DEFINITION
Bullying is defi ned as repeated, unreason- able actions intended to intimidate, degrade, humiliate, or undermine. It generally occurs when there is a power differential and can result in harm to one’s physical and mental health (Canadian Centre for Occupational Health and Safety, 2005). Bullying behav- iors may be overt, such as yelling or using profanity, threatening abuse, publicly belit- tling or humiliating, or spreading malicious rumors or gossip; the more covert behaviors, such as isolating an individual; changing expectations, guidelines, and deadlines; or providing incorrect information to sabotage one’s work, are equally destructive but less obvious to prove.
APPLICATION
The phrase “Nurses eat their young” has been around for generations and refers to the aggressive and unsupportive behavior senior nurses exhibit toward newer and younger student nurses. This often-quoted phrase suggests that bullying is unique to nurs- ing; however, in contrast, bullying occurs in collaboration, simplify project development,
provide peer support, and link users to information provided by national health care organizations (Billings, 2009). It is therefore recommended that blogs be incorporated into nursing curricula for faculty’s and stu- dents’ use.
It is also recommended that educators are provided with technical support and nec- essary training on how to use blogs. Due to the ethical and legal issues associated with the use of social media, it is essential that educators be familiar with the policy for the responsible use of social media in their insti- tution before adopting the use of blogging or any other social media in the courses.
According to the National Council of State Boards of Nursing (NCSBN, 2011), improper use of social media by nurses may violate state and federal laws established to protect patient privacy and confi dentiality.
Such violations may result in both civil and criminal penalties, including fi nes and pos- sible jail time. Therefore, there is the need for further research into the use of blogging in nursing education. More nursing fac- ulty should also be trained and encouraged to incorporate blogging as a form of social media in their courses.
Billings, D. M. (2009). Wikis and blogs:
Consider the possibilities for continuing nursing education. Journal of Continuing Education in Nursing, 40(12), 534–535.
Bonk, C. J., & Zhang, K. (2008). Empowering online learning: 100+ activities for read- ing, refl ecting, displaying and doing. San Francisco, CA: Jossey-Bass.
Carozza, B. (2012). 5 Reasons educators should blog. Retrieved from http://connected- principals.com/archives/5835
Curry, K. (2012). Increasing communications in the intensive care unit. Is blogging the answer? Critical Care Nursing Quarterly, 35(4), 328–334.
The National Council of State Boards of Nursing (NCSBN). (2011). White paper:
A nurses guide to the use of social media.
Retrieved from https://www.ncsbn.org/
Social_Media.pdf
BULLYING ■ 41
B
discipline, the education of future nursing practitioners requires that students gain knowledge and competency through clini- cal experience. While nursing educators are valued for their nursing expertise, they may not necessarily be equipped with theories of teaching and learning that prepare them to effectively provide feedback while recog- nizing the students’ efforts and building on the students’ strengths. Anecdotally, clinical instructors and staff nurses routinely defi ne their feedback to students as constructive criticism; students defi ne it as bullying. In a recent study of Canadian undergraduate bac- calaureate nursing students, 88% reported having experienced at least one act of bul- lying, with the clinical instructor identifi ed as the greatest source of the bullying behav- ior, followed by staff nurses (Clarke, Kane, Rajacich, & Lafreniere, 2012). The most fre- quently reported bullying behavior was the perception from students that their efforts were undervalued, followed by reports of being unjustly criticized. Nursing students who self-labeled as being bullied were signif- icantly more likely to consider leaving nurs- ing and believed that the bullying behavior had a negative impact on their learning expe- rience (Clarke et al., 2012).
The academic setting is a perfect oppor- tunity to provide role-playing or simulated scenarios for students and educators to act out aggressive interactions and problem- solve a nonaggressive resolution. Students may share experiences they perceive as nega- tive and demeaning and identify effective communication strategies to discuss with the instructor. Because bullies often do not iden- tify their behavior as bullying (Thompson, 2012) role-playing provides educators the opportunity to refl ect on behaviors and determine if they are contributing, directly or indirectly, to a bullying culture.
RECOMMENDATIONS
There is a need to ensure that nursing stu- dents are equipped with effective communi- cation and confl ict-resolution skills. Nursing students will not only benefi t by being all occupational sectors (Namie, 2014) and
across the age span (Longo, 2013). It is vital that nursing recognizes the existence of bul- lying, across all domains (clinical practice, administration, education, and research) in order to develop prevention strategies, establish reporting protocols, and imple- ment education and awareness programs to promote quality workplaces, free of bullying behaviors.
Within the academic domain, bullying has been reported as occurring from edu- cator to student, student to student, student to educator, and educator to educator. In all instances, the bullying behaviors nega- tively impact student recruitment, retention, satisfaction, and the overall quality of the educational setting (Beckman, Cannella, &
Wantland, 2013) and ultimately the quality of patient care. Within the educational domain, students must be prepared to recognize and manage bullying behaviors and be aware of the dynamics so that they themselves do not develop behaviors consistent with bullying interactions.
SYNOPSIS
Bullying in nursing education is a double- edged sword as health care and education are the occupational sectors reporting the largest proportion of bullying experiences (Namie, 2014). It is suggested that individu- als attracted to both nursing and education possess caring and nurturing qualities that make them susceptible targets to bullying.
It has also been theorized that nursing, as an oppressed group, experiences horizontal violence (bullying staff to staff) as a result of being a predominantly female group that is devalued within a hierarchical health care system (Purpora, Blegen, & Stotts, 2012; Roberts, 1983). Nurse educators have a responsibility to empower nursing students so that they do not adopt the oppressive group behaviors associated with bullying and lateral violence.
Nurse educators also have a responsi- bility to ensure that they are not perpetuat- ing bullying behavior. As a practice-based
ENE_20311_PTR_02_Alpha B_37-42_01-12-15.indd 41
ENE_20311_PTR_02_Alpha B_37-42_01-12-15.indd 41 1/10/2015 12:33:50 PM1/10/2015 12:33:50 PM
42 ■ BULLYING
B
Canadian Centre for Occupational Health and Safety. (2005). Bullying in the work- place. Retrieved from www.ccohs.ca/
oshanswers/
Clarke, C., Kane, D., Rajacich, D., & Lafreniere, K. (2012). Bullying in undergraduate clini- cal nursing education. Journal of Nursing Education, 51(5), 269–276.
Longo, J. (2013). Bullying and the older nurse. Journal of Nursing Management, 21, 950–955.
Namie, G. (2014). US workplace bullying survey.
Workplace Bullying Institute. Retrieved April 15 from www.workplacebullying .org/multi/pdf/WBI-2014-US-Survey .pdf
Purpora, C., Blegen, M., & Stotts, N. (2012).
Horizontal violence among hospital staff nurses related to oppresses self or oppressed group. Journal of Professional Nursing, 28, 306–314.
Roberts, S. (1983). Oppressed group behav- ior: Implications for nursing. Advances in Nursing Science, 5, 21–30.
Thompson, R. (2012). “Do No Harm” applies to nurses too! Pittsburgh, PA: inCredible Messages Press.
Debbie Kane prepared to address bullying behavior when
it occurs they will also be able to support their colleagues should they experience it.
Equally important is the need to ensure that all nurses who interact with nursing students are able to do so in a constructive and empow- ering manner. Promoting refl ective nursing practice will encourage nurses to refl ect on their own behavior and identify if they are guilty of bullying behaviors. Since nursing education does not exist in a vacuum, every member of the health care team must play an active role in eliminating bullying from the health care sector.
Research into the phenomenon of bully- ing needs to begin with the development of a unifi ed defi nition of bullying and valid and reliable standardized tools for measuring bullying. Studies that evaluate the implemen- tation of policies and legislation that address the existence and management of workplace violence, including bullying, are needed to create and sustain quality learning environ- ments for nursing students.
Beckman, C., Cannella, B., & Wantland, D.
(2013). Faculty perception of bullying in schools of nursing. Journal of Professional Nursing, 29(5), 287–294.
C
C
APSTONEP
ROJECTDEFINITION
Capstone projects are identifi ed by many different names such as capstone experi- ences, senior exhibition, or senior project.
In a capstone project, the individual is expected to identify a contemporary chal- lenge or issue with a clinical focus that can be evaluated using “evidence-based search strategies and critical appraisal of the literature” (Newland, 2013, p. 6). The Great Schools Partnership (n.d.) defi nes a capstone project as a complex and intricate assignment that is a concluding academic experience demonstrating a body of knowl- edge about a topic of interest. A capstone project is characterized by incorporating a strong decision-making process to guide the inquiry.
APPLICATION
While capstone projects can be found in any educational setting, they tend to be used pri- marily in master and/or doctoral programs in nursing education. The fundamental and central target of a capstone project is to investigate problems and issues identifi ed in health care. Through the investigation, evi- dence related to the identifi ed focus can be confi rmed to build on the topic being ana- lyzed. The ultimate outcome for each project embraces the idea of improving the quality of care delivered to individuals. A key point in the development and management of a cap- stone project is mentoring to ensure that each step of the project is carefully and effi ciently carried out.
Each project is specifi c to the setting and individual choice. The projects embrace all of the steps of critical thinking. A capstone endeavor can take the direction of a research venture, quality improvement undertaking, or an evidence-based practice venture. It is expected that the entire process results in careful consideration of how to improve an aspect of health care.
Capstone projects tend to be directed toward a clinical situation. According to Clarke (2013), the linkages between aca- demia and practice need to be directed toward patient/family-centered care, includ- ing fi nance and policy. Attention is directed on merging clinical and best practices to improve health care.
SYNOPSIS
In the DNP Essentials developed by the American Association of Colleges of Nursing (AACN, 2006), it is suggested that the fi nal DNP project delivers conclusions that ensued from practice engagement experiences. The entire process should be carefully reviewed and eval- uated by experts in the program. While discus- sion continues on the need for research to be incorporated in the projects, the main focus is that the project demonstrates sound decision making and analytical management. Rutledge and Renaud (2013) list examples of doctor of nursing practice (DNP) capstone projects that include pilot studies, program development and evaluation efforts, quality improvement projects, incorporation of interprofessional col- laborative models, evaluation of cost-effective- ness, and provider outcome effi ciency.
Overcash (2013) believes that there is a need for small projects to validate nursing research. The outcome of a capstone project
ENE_20311_PTR_03_Alpha C_43-100_01-12-15.indd 43
ENE_20311_PTR_03_Alpha C_43-100_01-12-15.indd 43 1/10/2015 12:34:10 PM1/10/2015 12:34:10 PM
44 ■ CARING
C
selected and used in the process to aid the scholar to thoroughly investigate problems.
In addition, experts are identifi ed and used as the project is planned and implemented.
These experts provide the scholar with addi- tional insight into the project topic. These networking connections are deliberately selected to augment information provided in conjunction with the mentor.
Capstone projects provide support and engagement with students to develop an in-depth evidence-based learning outcome.
An expectation of the capstone project is the commitment to lifelong learning through the use of decision making and evidence-based practice.
American Association of Colleges of Nursing (AACN). (2006). The essentials for doc- toral nursing for advanced nursing practice.
Washington, DC: Author.
Clarke, S. P. (2013). Practice-academia col- laboration in nursing: Contexts and future directions. Nursing Administration Quarterly, 37(3), 184–193.
Great Schools Partnership. (n.d.). Capstone project. Retrieved from http://edglossary.
org/capstone-project/
Newland, J. A. (2013). DNP scholarly projects change practice. The Nurse Practitioner, 38(4), 6.
Overcash, J. (2013, August). Nursing research:
Speaking up for the value of small proj- ects. Oncology Nurse Advisor, 21–23.
Rutledge, C. M., & Renaud, M. (2013). Back to school! Selecting a DNP program. Nursing Management, 44(11), 30–36; quiz 36. doi:
10–1097/01.NUMA.0000436363.14645.15 Carol Boswell