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critically analyze and finally, synthesise study findings as presented in the literature. 

Negative impact of incivility, bullying and violence on nursing professionals and the healthcare environment

Incivility, bullying and violence are one of the major issues in nursing profession that affects the performance and concentration of healthcare professionals working in the facility (Griffin & Clark, 2014). Where bullying and violence are acts that affect the person’s self-confidence and harm them physically, incivility is termed as the rude, disrespectful and discourteous behavior that affect the person in the process negatively which lead them to several actions that can harm them as well as others in the healthcare environment (Lachman, 2014). The American Nursing Association has described the definition of bullying as the repeated and unwanted harmful humiliation, due to which the recipient feels humiliation and distress and affects their self-confidence and self-esteemed (Spector, Zhou & Che, 2014). On the other hand, the world health organization determines violence as the verbal or physical act, which is delivered by the patients or colleagues within healthcare related workplace and these activities are responsible for their health and wellbeing deterioration (D'ambra & Andrews, 2014). Due to these factors within the healthcare facility blaming, sabotaging, disclosing personal information or unfair activities happen. The type of violence that occurs in this society that occurs in the nursing profession are customer and client related violence, criminal activities against nursing professionals, such actions due to personal relationship and act of bullying due to worker on worker violence or action (Clark, Ahten & Macy, 2013). These acts of violence, bullying and incivility are as Lachman (2014) mentioned that the root of bullying and violence depends on the unvalued, isolation, disrespectful and lack of self-esteemed are in the nursing profession due to the availability of female professionals in nursing profession and powerful male physicians and doctors in higher positions. Therefore, this power distribution determined the prevalence of such act of bullying and violence in nursing profession (Ariza-Montes et al., 2013).

While discussing this issue in the context of nursing profession, it should be mentioned that bullying, incivility and violence is not a recent phenomenon in this profession as in the year 1987, a researcher Cox warned the healthcare fraternity about the damages they are going to face due to increasing violence and bullying in the profession (Allen, Holland & Reynolds, 2015). Further, in the Australian nursing context as well there are plenty incidences and events analyzing which can determine the prevalence and occurrence of these unwanted phenomena in the facility (Carter et al., 2013). In the year 2012, the researchers Kvas and Seljak (2014) included a survey in their research paper that determined that 52% of the registered nurses and midwifes of healthcare facilities in Victoria were facing trouble in their profession due to the occurrence of violence, incivility and bullying in the workplace (Hayward et al., 2016). Further, recently in the year 2013, the Australian federal government passed an amendment in the parliament related to the Fair Work Act that added several new standards and specific provisions about workplace bullying and violence and the Nursing and Midwifery Board of Australia reflected the changes in policy by making amendments as per the act (Peters, 2014).

Different types of incivility, bullying and violence in nursing profession

The negative affect the new graduate nurses would face due to such prevalence of violence is easily visible by going through the statistics that determines that the number of nursing professions dropping out first few years of service is increasing in recent time (Carter et al., 2013). Further, these violence and bullying activities are difficult to control because nursing colleagues, patient, family members and visitors and members of interdisciplinary teams, could have carried out such activities and hence, majority of the cases are not even being disclosed to the higher authority of the healthcare authority (Hayward et al., 2016). Besides these issues are much more broader than the activity of bullying as majority of the victim nursing professionals are female and new joiners to the facility and they do not disclose such events as they think it will affect their professional career. Therefore, the prevalence of these unwanted activities affect majority of the female and fresh graduate nurses who transform themselves to professionals in such facility (Hurley et al., 2016).

The research question for this narrative literature review assignment will be as follows:

What are the primary and secondary strategies that new graduate nurses can utilize to overcome incivility and bullying in their nursing profession?

Search strategy is an important tool to identify research articles analyzing which the answer of research question are found  and those articles are chosen on the basis of several factors specificity of which determines authenticity of search strategy. For this assignment several databases, which will be used to search research articles, are: PubMed, Cochrane, CINAHL, Google Scholar and predefined key terms related to the research questions will be searched in these databases. The key terms that were used to search for the articles are: strategies of nurses to overcome incivility and bullying, nursing strategies to overcome bullying and incivility in workplace, nursing profession and bullying and violence, strategies to overcome bullying and violence in workplace and nursing profession and associated bullying and violence. Further searching these key terms in CINAHL, Cochrane, PubMed and Google scholar provides results 120, 247, 1418, 90070 respectively. After this, all these articles were sieved through several inclusion and exclusion criteria so that required and appropriate research articles could be used for the literature review.  

As the articles obtained from research included several relevant and irrelevant search results, the necessary research articles were separated from the group of obtained results using different inclusion and exclusion criteria. The inclusion criteria included required timeline, which was from 2013 to 2018. This was important as it determined the relevancy and authenticity of the research. Further, English language, was preferred as the inclusion criteria to increase its relativity. Finally, articles, where strategies related to coping from bullying and incivility and violence were used for prevention of such unwanted actions in healthcare facility were included in the assignment.

Causes of bullying and violence in nursing profession

On the other hand, research articles beyond the decided timeline for the narrative literature review, language other than English and having partial aspect of the research question were expelled from the assignment, as it would affect the primary aim of the research.  Finally, articles, which were non-specific with strategies about workplace bullying, harassment violence, books and informative research articles, were excluded.

Self-Reflection:

Two out of ten research papers reviewed by us critically talked about the experience of nursing professionals with regard to workplace bullying (Bowllan &Nancy,2015; Meires, 2018) .workplace bullying and violence have been reported to be the most common concerns among healthcare professionals. Statistical evidences have reported the prevalence of approximately 70% newly employed nursing professionals being bullied and humiliated at workplace (Meires,2018). It has also been suggested that in most of the cases there is nil availability of social support to deal with workplace bullying. 1 out of 6 nursing professionals have confirmed being exposed to workplace violence in Australia. Numerous determinant factors such as unavailability of peer support, being yelled upon and negative team coordination have been reported to be determinants of workplace violence.

According to the study conducted by Bowlan and Nancy (2015), workplace violence has been on the increase in comparison to the recent scientific trends. The research paper critically evaluates the national and international prevalence rates of workplace bullying. In this context, the authors of the paper have effectively suggested strategies such as incorporating effective training and framing strict policies to reduce the rate of bullying and ensure cooperation to fresh nursing professionals. 

According to Green (2018), workplace incivility has been counted as the most common form of element that disturbs the professional environment. The paper highlights the presence of uncivilized behavior across reputed health care organizations. The paper further suggests interventions such as mindfulness strategies to effectively cope with the problem and avoid the worsening of the scenario at the professional front. Inclusion of meditation has been reported as an effective intervention to channelize negative thoughts into positive outlook and create a positive work environment. Further training and intimidation by seniors can further help in effectively dealing with the occurrence of inappropriate behavior.

 A total of 3 out of the ten research articles reviewed have focused on education and awareness to reduce the prevalence of workplace violence (Jenkins et al., 2013, Darla et al., 2013 & Hogan et al., 2018). A research study conducted by Jenkins, Kerber and Woith (2013) has revealed the responses of healthcare professionals to effectively change with awareness strategy aimed at highlighting the negative implication of workplace bullying. Incorporation of a blended learning procedure to spread awareness related to the aggressive behavior and spreading awareness about workplace harassment has effectively helped in reducing the rate of bullying events across healthcare organizations. It has been stated in this regard that an effective visual presentation about workplace bullying and the associated negative impact that it can create can help in spreading awareness on large scale (Hogan et al., 2018). Educating nursing professionals about the appropriate ethical code of conduct and nursing standard can help in dealing with the seriousness of the issue (Jenkins, Kerber & Woith ,2013). Proper training to maintain team-coordination and extend support to individuals has been documented to elicit positive outcomes. It is pivotal to identify and prioritize the need to check workplace bullying so as to create and maintain a positive and healthy environment that would help enhance the professional experience of fresh nursing professionals. In addition to this, scientific studies have also reported that on account of negative workplace bullying there have been numerous cases of employee turnover (Hogan et al., 2018).

Prevalence of incivility, bullying and violence in nursing profession

Nursing profession has been affected greatly with the problem of employee turnover. The major issue identified with employee turnover is the amount of workload and non-cooperative behavior by the supervisors. Insufficient support from team leaders and co-workers has also been reported as major contributors of negative workplace experience. Lateral violence has been reported to be one of the major causes of workplace violence in the nursing profession. Lateral violence primarily involves in indulging violence against members of the peer group rather than engaging in violence with the offenders.

There is an increasing need to address the concern by adopting a strategy to address workplace abuse and violence related concerns. Workplace violence can be classified as any form of physical or verbal abuse that affect the self-esteem and emotional feelings of the professionals. Typically, a study conducted by the authors Darla, Susan, Edwards and Cristopher (2013) has identified three major concerns that contribute to the cause of adverse violence. The contributing factors identified were listed as humiliating behavior by the patient and the associated family members and non-cooperative behavior shown by colleagues and physicians. The study followed a qualitative design and proceeded with the documentation of the negative experiences of nursing professionals at a hospital setting. The authors proceeded with documenting the negative experiences of the professionals based upon a questionnaire response (Darla et al., 2013). The findings of the study indicated that the negative environment at workplace has led to a serious case of employee turnover. Recent trends in the nursing profession have witnessed an excessive amount of employee turnover which must be addressed on immediate basis. According to the authors, inclusion of awareness programs can help in combating issues related to employee turnover. Effective strategies that could be used to deal with the critical scenario would make use of the constructivist grounded theory. The constructivist grounded theory aims at creating a positive work environment with the inclusion of cooperative seniors and supervisors to guide the new registered nurses and make the professional experience a better one (Darla et al., 2013).

A total of 4 research articles have focused on devising effective team support strategies to deal with workplace bullying (Vogelpohl et al., 2013;Strandmark et al., 2013;Melanio,2014;Del Pratto,2013 &Tee,2016). Research studies have further stated that the employee turnover rate in the nursing profession is the highest and is almost around 42% (Tee, Ozcetin & Russell, 2016). The primary need to include education related to the maintenance of ethical standard and involve in cooperative strategies can help in improving team work and deal with issues related to employee attrition and turnover (Tee et al., 2016). The primary focus should be to make the professional experience of the newly licensed nursing professionals to be a positive one. In addition to this, it can further be stated that proper education to help the newly registered professionals to identify and report bullying and violence is pivotal (Del Pratto,2013). Other strategies to ensure a healthy professional environment would include delivering training to the supervisors, seniors and tenured employees to be supportive and be proactive in addressing the concerns of the new professionals.

Strategies employed to overcome incivility, bullying and violence in nursing profession

Significant improvement can be witnessed on complying with the strategies and program. The awareness programs would also help in pinpointing negative aspects of work culture. This would further help in designing strategies to adopt efficient measures and tackle the associated scenario. Hence, it can be stated that the literary evidences clearly point out towards the fact that workplace aggression and bullying is on the verge of rise and must steps must be taken to control the issue.

On closely analyzing the evidences furnished by the scientific papers it can be said that workplace aggression and violence is a primary problem in the nursing profession. Majority of the new registered nurses who have recently entered the profession have reported to be victims of workplace abuse at least once in their entire tenure of professional experience (Melanio,2014). In addition to this the research papers have also identified a relationship between the employee turnover rate and negative workplace experience. Violence in different forms has been reported by nursing professionals (Melanio,2014). Non-cooperation from team members, verbal abuse and ill treatment by the immediate family members of the patients has been recorded to be some of the negative experiences. Uncivil behavior by peers and engaging in lateral violence has also been defined as negative elements tightly linked to workplace violence (Vogelpohl, Rice Edwards& Bork,2013). The findings of the research papers highlight the need to adopt stringent measures to check workplace bullying. Effective strategies such as mindfulness based practices like indulging in yoga has been reported to be effective in dealing with work stress (Egues & Leinung, 2013).

 The primary requirement to deal with the criticality of the issue, based upon the evidence furnished by the research studies can be defined as the lack of awareness. Nursing educators and supervisors must actively engage in dispensing training to the subordinates about the maintenance of a positive work environment. In addition to this, it is also important to train the new professionals about the difference between a bullying and job responsibility (Egues & Leinung, 2013). Inclusion of anti-bullying committees across various healthcare organizations can help in stringent monitoring of case related to bullying and workplace aggression. Strong HR policies to ensure zero incidence of bullying should be included on a mandatory basis across various hospitals and care homes. In addition to this the employees must be made aware about the perception of workplace bullying as a punishable offence. Offenders detected in practicing any form of bullying must be treated with severity. This is expected to make other employees aware about the critical implication of the offence and strictly adhere to the ethical standards.

Evaluation of research studies conducted on incivility, bullying and violence in nursing profession

Installation of anti-bullying posters across various healthcare organizations can help in creating awareness to the maximum and successfully attract the attention of all the healthcare professionals. Therefore, it can be said that on complying with the discussed strategies the workplace environment can be improved significantly. Improved work environment would encourage the professionals to continue with the noble profession and the problems related to employee turnover would also be tackled in a smooth manner (Egues & Leinung, 2013).

Conclusion

Hence, to conclude it can be said that work place aggression and bullying elicits a negative impact on the mind-set of the employees. On an average a major proportion of nursing professionals have expressed discontent with the job role. The responses have mainly revealed negativity in terms of work environment, stress and insulting behavior from superiors. In order to ensure a positive working environment it is essential to eradicate workplace bullying completely. Strategies such as spreading awareness and educating professionals to be supportive towards the junior employees can help in making their professional experience a better one. Further in order to ensure a safe workplace environment the offenders identified to be involved in bullying must be penalised so as to make other employees aware about the critical implication of practicing work place harassment. Therefore, it can be said that these steps would help in making the professional experience of the new employees a happier and positive one. At, the same time it would also help in reducing the prevalence of workplace bullying.

References

Allen, B. C., Holland, P., & Reynolds, R. (2015). The effect of bullying on burnout in nurses: the moderating role of psychological detachment. Journal of Advanced Nursing, 71(2), 381-390.

Ariza-Montes, A., Muniz, N. M., Montero-Simó, M. J., & Araque-Padilla, R. A. (2013). Workplace bullying among healthcare workers. International journal of environmental research and public health, 10(8), 3121-3139.

Bowllan, N. M. (2015). Nursing students’ experience of bullying: Prevalence, impact, and interventions. Nurse educator, 40(4), 194-198.

Brewer-Smyth, K. (2018). Lateral violence in nursing: Implications and strategies for nurse educators. Journal of professional nursing, 34(1), 5-6.

Carter, M., Thompson, N., Crampton, P., Morrow, G., Burford, B., Gray, C., & Illing, J. (2013). Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting. BMJ open, 3(6), e002628.

Clark, C. M., Ahten, S. M., & Macy, R. (2013). Using problem-based learning scenarios to prepare nursing students to address incivility. Clinical Simulation in Nursing, 9(3), e75-e83.

D'ambra, A. M., & Andrews, D. R. (2014). Incivility, retention and new graduate nurses: an integrated review of the literature. Journal of Nursing Management, 22(6), 735-742.

Del Prato, D. (2013). Students' voices: the lived experience of faculty incivility as a barrier to professional formation in associate degree nursing education. Nurse Education Today, 33(3), 286-290.

Egues, A. L., & Leinung, E. Z. (2013, July). The bully within and without: strategies to address horizontal violence in nursing. In Nursing Forum (Vol. 48, No. 3, pp. 185-190).

Kvas, A., & Seljak, J. (2014). Unreported workplace violence in nursing. International nursing review, 61(3), 344-351.

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542.

Hayward, D., Bungay, V., Wolff, A. C., & MacDonald, V. (2016). A qualitative study of experienced nurses' voluntary turnover: learning from their perspectives. Journal of clinical nursing, 25(9-10), 1336-1345.

Hurley, J., Hutchinson, M., Bradbury, J., & Browne, G. (2016). Nexus between preventive policy inadequacies, workplace bullying, and mental health: Qualitative findings from the experiences of Australian public sector employees. International journal of mental health nursing, 25(1), 12-18.

Jenkins, S. D., Kerber, C. S., & Woith, W. M. (2013). An intervention to promote civility among nursing students. Nursing Education Perspectives, 34(2), 95-100.

Lachman, V. D. (2014). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. Medsurg nursing, 23(1), 56-60.

Meier, L. L., & Gross, S. (2015). Episodes of incivility between subordinates and supervisors: examining the role of self?control and time with an interaction?record diary study. Journal of Organizational Behavior, 36(8), 1096-1113.

Melanio, K. (2014, July). The bully within and without: strategies to address horizontal violence in nursing. In Nursing forum (Vol. 49, No. 3, pp. 151-155).

Peters, A. B. (2014). Faculty to faculty incivility: Experiences of novice nurse faculty in academia. Journal of Professional Nursing, 30(3), 213-227.

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