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Enhancing Undergraduate Nursing Students’ Knowledge and Self-Efficacy
About Workplace Bullying: A Quasi-experimental Study Abeer Alraja RN, MSN, PhD (c); Donna Martin, RN, PhD, Associate Professor;
College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
Workplace bullying (WB) among nurses is a prevalent
and serious problem in health care settings around
the world with detrimental physical, psychological and
• 30% of nurses reported that they were physically
assaulted by a patient.2
• 44% experienced emotional abuse from a patient.2
• 88.72% of nursing students reported experiencing
at least 1 act of bullying.10
Design: Quasi-experimental, using a 1 group
Sample: Second, third and fourth year
undergraduate nursing students at 3 Canadian
schools of nursing were invited to participate.
Dependent variables: Knowledge, Self-efficacy
of WB, & Intent to Intervene.
Independent variable: Completion of 3 online
characteristics, The Self-efficacy to Respond to
Disruptive Behaviours (SERDB) questionnaire11,
& WB knowledge assessment test.
Descriptive statistical techniques were used to
describe the sample.
A paired sample t-test analyzed the difference
in summed scores for the items on the pre-test
•Western and North-Western Region Canadian Association of Schools of Nursing
(WNRCASN) Graduate Student Research Award.
•College of Nursing Endowment Fund Graduate Student Research Grant.
•College of Nursing Endowment Fund Graduate Student Travel Award.
“Nursing truly is one of the most difficult professions out
there. We are constantly exposed to diseases, ridicule,
and unmanageable circumstances” Newly graduated nurse
To evaluate the effectiveness of an online evidence-
based educational intervention in enhancing
knowledge, self-efficacy, and intent to intervene
related to WB among undergraduate nursing students
in three Canadian schools of nursing.
• Including education on workplace bullying is
highly recommended in nursing curricula.5
• The Canadian Nurses Association and the
Canadian Federation of Nurses Unions strongly
support violence-free workplaces.6
• There is a scarceness of interventional research
aimed at educating nursing students on effective
and appropriate responses to WB.7
Discussion and Conclusion
• What is Workplace Bullying? • Introducing the topic of WB including definition,
descriptions of acts and sources of WB as well as its antecedents and consequences on personal health, patient safety, and healthcare organizations.
• How to Address Workplace Bullying? • Providing information about nursing students' and
nurses' legal rights and responsibilities with relation WB and strategies to manage bullying acts in the workplace.
• Application of Knowledge. • Involves five practice scenarios to further facilitate
nursing students' abilities to implement the strategies they learned in the previous modules.
The content of the modules was developed from a
review of the literature and guided by critical social
theory and cognitive social learning theory.8-9
1. Lindsey B. Anderson & Melanie Morgan (2017). An Examination of Nurses’ Intergenerational Communicative Experiences in
the Workplace: Do Nurses Eat Their Young? Communication Quarterly, 65:4, 377-401.
2. Laschinger, H. K., & Nosko, A. (2015). Exposure to workplace bullying and post-traumatic stress disorder symptomology: The
role of protective psychological resources. Journal of Nursing Management, 23(2), 252–262. https://doi.org/10.1111/jonm.12122
3. Sauer, P. A., & McCoy, T. P. (2017). Nurse bullying: Impact on nurses’ health. Western Journal of Nursing Research, 39(12),
4CNA code of ethics
5. Sanner-Stiehr, E. (2017). Using simulation to teach responses to lateral violence: Guidelines for nurse educators. Nurse
Educator, 42(3), 133–137.
6. Canadian Nurses Association, & Canadian Federation of Nurses Unions (CFNU). (2014). Workplace Violence and Bullying:
Joint Position Statement.
7. Mellor, P., Gregoric, C., & Gillham, D. (2017). Strategies new graduate registered nurses require to care and advocate for
themselves: A literature review. Contemporary Nurse, 53(3), 390–405. https://doi.org/10.1080/10376178.2017.13489038
8. Browne, A. J. (2000). The potential contributions of critical social theory to nursing science. Canadian Journal of Nursing
Research, 32(2), 35-55.
9. Bandura, A. (1986). Social Foundations of Thought and Action. Cliff, NJ: Prentice Hall, Englewood.
10. Clarke, C. M., Kane, D. J., Rajacich, D. L., & Lafreniere, K. D. (2012). Bullying in undergraduate clinical nursing education.
Journal of Nursing Education, 51(5), 269–276.
11. Sanner-Stiehr, E. (2018). Responding to disruptive behaviors in nursing: A longitudinal, quasi- experimental investigation of
training for nursing students. Nurse Education Today 68, 105–111.
• Preliminary results indicate that completion of the
online educational modules had a significant
influence in enhancing nursing students’ knowledge,
self-efficacy, and intent to intervene in future events
• Results highlight the importance of including
evidence-based educational modules in nursing
curricula to educate nursing students about WB.
Participants were predominantly between 20
and 30 years old (83.3%; n=30).
Females comprised 77.8% (n=28) and 22.2%
(n=8) were male.
Participants were distributed through the
program with 30.6% (n=11) in their 2nd year,
36.1% (n=13) in their 3rd year, & 33.3% (n=12)
in their 4th year.
SERDB Pre/post-test mean scores and paired t-test results
Instrument Items Pre- test
Confidence in ability to respond effectively 4.49 7.36 7.69 0.000*
Previous engagement in effective responses 3.83 4.53 1.719 0.095
Responding effectively is important 8.31 9.14 2.643 0.012*
I know how to respond effectively 4.43 7.5 6.619 0.000*
Responding effectively will end the behaviors 7.03 8.22 3.319 0.002*
Overall self-efficacy in stressful situational context 4.06 6.69 6.541 0.000*
Overall self-efficacy in normal situational context 5.37 7.75 5.67 0.000*
I believe in my ability to respond effectively 4.53 7.42 6.809 0.000*
Responding effectively is a valuable skill 8.54 9.25 2.225 0.033*
I care about being able to respond effectively 8.14 9.06 3.357 0.002*
* Significant results with P