Aim: The purpose of this article was to explore workplace routines and strategies for preventing and managing bullying in the context of health and elderly care. Background: Bullying is a serious problem in workplaces with consequences for the individual, the organisation and the quality of care. Method: Open-ended interviews were conducted with 12 participants, including managers and specialists within one hospital and three municipalities. The interviews were analysed with qualitative content analysis. Results: Bullying was often concealed, due to avoidance, unclear definition and lack of direct strategies against bullying. No preventative work focusing on bullying existed. Psychosocial issues were not prioritized at workplace meetings. The supervisor had the formal responsibility to identify, manage and solve the bullying problem. The most common decision to solve the problem was to split the group. Conclusions: The findings showed that bullying was a concealed problem and was first acknowledged when the problem was acute. Implications for Nursing Management: Crucial strategies to prevent and combat bullying consist of acknowledgement of the problem, transformational leadership, prioritization of psycho-social issues, support of a humanistic value system and work through bullying problems to achieve long-term changes. © 2018 John Wiley & Sons Ltd

Workplace bullying is a taboo event which occurs worldwide, although the prevalence varies significantly between and within countries. Nurses have been regarded an occupational risk group for bullying at the work place. Bullying in health and social care contexts is sometimes reported as frequent and, other times, as not occurring, which sparked our interest in mapping the occurrence of bullying in the health and social care system in Sweden. Thus, the purpose of the study was to examine the prevalence of bullying, and to discuss cultural traditions and environmental factors that affect bullying in workplaces. The sample (n = 2810) consisted of employees at inpatient wards at four hospitals, and employees at municipal eldercare wards in Sweden. A questionnaire including NAQ‐22 R was distributed and subsequently analysed with descriptive statistics using SPSS. The youngest group of respondents scored higher than the older groups. Using contrasting estimates of bullying, the prevalence varied between 4.1 and 18.5%, with the lowest prevalence in regards to self‐reported exposure. According to the cut‐off scores, NAQ‐22 R, 8.6% of the respondents were occasionally exposed to bullying while 2.3% were considered to be victims of severe bullying. Work‐related negative acts were more common than personal negative acts. The variations in prevalence of bullying as a result of contrasting estimation strategies are discussed from perspective of the 'law of Jante', the 'tall poppy syndrome' and shame. Bullying deteriorates the working conditions which may have an impact on quality of patient care.

Falls are a daily occurrence in nursing homes and few interventions for reducing fall-related injuries have proven to be effective. Impact absorbing flooring (IAF) in residential care has shown promising results in reducing fail-injuries and in the process of developing and implementing IAF all aspects are valuable to explore. Therefore, the aim of this qualitative study is to describe the enrolled nurses (ENs) experiences of IAF. We carried out focus group interviews with ENs and used content analysis to process the data. The ENs experienced both negative and positive aspects with the IAF. Importantly, the ENs perceived the IAF as effective in preventing fall-injuries. They also appreciated the improvements in acoustics. Negative aspects were that the flooring initially was challenging to walk on and that it made it harder to maneuver heavy equipment. A significant and transferable finding in this study was the importance of the ENs' perceived difficulty in preventing fall-injuries amongst elderly people living in nursing homes. This seemed to be a driving force to accept the intervention. Although IAF affects the working conditions in a nursing home, ENs are willing to accept these issues given the perceived effectiveness of the intervention.

Child sexual abuse (CSA) is a global public health problem with major consequences for the individual child and society. An earlier Swedish study showed that the school nurses did not initially talk about nor mention CSA as one form of child abuse. For the child to receive adequate support, the disclosure is a precondition and is dependent on an available person prepared to listen. The aim of the study was to explore the ability of the school nurses to detect and support sexually abused children. It is a secondary analysis of focus group interviews with school nurses. Thematic analysis was performed. Results showed that the school nurses avoided addressing CSA due to arousal of strong emotions, ambivalence, and a complicated disclosure process. In order to detect CSA and support abused children, attentiveness of sexual abuse as a possible cause of physical and mental illhealth is crucial.

The aim of the present study was to explore preventive strategies and processes to counteract bullying in workplaces. Data were collected by individual interviews and focus group discussions at one hospital and two nursing home wards for elderly, a total of 29 participants. In the analysis of the interviews we were inspired by constructivist grounded theory. Persistent work with a humanistic value system by supervisor and coworkers, raising awareness about the bullying problem, strong group collaboration, and conflict management, along with an open atmosphere at the workplace, appears to be imperative for accomplishing a policy of zero tolerance for bullying.

Aim: Our objective was to develop and implement an intervention program in collaboration with workplace personnel, to evaluate the process as a vehicle to prevent and combat bullying. Methods: The project emanates from a community-based participatory approach. We obtained data from individual and focus group interviews. We used grounded theory methodology, and made a comparative analysis before and after the intervention. Results: Focus group interviews at the three first meetings indicated that those best positioned to prevent and combat bullying were the immediate supervisors, in collaboration with co-workers and upper management. The goal of zero tolerance toward bullying can be achieved if all concerned work together, using a humanistic value system, an open workplace atmosphere, group collaboration and conflict resolution. We developed an intervention, including lecturers and reflection groups, which ultimately resulted in an action plan. Focus group interviews at the fourth meeting, after the implementation, showed that employees were then more aware of bullying problems; the atmosphere at the workplace improved; the collaboration between and within the group was stronger; and the supervisor worked continuously to prevent and combat bullying, using the humanistic values suggested. We propose additional systematic work to implement our action plan and a conflict resolution system. Conclusions: The anti-bullying program implementation in the workplace achieved some success, but the intervention process is ongoing.

One of the aims of the study was to investigate how participants in self-help groups (SHG) for women (n = 87) who had been sexually abused in childhood rated their mental health and to what extent they were at risk of developing posttraumatic stress disorder (PTSD). A further aim was to investigate the relationship between the ratings of mental health, occurrence of PTSD, women's interpersonal relationships, reasons for participating in an SHG and characteristics of the childhood sexual abuse (CSA). The participants completed questionnaires regarding their personal relationships, reasons for joining a group, abuse characteristics, mental health (Symptom Checklist-90-Revised) and PTSD (Impact of Event Scale-Revised). The women showed poor mental health, and more than half of them were at risk of developing PTSD. Lack of social support and feelings of shame correlated with poor mental health, whereas guilt did not. Relationships with female friends had a positive association. Further research is needed to determine whether participating in an SHG could provide adequate social support and reduce feelings of shame, thereby contributing to the healing process in the aftermath of CSA.

Integrating an action program in daily practice to stop and prevent bullying

Background & Context: Bullying is a public health problem that negatively affects health at workplaces. In the public sectors, including health care, it is more common with bullying problems compared to other sectors. Earlier research has primarily focused on incidence, prevalence, risk factors and relationships between bullying and ill-health.  To a much lesser degree, research has focused on prevention. The aim of this study was to develop and implement an intervention to stop and prevent bullying at workplaces in collaboration with employees.

Methodology

This intervention study is integrated in a larger research project. Based on results from questionnaires targeting bullying, three workplaces in the healthcare sector were invited to participate. After approval from superiors, employees were invited to participate in focus-groups (FG), resulting in groups of 6-8 participants at one psychiatric ward in a county council, and two elderly care wards in respective municipalities. FG interviews were conducted twice; the first interview captured views on bullying, the second interview prepared for and developed the intervention. No superior participated in the first interview in order to have employees feel free expressing their views. Instead the department head was interviewed individually. The second included both employees and department heads. The FG interviews were analysed according to Grounded Theory.

Findings: The first interview revealed that the employees had insufficient knowledge about bullying and how to manage it. The second FG demonstrated that there were insufficient opportunities for reflections about bullying problems.  Employees also expressed that they did not feel recognized and valued by superiors in higher levels of the organization.

Given this, the researchers have, as part of the intervention, held half-day lectures on the phenomena of bullying, conflict management, communication and shame. The intervention also contained discussions in small groups focused around game-cards that were specifically designed to initiate discussions about specific situations where bullying may occur and how one may prevent or manage this.

In the FGs, it was furthermore suggested to write a contract that ensured that everyone treats each other with tolerance and respect at the workplace. Both interviews revealed that managers play key roles in preventing workplace bullying.  Appropriate leadership creates safety at the work-places, whereas inappropriate leadership creates fear.

Building on these findings from the FGs, next steps include plan of action, targeting e.g., compulsory, continuing discussions concerning bullying improved contact with the superior level and a workplace contract of mutual respect.

Suggestions for the action plan will be discussed in one additional FG, upon which the plan will be introduced to the directors of the workplaces for their support.

 In summary the results of the findings are a developed intervention/action program consisting of lectures, game card-discussions and an action plan in collaboration with employees and managers.

 Implications for practice, training and organization: 

Systematic longitudinal workplace interventions is one way of shouldering the responsibility of tackling bullying in workplaces, highlighting this often hidden problem.

3 learning objectives:

• Bullying in the workplace is prevalent, and yet  not acknowledged
• Managers play key roles in preventing workplace bullying
• Leadership can contribute to safety as well as fear in the workplace