues,

and victims. All the groups participated in the program from their past hospital bullying

experiences.

Courtney-Pratt, Pich, Levett-Jones, and Moxey (2018) examined nursing students'

encounters with bullying in clinical and educational environments. The study used a qualitative

design and collected data from 18 nursing students in Australia through semi-structured
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interviews (Courtney et al., 2018). The findings revealed that bullying was a prevalent issue in

nursing education, with various forms of mistreatment, such as verbal abuse, exclusion, and

humiliation. The authors concluded that nursing educators and clinical staff must provide safe

and supportive learning environments that promote positive learning experiences. The study is

relevant to the project as it gives a qualitative perspective on bullying among nursing students in

medical and educational contexts. It emphasizes the significance of the learning settings that are

both encouraging and secure in preventing bullying in nursing education.

Solutions to the Bullying Problem in Nursing

Iheduru-Anderson (2014)conducted a study to teach senior nursing students how to deter

lateral violence in nursing. The study used a quasi-experimental design and collected data from

74 nursing students in the United States using a self-administered questionnaire (Iheduru, 2014).

The findings indicated that the educational intervention significantly improved students'

knowledge, attitudes, and behaviors about stopping lateral violence. The author concluded that

nursing education programs should integrate lateral violence prevention education to reduce

bullying in nursing. The study is relevant to the project as it provides an intervention to prevent

bullying in nursing education. It emphasizes the importance of educating nursing students on

lateral violence prevention and encourages nursing education programs to integrate this

education.

Rutherford, Gillespie, and Smith (2019) undertook an integrated evaluation to find

interventions for bullying nursing students and pre-licensure professionals. The study included

13 studies from different countries and settings. The findings revealed that several interventions

effectively reduced bullyings, such as education programs, mentoring, and reporting systems

(Rutherford et al., 2019). The authors concluded that a multifaceted approach that includes
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education, policies, and reporting systems is necessary to address bullying in nursing education

and practice. The study is pertinent to the project because it thoroughly examines the

counterproductive behavior directed at nursing professionals and prelicensure students. It

emphasizes the need for a multifaceted approach that includes education, policies, and reporting

systems to address the problem.

Experiences of Nursing Students and Personnel to bullying

Scammell et al. (2020) conducted a scoping review of undergraduate nurse education to

identify learning opportunities for leadership development. It aimed to explore the learning

experiences of nursing students and identify the leadership skills required to become competent

practitioners (Scammell et al., 2020). The study employed a scoping review methodology,

extensively searching literature databases and identifying relevant studies published between

2010 and 2019. The researchers included 67 studies in their review, and the findings revealed

that nursing education has evolved over the years to incorporate new learning strategies and

technologies (Scammell et al., 2020). However, the traditional model of didactic instruction

remains dominant in many nursing programs. One of the study's key findings was that nursing

students face numerous challenges, including bullying and harassment by their peers and senior

nurses. This finding is highly relevant to the project, as it confirms the problem's existence and

the need to address it. According to Scammell, bullying nursing students can decrease motivation

and anxiety and even cause dropouts from nursing programs (Scammell et al., 2020). Thus, the

study highlights the importance of creating a safe and supportive learning environment for

nursing students.

Aul (2017) researches to determine whether there is a deviation in the perceptions of

uncivil behaviors among nursing students. The study also aims to assess the possibility of a
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relationship between uncivil behaviors and other factors, which include age, parental level of

education, gender, and ethnic background. The participants in the research were pre-licensure

senior nursing students and nursing faculty from various schools, both of which provided a

sample (Aul, 2017). The instrument that was implemented in the research was the validated

survey instrument. The findings of the study indicated that the perception of participants

concerning perceptions and experiences in uncivil behaviors had both similarities and

differences. There were no significant differences between age, parental level of education,

gender, ethnic background, and the occurrence of uncivil behaviors.

Crawford et al. (2019) conducted an interrogative review to examine the evidence

regarding nurse–nurse incivility, bullying, and workplace violence. The participants for the study

were students, new graduates, and experienced academic faculty. The study employed the

Ganong and Cooper methodology. The results of the study indicated the incidents of bullying.

Corney (2008) conducted research intending to highlight the problem of bullying in the

nursing profession. The study employed a Heideggerian methodology to illuminate the

phenomenon of bullying. Interviews were used to research the participants, a sample of nurses.

The finding of the research indicated how nurses felt and experienced bullying behavior.

Gaps in Research

The literature on nursing students' experiences with bullying highlights several gaps in

knowledge that need further exploration. While the reviewed studies emphasize the prevalence

and adverse effects on nursing students' mental health and academic achievement, they offer

limited insight into the root causes of bullying and practical strategies to prevent it. Moreover,

the literature does not adequately address how nursing educators can incorporate anti-bullying

education into their curricula. Abdelaziz and Abu's study provides an in-depth exploration of the
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impact of bullying on nursing students' mental health and academic achievement (2022). Their

findings indicate bullying negatively affects nursing students' emotional well-being, academic

performance, and clinical skills development. However, the study must identify the root causes

of bullying and practical interventions to prevent it.

Similarly, Courtney et al. (2018) examine nursing students' bullying experiences in

clinical and academic settings. Their study highlights the prevalence of bullying and its

detrimental effects on nursing students' confidence, self-esteem, and professional identity.

However, their findings must comprehensively explain the factors contributing to bullying in

nursing education (Courtney et al., 2018). Iheduru-Anderson offers a unique perspective on the

issue of bullying in nursing education by proposing an educational intervention to address lateral

violence. However, the article needs to provide empirical evidence on the effectiveness of the

proposed intervention, and its generalizability to different educational settings remains to be

determined (Iheduru, 2014). Rutherford's integrative review of interventions against bullying

among prelicensure nursing students and professionals identified several strategies to prevent

and address bullying in nursing education (2019). However, the authors noted that most

interventions needed more rigor in their design and evaluation, limiting their ability to make firm

recommendations.

Scammell et al. (2020) conducted a scoping review of undergraduate nurse education to

explore how nursing students learn to lead. The study identified several educational approaches

that promote leadership development in nursing education, but the review did not directly

address the issue of bullying in nursing education (Scammell et al., 2020). The gaps in

knowledge in the reviewed studies have significant implications for nursing education. The lack

of understanding of the root causes of bullying in nursing education impedes the development of
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effective prevention and intervention strategies (Aul, 2017). The limited research on

incorporating anti-bullying education into nursing curricula suggests that nursing educators may

need more training and resources to address this issue.

Solutions

Healthcare organizations and nursing educators should implement policies and

procedures that prohibit bullying behavior and provide clear guidance on reporting and

addressing bullying incidents. The policies and procedures could include training and education

for healthcare professionals and nursing students on the harmful effects of bullying behavior and

how to promote a respectful and supportive learning environment (Benmore, 2018). Clinical

supervisors should be trained to provide effective feedback and support to nursing students

during their clinical placement. They should be held accountable for ensuring a safe and

supportive learning environment (Corney, 2008). The organizations should foster a culture of

collaboration and mutual respect among healthcare professionals, which can be achieved by

promoting interprofessional education and training and encouraging open communication and

teamwork. Future research should focus on exploring the root causes of bullying in nursing

education and developing evidence-based interventions to prevent and address these gaps in

knowledge (Runnels & Garvida, 2019). Additionally, nursing educators must incorporate anti-

bullying education into their curriculum and receive training on effectively addressing and

preventing bullying in the classroom and clinical settings.

Conclusion

In conclusion, the current research on nurses bullying nursing students highlights the

pervasive nature of this problem and its potential impact on the nursing profession. By

identifying the most common forms of bullying and the potential consequences for nursing
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students, this research can inform the development of targeted interventions and policies to

prevent and address bullying in nursing education (Ma et al., 2021). However, it is essential to

note that much of this research is based on self-reported data, which may be subject to bias and

underreporting. Therefore, future research in this area should employ various methods to provide

a more comprehensive understanding of this problem.

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Theoretical Framework

Bullying is pervasive among nursing students and causes numerous challenges to their

learning. It can occur in clinical and educational settings and involves intimidating, yelling, and

mistreating nursing students. The literature review focused on establishing whether bullying is

caused by nurse burnout, the effects on learners and patient care, and the role of the nursing

curriculum in stopping or reducing lateral violence. Findings indicate the severe impact of

bullying on nursing students and that the nursing curriculum can be enhanced to address the

bullying problem. The solution lies in implementing state-mandated anti-bullying nursing

education into the curriculum at nursing schools and healthcare organizations. Swanson's caring

model provides a framework that can be applied to nursing education curricula to prevent or

reduce nurse bullying in nursing education and practice.

Summary of Literature and Existing Gaps

On the question of the effects of bullying on nursing students and patient care, the review

ascertained that bullying significantly affects nursing students' mental health and academic

achievement. Bullying and harassment are shown to be perpetrated by peers and senior nurses,

confirming the problem's existence and the need to address it (Abdelaziz & Abu, 2022). In

particular, students suffered higher levels of depression, anxiety, and stress, lower academic

achievement, and less job satisfaction. Courtney-Pratt et al. (2018) state that bullying nursing

students can decrease motivation and result in dropouts from nursing programs. However, the

reviewed works do not address the root causes of bullying and provide practical interventions to

prevent it. It also did not directly address the issue of bullying in nursing education.

Several interventions have been proposed in the literature to effectively reduce bullying,
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such as education programs, mentoring, and reporting systems. Iheduru-Anderson (2014)

supports a multifaceted approach to the problem, including education, policies, and reporting

systems to support nursing education and practice. However, the interventions require more rigor

in their design and evaluation, limiting their applicability and effectiveness. The gaps can be

applied by enhancing nursing training and education to make it rigorous and comprehensively

cover the bullying of nursing students.

Regarding the nursing curriculum, the literature shows that educational interventions

have helped significantly improve students' knowledge, attitudes, and behaviors on preventing

lateral violence. Rutherford et al. (2019) state that there is a need for nursing education programs

to integrate lateral violence prevention education to reduce bullying among nursing students.

However, the interventions lack empirical evidence of their effectiveness, and the

generalizability of findings to different educational settings has not been settled. From the

qualitative perspective, the literature indicates that the bullying problem is prevalent in nursing

education, with various forms of mistreatment, such as verbal abuse, exclusion, and humiliation.

According to Scammell et al. (2020), nursing educators and clinical staff must provide safe,

supportive learning environments that promote positive learning experiences. However, a simple

design and curriculum evaluation gap limits their ability to make firm recommendations. An

enhanced curriculum design will help fill the gaps and enhance the generalizability of findings to

different nursing contexts.

Proposed Solution

There is a need for healthcare organizations and nursing educators to enforce policies and

procedures that explicitly prohibit bullying behavior and provide clear guidance on how to report

and address cases of lateral violence. One possible approach is to ensure healthcare professionals
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and nursing students are enlightened on the toxic effects of bullying conduct and the benefits of

being respectful and supportive in learning and practice. Nursing educators should incorporate

anti-bullying education into the curriculum, and the instructors should be trained effectively in

addressing and preventing bullying in the classroom and clinical settings.

Implementing anti-bullying nursing education into the curriculum at nursing schools and

healthcare organizations can help alleviate the problem. The view is referenced to the theoretical

framework advanced by Kristen M. Swanson. According to Andershed and Olsson (2009),

Kristen Swanson's middle-range theory of caring suggests that caring is vital in nursing, which

entails a nurturing process that involves empathy, compassion, and respect for the patient's

dignity. Swanson's caring model can be applied to nursing education curricula to prevent or

reduce nurse-to-nurse and nurse-to-student bullying. The theory proposes that "caring is a

nurturing way of relating to a valued other toward whom one feels a personal sense of

commitment and responsibility" (Andershed & Olsson 2009, p.601). Accordingly, the Swanson

model defines nursing as informed caring for the well-being of others. The view has been widely

embraced in nursing education and practice, especially in improving patient care and providing a

more holistic approach to the profession.

The evaluated works do not address the fundamental causes of bullying or provide

experimental treatments to avoid it. Stakeholders may want to consider doing more research

focused on the root causes of bullying in nursing education to address the highlighted gap in the

works that have been reviewed. To effectively prevent bullying, it is necessary to explore a

variety of factors, including power dynamics, corporate culture, stress, and human qualities, to

name just a few of these areas. More effective therapies can be developed with a deeper

understanding of the underlying factors.

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The research findings should inform the development of nursing education initiatives

that aim to avoid and respond to bullying. These measures need to address the fundamental

problems that have been identified and be modified so that they are suitable for the particulars of

educational settings for nurses. Some examples of practical approaches include the establishment

of anti-bullying rules, the provision of instruction in communication and conflict resolution, the

cultivation of a culture of respect, and the development of helpful learning settings.

When determining what constitutes suitable behavior in their classes, teachers wield a

significant amount of power. It is crucial to offer educators professional development programs

that concentrate on recognizing and responding appropriately to bullying behavior. Professional

development programs will ensure that educators have the knowledge and abilities to prevent

and respond appropriately to bullying incidents. Additionally, educators require direction on how

to provide inclusive educational environments for kids of varying backgrounds.

When nursing students take an active role in the fight against bullying, it can be both

uplifting and helpful for everyone concerned. Encouragement of student-led initiatives, such as

anti-bullying campaigns, support groups, and peer mentoring programs, can effectively instill a

feeling of ownership and responsibility in children. The student-led initiative can be encouraged

by allowing children to lead and participate in community service projects. People's

understanding of bullying can be improved due to these efforts, and they can also get tools and

be encouraged to have more open conversations about the subject.

Nursing schools, professional nursing organizations, regulatory bodies, and student

groups must collaborate in their efforts to address bullying in a manner that is both efficient and

effective. It is helpful to form partnerships and working groups so that information can be more

effectively shared, policies can be developed, and standardized processes may be implemented.
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With the assistance of these partnerships, it is possible to review and keep closer track of the

progress made by various programs.

It is essential to deal with incidents involving bullying quickly; hence, it is crucial to

establish reporting mechanisms that are both anonymous and easy to access. Creating an

atmosphere where students and teachers can report incidents without fear of punishment is

paramount. Providing services such as counseling, mediation, training, and materials for conflict

resolution can help those who have been bullied and create a more peaceful environment within

the school, which can be accomplished by making these resources available.

It is necessary to do ongoing research into the efficacy of interventions and look for

ways to make them more effective. It is essential to actively collect feedback from students,

academics, and other stakeholders and incorporate it into ongoing improvement efforts. Regular

assessments of the learning environment, questionnaires, and recording of bullying occurrences

can be important to make educated judgments and fine-tune therapies. These can all be done to

gather information that can be used.

It is vital to improve the design of nursing curricula and assess it to reduce the skills gap

and create caring classroom environments. Collaboration between those who design educational

curricula and those who teach is necessary to integrate education to prevent lateral aggression

effectively. The collaboration requires establishing particular goals for the learning process,

adopting strategies and activities backed by evidence, and monitoring progress in a relevant

manner. If the curriculum is routinely evaluated and modified in response to feedback from both

students and educators, it will be possible to improve both its efficacy and its relevance.

It is encouraged to conduct research at many sites because it enhances the possibility that

the findings will apply to various settings in which nursing education is provided. Collaboration
 BULLYING IN NURSING 24

between several nursing education programs or institutions makes it simpler to share data

gathered from nursing programs located in a variety of geographic areas, educational levels, and

program kinds. Thanks to this methodology, the results can be more accurately generalized to a

more extensive range of situations concerning nursing education.

In-depth research investigations must be carried out to develop empirical evidence on the

effectiveness of educational interventions in avoiding bullying among nursing students.

Experimentally or quasi-experimentally structured research can be utilized to compare the

outcomes of nursing education programs with and without instruction on avoiding lateral

aggression. Through the collection and analysis of high-quality data, researchers can provide

empirical proof for the usefulness of these interventions.

Conclusion

Bullying is a significant concern in nursing education and practice that causes severe

adverse effects on students and fellow nurses. The problem has been found to cause mental

effects on affected individuals, which impacts nursing practice due to lower job satisfaction and

lack of motivation. Furthermore, the adverse effects of bullying further impact nursing shortages,

high turnover costs, and safe patient care. Literature supports the need to deal with the challenge

through education and training. The approach calls for integrating bullying education into the

nursing curriculum, and the project proposes this be effected through Swanson's middle-range

theory of caring. The idea provides a practical framework for learning and fostering care in

nursing through the education system.

 BULLYING IN NURSING 25

Predictions, Outcomes, and Variables

The issue of nursing bullying among learners and practitioners has been a growing

concern in recent years. The research project aims to underscore the adverse impact of bullying

on nursing students practicing nurses and propose a solution to the problem. The focus of the

project is centered on adjusting the current nursing curriculum to ensure that the nursing program

adequately covers the topic of bullying and its impact on the profession. The project is based on

the view that implementing anti-bullying nursing education into the nursing curriculum can help

reduce highly undesirable behavior.

The central aim is to incorporate anti-bullying education into the teaching curriculum.

Instructors should be trained to address and prevent bullying in the classroom and clinical

settings. The goal is oriented to the operations within the hospital environment to determine if

anti-bullying education will help reduce the nurse-to-nurse and nurse-to-nursing student bullying

problem. Education will positively impact reducing the problem as the outcome can be measured

by the number of cases observed or reported by students and nurses and the enrollment and

dropout numbers. Meeting the objective would be time-consuming and expensive, considering

that curriculum development requires expert input. Introducing bullying education into the

program further needs to be evaluated by the relevant bodies, especially ensuring that it meets

the expected quality standards suitable to the nursing profession.

Measurement

Tracking the number of bullying witnessed or reported by students and nurses is one way

to monitor progress toward the goal. There has been progress if there has been a reduction in

reported instances. Monitoring student engagement and attrition rates is one way to assess the

efficacy of educational programming designed to combat bullying. If this educational plan is

 BULLYING IN NURSING 26

successful, the results may include an increase in the number of students enrolled and a decrease

in the percentage of students who drop out.

It is expected that a wide variety of stakeholders, such as educators, nurses, nursing

students, and possibly even hospital officials, will all work together to achieve the aim. They

concur that halting and treating bullying in healthcare facilities is paramount.

Two hypothetical areas where most, if not all, of the essential parties, would likely agree

are the introduction of anti-bullying education and the training of teachers to confront bullying.

Because instructors, nurses, nursing students, and administrators recognize the value of reducing

bullying among nursing students and nurses, there is a need for anti-bullying education among

these key stakeholders.

Variables

Change of the curriculum will involve several variables ranging from a basic description

of the participants by indicating their age, gender, race, ethnicity, and level of education.

According to various research, bullying is a major factor in why nurses leave or consider leaving

their jobs and is approximately 34% (Edmonson & Zelonka, 2019). The variables are based on

participant reports and cannot be controlled by the researcher. Additionally, the project will aim

to describe the impact of a curriculum change on the nursing program, enrollment and dropout

numbers, job satisfaction, and the nature of the working culture and environment. Therefore,

implementing the curriculum at a department level will require adequate resources to collect and

analyze the variables' data. However, the state and professional bodies can further support the

refinement of the courses as a requirement in a continued effort to eliminate lateral violence and

bullying in the healthcare industry. Stricter mandates and fines should be placed on institutions

that do not implement these programs or have higher rates of human resource complaints
 BULLYING IN NURSING 27

regarding bullying. The measures will help in holding the institution and stakeholders

accountable for being part of the solution.

Data Collection

The research is best conducted using a mixed-method approach that combines qualitative

and quantitative data collection methods. The design is expected to provide a more

comprehensive understanding of the nursing curriculum's impact on reducing bullying.

Qualitative data can be collected through interviews, focus groups, or open-ended survey

questions. Qualitative data can be used to collect information on bullying among nursing

students, which would allow for a more in-depth understanding of the experiences nursing

students have out of an enhanced nursing curriculum.

Quantitative data can be collected through surveys, allowing for large sample size and the

ability to analyze the data statistically. The survey could include questions about the prevalence

and frequency of bullying among nursing students and the impact of nursing education on

bullying. Patten and Newhart (2018) state that quantitative data would allow identifying patterns

and relationships between variables. Therefore, the mixed method approach would allow for the

triangulation of data from both quantitative and qualitative sources, which would provide a

complete picture of the issue of bullying among nursing students and the nursing education on

the problem, thus allowing for a more nuanced understanding of the issue and inform the

development of additional interventions to address bullying.

Impact of Research on the Community or Social Change

The research adds to the existing literature by highlighting the harmful effects of bullying

among nursing students and practitioners. In particular, the study will support the community by

pushing for a policy shift to prohibit bullying explicitly. Societal will benefit from having a clear
 BULLYING IN NURSING 28

procedural framework for reporting and addressing lateral violence cases. Societal will be

enabled by supporting adequate learning on the toxic effects of bullying mannerisms and the

benefits of being respectful and supportive in nursing education and practice.

Limitations of the research

Like any other discipline, the nursing profession has knowledge gaps regarding bullying

victims and perpetrators. The following are some examples of common issues that arise with

bullying research in the nursing literature:

Data collection on bullying experiences frequently relies on self-reporting methods, even

though these approaches are prone to bias. On the other hand, self-reporting can be inaccurate

due to several variables, such as the social desirability bias or people's reluctance to open up

about their life. The frequency of bullying and its effects are susceptible to either

underestimation or exaggeration, depending on the direction the bias takes.

The research findings may not be generalized to a larger population due to the

characteristics of the sample populations. Suppose research is restricted to investigating only one

kind of healthcare institution, one area, or one population group. In that case, the results may not

be representative of the nursing profession's broad diversity in an appropriate manner. As a

consequence of this, the findings might not apply to a variety of contexts or groups.

A cross-sectional design, in which information is recorded at a particular time, is utilized

in many investigations. Research on the origins and consequences of bullying over a more

extended period is impeded by the nature of the problem. Studies that follow people over time

and keep track of their behaviors throughout their lives can provide more light on what causes

and contributes to bullying in nursing.

Due to the lack of clearly defined definitions and metrics for bullying in nursing, it may
 BULLYING IN NURSING 29

not be easy to compare and combine the findings from multiple studies. Differences in the

description, operationalization, and quantification of bullying can lead to variations in the

reported prevalence rates of bullying, which makes it challenging to draw factual inferences from

the data.

There is a lot of data on the occurrence and repercussions of bullying in the nursing

profession; however, there is less information on effective interventions and the results of those

interventions. There is a pressing need for additional research testing the effectiveness of specific

interventions, strategies, and policies to treat or prevent bullying in the nursing profession,

Those of research that are either positive or statistically significant have a greater chance

of being published than those that are either null or inconclusive. This publication bias in the

overall representation of research on bullying in nursing may result in an overemphasis on

certain traits or outcomes and an underrepresentation of less favorable or inconclusive findings.

The reason that bullying in the nursing profession is rarely reported is likely due to a

combination of factors, including the fear of retaliation, feelings of humiliation, and concerns

about one's professional reputation. As a result of this, the true prevalence of bullying among

nurses, as well as the consequences of bullying, may be underestimated.

Limitations from the Literature Reviewed

Studies that were examined were carried out on minimal groups of participants, such as

nursing students from Egypt, Australia, and the United States. Likely, the findings don't apply to

nursing students and professionals who live in other parts of the world or come from different

cultural backgrounds. Consequently, additional caution is required before generalizing the

findings to cover the entire population.

The fact that several of the research relied on self-administered questionnaires or

 BULLYING IN NURSING 30

qualitative interviews was a methodological fault in a few investigations. While informative,

these approaches are susceptible to being influenced by respondent bias and may not be able to

capture the complexity of bullying incidents. In addition, using cross-sectional designs in

particular research makes it difficult to establish causal linkages or evaluate their long-term

effects.

Due to the absence of standardized measures for bullying in nursing throughout the

analyzed study, it is difficult to compare data and generate consistency in defining and

measuring bullying, which makes it more challenging to conclude the research. Because of this

disparity, the results' trustworthiness and precision may be questioned.

While the studies that were looked at shed light on the prevalence and impact of bullying,

they do not give much investigation into the fundamental causes and elements that contribute to

bullying in nursing education and practice. A more profound knowledge of these underlying

elements is required for the development of strategies that are both preventative and

interventional.

The bullying that nursing students experienced received disproportionate attention, while

the bullying shared by nurses in the field received nowhere near as much attention. Because of

this gap, researchers have not been able to conduct an exhaustive investigation of the

mechanisms at play when bullying occurs in the nursing profession.

A phenomenon known as "publication bias," which could place when more positive

studies than negative ones are published, is one of the potential shortcomings in the evaluated

body of research. This bias may impact the dissemination of research on bullying in nursing,

making it impossible to access less favorable or inconclusive findings.

Most examined studies only looked at the short-term effects of bullying on nursing
 BULLYING IN NURSING 31

students' mental health and academic performance. There was no long-term follow-up. On the

other hand, there was a widespread shortage of long-term follow-up investigations to determine

whether or not bullying incidents continued or were resolved.

 BULLYING IN NURSING 32

Methodology

Bullying in medical education and practice in health care can be considered one of the

current industry issues in focus. Addressing this issue is significant because developing effective

strategies to reduce bullying in the healthcare profession, particularly nursing, is necessary due to

observations and summaries in relevant research. It is critical because of the accompanying

complexities and severity of the consequences caused by the existence of such a social

phenomenon in work, educational, and trainee environments, among which it is imperative to list

academic performance, mental health, and satisfaction with the situation. This research project

includes examining the effects of implementing anti-bullying and the effectiveness of other

solutions to the problem. This section focuses specifically on formulating and understanding the

research methodology, which includes the proposed design, details of data collection and

processing strategies, and ensuring the validity of the study.

Statement of Purpose

At the beginning of the methodology formation, general objectives must be formulated to

understand better the most effective and necessary ways to conduct the study. Thus, the purpose

is to examine the specifics of the impact of implementing specific training for nurses against

bullying and moral abuse. Moreover, the direction of the study includes embodying the growing

concern about bullying in nursing education and practice to find solutions to mitigate the

problem. In doing so, the efficacy of education involves actively fostering a supportive

atmosphere in the industry that includes an understanding of equality and respect for one another

by all concerned.
 BULLYING IN NURSING 33

The main focus of the study seeks to introduce new types of instruction or to expand on

previous interaction courses to reduce or eliminate negative probabilities of bullying. It is a point

that relates to the main object of study. Causes include the importance of academic performance,

satisfaction with the social environment, and the mental well-being of nursing students,

practicing and registered professionals from the same field. An additional reason is a desire to

develop an optimal approach to reduce the negative consequences necessarily associated with

bullying: a drop in the quality of patient care, the dismissal of staff, or a decline in the

professional development of nurses.

Population-based research includes a sample of nursing students and practicing nurses in

academic institutions, and healthcare organizations formed through purposiveness and

convenience. In this context, the purposefulness of sampling is implicit in the realization by

diversifying and providing participants from different settings and backgrounds while

maintaining proportionality. It implies seeking out and inviting participants of different racial

and ethnic backgrounds, sex and gender identities, and age groups to comprehensively approach

anonymized nurses' personal experiences (Ma et al., 2021). Convenience sampling is planned for

use by selecting active participants in programs, training, or practice in healthcare institutions,

subject to confirmation of willingness to participate, as it can pose an issue (Abdelaziz & Abu,

2022). This type of conditions practical access to the necessary participants capable of providing

data for checking the effectiveness of anti-bullying training. Accordingly, population-based

studies involve recruiting willing participants through modern technology, particularly electronic

mailing lists and messengers, and creating announcements on resources relevant to nursing work

or training. Indeed, ethics and confidentiality must be maintained by obtaining informed consent,

ensuring the security of the data obtained, and encrypting participants for confidentiality
 BULLYING IN NURSING 34

purposes.

Description of the Methodology

The study involves a mixed-methods design incorporating quantitative and qualitative

data collection methods. This approach was justified in previous sections of the paper and is to

gain as comprehensive a view as possible of the impact of nurse anti-bullying training in the

curriculum on reducing the likelihood of abusive environments. The combined approach in this

format has the most coverage and can help triangulate data from different sources to get the most

detailed and holistic view of the report's topic.

Therefore, in defining a more precise research design, each of the components of the

specifics of the study should be evaluated separately. For example, the quantitative part involves

collecting numerical data from surveys to determine the prevalence of bullying. Moreover, it

notes changes in the number of these occurrences and trends of increase or decrease and

determines the effectiveness of newly implemented training. A descriptive design can achieve a

comprehensive report on the characteristics and frequency of incidents and the implementation

of educated interventions.

Furthermore, quantitative data analysis utilizing sample surveys should include

correlation methods and descriptive statistics. In this way, it will be possible to connect anti-

bullying training and the incidence of such disrespect in practice. Surveys should include

questions about the team's existence, nature, and frequency of bullying or humiliation. Observing

the effectiveness of interventions can contribute to understanding the overall impact on creating

a healthy work environment and the dynamics of satisfaction with work or training processes.

The qualitative component, in turn, includes a discussion of the research topic with the
 BULLYING IN NURSING 35

participants and goes beyond a standardized test questionnaire with pre-determined options.

Semi-structured interviews with nursing students and practicing nurses can be conducted in focus

groups to look for causes and commonalities in potential bullying incidents (Griffiths et al.,

2020). Furthermore, this method of thematic analysis facilitates the identification and

classification of themes and patterns in the data, encompassing an understanding of perspectives

as a result of narrative comparison of interviews and participants' experiences with the issue of

bullying to emphasize the dynamics of attitudes toward this manifestation.

The other methods reviewed include historical and experimental designs, which are

discarded for several reasons. Although historical research contributes to understanding

phenomena and events over time, it cannot be used to determine the current level of the problem

and the impact of proposed anti-bullying training on its level. In some cases, such a design may

contribute to a prediction of relative accuracy that has little correlation to the dynamics of the

issue and its development. Experimental design, on the other hand, may allow for the most

specific research and consideration of levels of controlled intervention (Timans et al., 2019).

However, this involves some complexities, including the inadequacy of real-world nursing

settings and the inability to divert staff from health promotion work.

Thus, a mixed-methods approach will allow quantitative and qualitative data collection to

examine the topic and research question comprehensively. Moreover, a combination of designs is

not uncommon in academic work, and a combination of selected ones can be pretty effective

regarding reliability and integrity (Timans et al., 2019). That said, the existing gap in the

knowledge base has a much better chance of being filled through a wide range of tools, which is

what the study emphasizes.

Assumptions
 BULLYING IN NURSING 36

Bullying is a widespread problem in the healthcare industry, particularly in medical

education and practice, and it needs to be addressed. Comprehensive anti-bullying policies are

required in nursing and throughout the healthcare industry. In healthcare settings, the impacts of

bullying on students' academic progress, mental health, and job satisfaction are all adverse.

Bullying can harm all three of these areas. If anti-bullying training is required for nurses, there

will be fewer instances of bullying in the nursing profession.

It is possible to investigate anti-bullying initiatives and determine how effective they are.

The target demographic is students in nursing programs and registered nurses in hospitals and

other healthcare facilities. It is possible to gain a deeper comprehension of nurses' experiences by

drawing samples from diverse occupational settings and population subgroups. The full scope of

the benefits of anti-bullying training will be revealed when quantitative and qualitative data

collection methods are used together.

By analyzing numerical data, one can ascertain the prevalence of bullying and the

effectiveness of various training interventions. The participants' experiences, points of view, and

opinions on bullying will become apparent by examining qualitative data. A mixed-methods

approach yields results that are more trustworthy and comprehensive than those obtained through

the use of just one technique for data collection.

Data Collection

Thus, data collection should follow the previously defined mixed design and include

qualitative and quantitative approaches. Both contextual and numerical information should be

collected to increase the feasibility and the ability to capture participants' personal experiences

and diverse perspectives. Quantitative data includes questionnaires in electronic or brief voice

format that involve selecting a response from the choices offered on a Likert scale or self-
 BULLYING IN NURSING 37

introducing what can be interpreted in numerical format. It considers previous researchers'

experience assessing bullying levels in the medical field, focusing on nurses (Abdelaziz & Abu,

2022). Additional adaptation and tweaking of the instruments can be made during the sampling

process to understand levels of coverage and compliance with given parameters of diversification

and validity.

Electronic or physical media will be questionnaires directly, depending on the interview

and meeting formats. Undoubtedly, the advantage should be given to the digital completion

method because of the convenience for both parties and the time savings in collecting and

digitizing the information. It is suggested that a minimum of 50 individuals belonging to groups

of students or current nurses be considered among such a sample to maximize the accuracy of the

outgoing data. If possible, having the same group of observers complete the questionnaire before

and after the respectful interaction pre-training would be most optimal. In each case, informed

consent and explicit adherence to data security guidelines will be mandatory. In the future, a

correlational analysis will be possible in addition to descriptive analysis, and the efficacy of the

training should become evident.

Qualitative data are planned to be collected in the form of detailed semi-structured

interviews and additional focus group discussions. Implementation can be done via online

messengers or video conferencing applications, leaving face-to-face meetings as an extreme case

and ineffective method. The total number of participants is planned to be at least twenty people,

combining an increased amount of data for better credibility and not exaggerating the time cost

of the process. The tools used in the qualitative data collection process include a set of questions

and topics, an interview guide, and a transcript or discussion protocol, and are developed

according to established guidelines. In doing so, the main goal should be to have the assurance of
 BULLYING IN NURSING 38

collecting all of the information necessary to achieve the study's goals as much as possible. Data

recording also requires the consent of the participants, and in the absence of video, non-verbal or

intonation cues should be marked separately.

The analysis plan includes an appropriate symbiosis of the methods mentioned in the

formation of the research design. Thus, quantitative data analysis implies applying statistical and

correlation parsing methods, which can be carried out with the help of appropriate software:

SPSS, MS Excel, and others. Averages, deviations, and frequencies represent descriptive

statistics, while logical statistics contribute to studying relationships between variables.

Qualitative data are decoded and analyzed using thematic and narrative analysis to identify

common themes, patterns, and categories of data. This analysis will be conducted iteratively,

highlighting a turn-by-turn approach and identifying common relationships in describing

different experiences and opinions. Moreover, it can help ensure that the material is saturated

with data, and when compared to the results of quantitative analysis, significantly increases the

summative validity of the work.

The connection to the research questions and topic is close and obvious, as the data's

examination and interpretation are conducted to achieve specific research objectives. It is

directed at identifying trends, dependencies, and key outcomes of the anti-bullying training

intervention on the level of social trust in teams and the overall health of nursing interactions.

Supported by statistics from interview processing, data on the effectiveness of such training

courses will become even more accurate and unbiased.

As a generalization of the question, it is possible to create a data analysis plan, and it also

includes a mixed-methods approach to assess the effectiveness of anti-bullying and moral

bullying in the nursing curriculum. First, some of the information from the quantitative
 BULLYING IN NURSING 39

component of the data collection should be analyzed, and the discussion process in further

interviews can be focused and sub-edited to focus on the important points of the topic. After that,

a thematic analysis of the data from the interviews can already be conducted to uncover students'

or nurse practitioners' perceptions, experiences, and attitudes in the context of bullying. Further

integration is designed to highlight general trends and draw conclusions about the dynamics of

the problem and the effectiveness of existing countermeasures.

Factors Influencing Data Collection

Researchers consider the practicalities of collecting qualitative and quantitative data for a

complete picture. This option is based on the researchers' ability to record the participants'

perspectives and life experiences. Background study determines whether electronic or brief voice

questionnaires are utilized to collect quantitative data on medical bullying, particularly among

nurses (Abdelaziz & Abu, 2022). Researchers are following industry standards.

Researchers know they must adjust data collection equipment during sampling. They can

assess coverage and diversity to ensure accurate and relevant data. Due to its simplicity and

efficiency, digital completion is chosen for data collection by participants and researchers.

Optimizing data collecting and digitization motivated this decision. The researchers will use 50

nursing students and practicing nurses to ensure data quality. Statistical power and the need for

reliable results may influence sample size.

Researchers recommend explicit consent and rigorous processes for protecting sensitive

data, which concerns data collection for confidentiality and ethics. In-depth semi-structured

interviews and additional focus group discussions will be used to acquire qualitative data. When

in-person meetings are impractical, convenience and efficiency determine whether to utilize

internet messengers or video conferencing software.

 BULLYING IN NURSING 40

Researchers analyzed quantitative data using SPSS and Excel. Descriptive and logical

statistics investigate trends and correlations. Thematic and narrative analysis for qualitative data

focuses on identifying common themes, patterns, and data categories. These analysis methods

were presumably chosen due to field standards. Study questions and objectives guide data

collecting. Data analysis and interpretation should indicate anti-bullying training program

patterns, correlations, and notable findings. The study's objectives determine data collection and

analysis.

Conclusion

Thus, the primary purpose of this section is to define the design, data collection, and

evaluation methods and maintain the study's validity in the context of the pressing issue of

bullying in nursing practice and education under consideration. Examining the levels of impact

of the bullying prevention strategy based on the proposed methods of processing and testing the

results suggests that the research objectives will be achieved most effectively. Moreover, the

careful planning of the data collection, interpretation, and analysis that this section is responsible

for generating contributes to existing knowledge bases, promoting a culture of respect and

diversification, and providing the necessary potential policy changes for increased support and

professionalism in nursing education.

 BULLYING IN NURSING 41

Key Stakeholders

There are several relevant parties to consider when attempting to address and find a

solution to the problem of bullying in the nursing profession. These parties include the

following:

Students in the Nursing Profession Nursing students have one of the highest rates of

being bullied at school compared to students in any other profession. They need to advocate for

safer conditions in schools, report incidents when they occur, and participate in educational

efforts in this area. Students' perspectives and ideas are valuable to developing anti-bullying

policies and programs.

Practitioners in Nursing: Experienced nurses can potentially be both victims and

perpetrators of bullying. They must be involved to create a climate where nurses are appreciated

and cherished. Practitioners can fulfill the roles of mentors and role models by assisting students

and working together to cultivate a welcoming and diverse workplace environment.

Educators working in the profession of nursing have a significant impact on the direction

that academic institutions take. They are vital in establishing a safe environment, assisting

students in locating their way around the school, and quickly responding to bullying incidents.

For educators to play their bit in the fight against bullying, they should incorporate teachings on

the subject into their lesson plans.

Higher education establishments in the nursing area have a moral commitment to fulfill

the educational needs of their students by providing a safe and encouraging atmosphere in which

to study. They can train teachers and staff on handling bullying situations, design policies and
 BULLYING IN NURSING 42

protocols to avoid bullying among children and settle conflicts resulting from bullying.

Collaborating with healthcare organizations and other professional groups can be an effective

strategy for bolstering anti-bullying initiatives.

Associations and Organizations for Nurses: These groups have the potential to impact

nursing by establishing standards for the profession that promote a constructive working

atmosphere that is abundant in mutual respect and comprehension. Those who have been bullied

in the past can benefit from establishing guidelines, policies, and educational resources geared

toward stopping bullying.

It is the responsibility of hospitals, clinics, and other healthcare facilities to ensure that

the working conditions of its nurses are safe and conducive to good health. They can support

efforts to create an environment of mutual respect and cooperation among medical staff, adopt

policies against bullying with a zero-tolerance policy, host training on effective communication

and conflict resolution, etc.

Regulatory bodies and accreditation agencies can exercise their authority to enforce

professional standards and norms. They might contribute to the fight against bullying by

mandating that schools and hospitals establish anti-bullying policies, conducting random checks

to ensure these policies are being adhered to, and penalizing those who break the rules.
 BULLYING IN NURSING 43

Ethical Consideration

Key Populations

Participants. A sample of nursing students and working nurses from academic

institutions will participate in this study. To thoroughly examine the subjective experiences of

anonymous nurses, they will represent a variety of racial and ethnic backgrounds, sex and gender

identities, and age groupings (Timans et al., 2019). At the same time, they will be employees of

various medical institutions that differ in economic development, geographical, demographic,

and socio-cultural indicators.

Researchers. Researchers must have a medical background to understand the

terminology used by participants. In addition, they must know about the phenomenon of

bullying, such as awareness of its signs and ways of manifestation (Benmore et al., 2018).

Researchers having a medical background ensures recognition of cases of bullying in participants

unaware of it.

Participant Recruitment

When recruiting participants, it is necessary to guarantee the confidentiality and non-

disclosure of diagnostic information without the subject's explicit consent. It is also

recommended to test potential participants for the presence of subjective attitudes to achieve

maximum objectivity in judgments (Benmore et al., 2018). In addition, it is necessary to assess

the level of professional competence of nurses involved in the study to establish bullying and not

errors caused by insufficient knowledge in the occupational field. Thus, potential participants'

consent must also be gathered to arrange a competency test.

 BULLYING IN NURSING 44

Addressing Considerations

Potential participants must pass rapid tests for bias and professional qualifications to

address the listed considerations. After that, they must sign a confidentiality agreement, which

will stipulate which of the information provided to them can be published.

Data Collection & Intervention Activities

Participants Refusing Participation. Some participants may refuse due to fear of

negative consequences from voicing certain information by them. For example, they may worry

about a possible dismissal due to the situations they told the researcher.

Early Withdrawal from Study. Some of the questions may seem uncomfortable to

participants. They may feel ashamed or angry when they need to recall bullying-related

situations (Timans et al., 2019), which may cause them to withdraw early from the study.

`Predictable Adverse Events. Adverse events may include the fact that during an oral

survey, some participants may get confused and answer not quite the way they wanted. These

introverts often find it challenging to quickly figure out and express their experience in detail.

Addressing Concerns

Participants Refusing Participation. It is necessary to ensure their confidentiality to

avoid participants' refusal to participate due to fear of consequences from the disclosed

information. To do this, the participants will sign an agreement that guarantees anonymity when

publishing their provided data (Benmore et al., 2018). The researcher's explanation of this

information will give the participant confidence in providing the necessary information.

Early Withdrawal from Study. It is necessary to make an open-type questionnaire to

prevent the early withdrawal of participants from the study. Open–type questionnaires will allow

the participant to refrain from answering a question they find uncomfortable and move on to the
 BULLYING IN NURSING 45

next one (Timans et al., 2019). Then there will not be such a situation that, due to the inability to

refuse to answer the question, the participant will prematurely stop participating in the study.

Predicable Adverse Events. To avoid these events, you can give participants a list of

approximate questions that will be included in the interview, thus giving them time to prepare

their answers and think about how to formulate them (Timans et al., 2019). In addition, the

researchers can allow participants to prepare notes and take them to the interview to avoid

forgetting what they wanted to say because of the anxiety during the conversation.

Treatment of Data

Description of Process. The first stage of interview processing is compiling a written

text (transcript) of the participant's statements. The experience of conducting surveys shows that

magnetic recordings and handwritten recordings made during the interview cannot be used as the

primary material for their comprehension and processing (Timans et al., 2019). After that, the

data obtained will be synthesized, and the answers to the questions will be placed in semantic

categories.

Access. Access to the research data will be provided directly to researchers. Access will

be provided to avoid data leakage and preserve confidentiality, which is extremely important for

participants.

Protection of Confidential Material

It is necessary to ensure secrecy or confidentiality to protect the confidentiality of the

material provided by participants. To do this, when conducting a study, both the researcher and

participant must sign a legal contract (Timans et al., 2019). It should specify the composition of

the information about the study, which they recognize as confidential.

Conflicts of Interest
 BULLYING IN NURSING 46

Conflicts of interest that may arise if my study were to be implemented lie in the

disagreement between the information provided by the medical staff and the clinic management.

It is beneficial for nurses to have their work recognized as more stressful to receive additional

payments (Benmore et al., 2018). It comes into a conflict of interest with the management, which

is more profitable to hide cases of bullying nurses.

Trustworthiness

Quantitative and qualitative strategies must be assumed due to the mixed methodology in

considering the research's credibility and appropriateness. Thus, the qualitative part can be

achieved by selecting the most appropriate sample of participants, building trust and rapport with

them, and triangulating the data obtained from existing sources and their observations (Palinkas

et al., 2019). An audit trail may be used to document all decisions and actions taken during data

collection and processing.

Dependability should contribute to the transparency and replicability of the study by

clearly documenting the design, collecting data on bullying, and following generally accepted

procedures during analysis. The reflective control log can be supplemented with the researcher's

thoughts and assumptions to achieve this quality. Mixed methods can ensure confirmability, as

they highlight and simplify the impartiality of the researchers' position (Palinkas et al., 2019). In

addition, citations and comparisons with similar work in the industry can increase traceability,

overall confirmability, and scientific rigor. Transferability requires detailed description and

control of all steps of the study to demonstrate the universality of results and their ability to be

applied in similar but different contexts - this is greatly aided by diversified strategies for

selecting participants in the sample and all perspectives on the topic.

Quantitative qualities include internal and external validity, objectivity, and reliability,
 BULLYING IN NURSING 47

and the first two imply that the work meets all established norms. Internal validity measures how

well a study demonstrates a causal relationship between variables inside its environment. Internal

validity in nursing bullying research requires addressing concerns that could undermine

outcomes. Internal validity is supported by strategies for finding correlations and causal

relationships, and randomization among statistical methods can be applied to increase validity

and minimize mixed variables. Controlling confounding variables that may impact bullying's

effects is important. Gender, experience, and business culture may confound the correlation.

Randomization, matching, or regression analysis can control such factors. It also involves

choosing a study that allows causal inferences. RCTs or well-designed longitudinal studies boost

internal validity.

Standardized data gathering reduces measurement error and bias. For accurate data,

please explain what is being gathered, how it will be measured, and by whom. Pilot testing and

inter-rater reliability evaluation reduce measurement error and improve internal validity.

Addressing attrition and missing data prevents bias and preserves the study's internal validity.

Tracking people, offering incentives, and using statistical approaches like imputation should be

used to handle missing data.

External validity refers to a study's ability to be applied to other persons, places, and

conditions. Bullying studies in nursing need external validity to be relevant. For setting

relevance, we considered the study's nursing surroundings. The study considers workplace

cultures and bullying dynamics change o exercise external validity. External validity lies in the

careful preparation for the study, including selecting appropriate participants from the required

nursing population, and consists of representativeness, contextualization, and recognition of

study organisms.
 BULLYING IN NURSING 48

Objectivity includes the absence of bias and correlates largely with qualitative research -

standardization of data collection and analysis procedures additionally supports the strategy of

interaction with the sample. Adherence to generalized rules and protocols in analysis or early

partial anonymization of results is also part of a unified strategy for achieving performance.

Reliability correlates with dependability in many ways and requires a careful approach to using

optimal and effective tools.

Reliability of the quantitative participant data includes identifying the components of

nurse bullying that will be measured and defining bullying variables like frequency, form, and

emotional impact. Definitions will improve data collection. It also involves using proven

technologies to measure the variables of interest. Accurate measurement devices promote

repeatability and comparability.

There will be a test for a group of possible respondents before releasing the whole survey,

addressing data-gathering tools, guidelines, and process issues. Pilot testing improves the

accuracy of the data. Standardizing data collection reduces bias and ensures participant

homogeneity. Interviewers and survey administrators will be instructed to be consistent. Data is

more consistent and error-free.

There will be training for all data collectors to assess rating consistency by comparing

raters' opinions on a set of practice participants, ensuring reliable data collection. To maximize

population representation and minimize selection bias, the researchers will choose participants

through randomization or sampling. Randomization and other sample methods improve validity

and generalizability.

The research will verify data entry and implement quality control to discover and repair

errors. Safety storage and backup data will help to avoid loss or tampering. We will also collect
 BULLYING IN NURSING 49

test-retest data from the same people at various periods and analyze reaction stability over time.

Repeated responses indicate reliability. The research will employ statistical analysis to verify

data. Internal consistency can be measured by Cronbach's alpha and inter-rater reliability by ICC.

These studies quantify data quality. Asking local nurses and specialists about bullying improves

the quantitative findings by getting their input on the study’s strategy and data collection

procedures.
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Significance and Summary

Summation of the Research

Bullying occurs among nursing students and registered nurses, making it an urgent

problem. Recent years have seen a rise in the number of studies investigating bullying in nursing

and its consequences. The nursing profession faces a significant problem with bullying. It harms

patients' treatment, safety, mental health, the satisfaction gained from working, and professional

growth and development.

The importance of the topic is reflected in the surveys and reports compiled by nursing

organizations. These questionnaires have been filled out honestly by nurses and nursing students

who have been bullied, and their responses have been included. They demonstrate that many

individuals employed in the healthcare industry have been bullied.

Bullying in the nursing profession is frequently covered in nursing journals. These

articles discuss different definitions, philosophies, and case studies about bullying. Students in

nursing programs should devote some class time to learning about the causes, impacts, and

potential remedies of bullying.

Many nursing organizations have implemented anti-bullying policies. Declarations and

materials have been made available by the American Nurses Association (ANA) to combat

workplace bullying and encourage happy workplaces. These recommendations consider how

serious the problem is and the need to take preventative measures.

Harassment of nurses can result in significant legal problems for hospitals and other types

of healthcare facilities. Bullying in the workplace justifies taking legal action. According to these

judgments, companies can be held legally responsible for their indifference toward the adverse

effects that bullying has on both their employees and their patients.
 BULLYING IN NURSING 51

Recent coverage in the media has focused on bullying in nursing. There have been

reports in the media and documentaries about nurses who were bullied while on the job. The

publicity the subject received in the media helped bring attention to it and promoted awareness.

The present body of research on bullying among nursing students contains significant

holes. Although previous research has highlighted the issue of bullying among nursing students

and its detrimental repercussions, it has not produced much in the way of explaining or solving

the problem. In addition, there is a shortage of in-depth studies on how nursing professors may

include anti-bullying instruction into already established course material. According to the

research that Abdelaziz and Abu (2022) conducted, bullying harms the mental health and

academic performance of nursing students. However, the research does not explain why this

occurs or suggest solutions. Although Courtney et al. (2018) highlight the ubiquity of bullying

and its profound implications, they do not comprehensively examine the elements contributing to

the problem.

Iheduru (2014) suggests an educational strategy for dealing with bullying, although any

available data do not support this strategy. Rutherford (2019) emphasizes measures to combat

bullying but notes that more rigorous design and evaluation are necessary. Scammell et al.

(2020) emphasize how important it is for nurses to have leadership training, but they do not

address the issue of bullying. Because of information gaps, nursing education cannot effectively

teach preventative and intervention strategies. In addition, the limited research on the addition of

anti-bullying instruction reveals that nurse educators require additional training and resources to

address this problem effectively. These shortcomings must be remedied to provide nursing

students a secure and intellectually challenging atmosphere.

 BULLYING IN NURSING 52

Significance of the Study

The conclusions drawn from studies on bullying have been helpful to a number of

different facets of nursing and nursing education. Research on bullying conducted within the

nursing profession educates both the nursing profession and the general public on the nature and

scope of the problem. Investigation into the matter raises people's awareness, encouraging those

who have a stake in the matter to take action. It allows individuals and organizations to advocate

for creating new laws, rules, and programs that foster an atmosphere conducive to learning and

growth.

The outcomes of this study give data that could potentially be used to influence future

anti-bullying policies and practices in the nursing profession. The findings can assist

organizations, nursing organizations, and regulatory bodies in developing anti-bullying policies

and implementing those policies, including rules of zero tolerance, mechanisms for reporting

bullying, and specific methods for dealing with situations described. These laws are intended to

establish a climate in which nursing students and professionals can work and study in an

atmosphere that is characterized by mutual deference and assistance to one another.

Research on bullying within the nursing profession impacts educational programs and

curricula establishment. It highlights the importance of anti-bullying education and provides

insights into valuable approaches that may be used to avoid and cope with bullying. Nursing

instructors may use this research to develop new content for their curricula that addresses

bullying, dispute resolution, and courteous discourse. By bringing the issue to the attention of

nursing students and professionals, we can create an atmosphere in which everyone is treated

with respect and provide victims with the resources they require to deal with the effects of

bullying.
 BULLYING IN NURSING 53

The findings of the study will have significant repercussions on the way that healthcare

organizations conduct their cultures. Companies can use the data to analyze their culture and

locate problem areas. They can take action to make their place of employment more welcoming

by emphasizing mutual respect, collaborative effort, and positive reinforcement. Examples of

things that can be done include leadership development, fostering open dialogue, establishing

mentoring programs, and encouraging individuals to speak up when they witness bullying. By

tackling bullying, companies can create an atmosphere that boosts their employees' health,

morale, and job satisfaction, in addition to the quality of care they provide to patients.

The study's findings on bullying in nursing highlight the significance of continuing

education and maintaining a healthy personal life for registered nurses and nursing students. The

detrimental effects of bullying on one's health, level of job satisfaction, and opportunities for

professional advancement are emphasized. Because of this knowledge, businesses and

educational institutions are more likely to invest in programs that encourage the nursing staff's

personal and professional development. In this category, you might find professional and

educational advancement possibilities, counseling services, and activities that include peer

interactions.

Recommendations

The research on bullying in nursing led to the formulation of several hypotheses and

recommendations for further research, which are as follows:

Researching the factors that lead to bullying in nursing education is required to get to the

bottom of the problem and find a solution. The research includes how people, groups, and

institutions form and maintain bullying behaviors. This research will be beneficial in gaining a

deeper comprehension of the complex dynamics and the development of workable solutions.
 BULLYING IN NURSING 54

Another recommendation is developing efficient preventative strategies and investigating

and evaluating potential solutions to the problem of bullying in academic contexts, including

nursing students. Find strategies supported by research that can be implemented at the individual,

organizational, and educational levels to make the educational experience for nursing students

more positive and conducive to success.

Stakeholders can examine the efficacy of the interventions by conducting an in-depth

analysis to see how effective anti-bullying initiatives are at nursing schools. They can discover

how effective various anti-bullying programs, policies, educational interventions, and support

systems are in creating an environment of mutual respect and competence.

Incorporating anti-bullying education into nursing programs and looking into case studies

of similar programs that have been successful is also an important consideration. It is vital to

examine several educational modalities, such as workshops, simulation-based training, and

reflection exercises, to equip nursing students to deal with bullying better, which will be

accomplished by equipping nursing students to cope with bullying.

The stakeholders need to consider the repercussions of bullying. They should keep tabs

on nursing students during their education, observe how bullying influences their mental health,

job prospects, and overall development, and investigate this topic in light of how it pertains to

nursing burnout, work satisfaction, and professional advancement.

There is a need to examine the effect that onlookers had, as well as the company's culture,

which involves investigating the role of bystanders and the workplace culture in bullying in the

nursing profession. It is essential to investigate the individuals who witnessed bullying and the

organizational aspects supporting or prohibiting it. There is a need to create an environment

where bystanders feel safe intervening when bullying incidents occur.

 BULLYING IN NURSING 55

Educators need to analyze how the educational systems of various countries are similar

and different. By performing comparative research, they can investigate how students' bullying

experiences in different educational settings and nations are similar and different. They can also

consider the role that factors such as society and environment play in determining the prevalence

of the manifestations of bullying.

Investigating how bullying may affect the standard of care provided to patients and their

safety is also an important aspect. There is a need to examine how bullying in nursing school can

affect patient outcomes, such as drug administration errors and contentment levels. The findings

of this study might be used to highlight the necessity of combating bullying within the nursing

profession for the sake of the nurses' health and the health of the patients they care for.

Understanding the topic from the points of view of several different interested parties is

imperative. Investigating the perspectives and experiences of a wide range of healthcare workers,

including nursing students, nurses, clinical professors, nurse managers, and others, is crucial.

When many points of view are considered, the dynamics and impacts of bullying in the nursing

profession can be comprehended with greater clarity.

There is a need to consider the effects of bullying on organizational culture in nursing by

examining how healthcare organizations' leadership, communication, power dynamics, and

support systems all contribute to developing and continuing bullying situations.

Paying close attention to the specifics and researching the incidence of bullying in

distinct healthcare environments such as hospitals, nursing homes, and clinics can be helpful.

Paying close attention can assist in shedding light on the specific challenges and dynamics of

bullying in various practice settings.

As part of evaluating the effect on patient care, stakeholders can consider determining
 BULLYING IN NURSING 56

whether or not there is a connection between bullying and unfavorable health outcomes. They

must discover how bullying affects healthcare workers' ability to collaborate, communicate, and

keep patients safe.

There is a need to research the effectiveness of anti-bullying and prevention initiatives

established for the nursing profession by examining the efficacy of anti-bullying activities, such

as educational programs, regulatory reforms, mentorship programs, and supportive workplace

interventions, to reduce bullying behaviors and improve the overall quality of the workplace.

There is a need to investigate the relationship between bullying and experiencing burnout

in nursing. The investigation can consider how emotionally depleted, depersonalized, and less

successful nurses can feel when they are bullied at work and how this can be caused by bullying.

There is a need to investigate how technology might have led to instances of bullying,

which involves examining how cyberspace and social media contribute to the proliferation of

bullying among nursing students and practitioners.

 BULLYING IN NURSING 57

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