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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

    organizational consequences.1-4

    In Canada:

    • 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

    educational modules.

    Measurements: Sociodemographic

    characteristics, The Self-efficacy to Respond to

    Disruptive Behaviours (SERDB) questionnaire11,

    & WB knowledge assessment test.

    Data Analysis:

     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

    and post-test.

    Preliminary Results



    •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

    Research Objective


    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.

    Module 1

    • 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.

    Module 2

    • Application of Knowledge. • Involves five practice scenarios to further facilitate

    nursing students' abilities to implement the strategies they learned in the previous modules.

    Module 3

    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),

    1533–1546. https://doi.org/10.1177/0193945916681278

    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

    Browne, 2000

    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

    of WB.

    • 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

    at CI=95%

    Instrument Items Pre- test





    t Sig.

    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


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