Bullying in Nursing: Research Critique

Background of Study

A study by Aristidou et al. (2020) explores the problem of workplace bullying with a focus on nursing practice. According to the article, there is a lack of a standardized methodology to examine workplace bullying, which “contributes to unclear data about the extent of the phenomenon, thus hindering effective management of it” (Aristidou et al., 2020, p. 163). As for the significance of the research, it is, in fact, the first structured effort in academia to inspect bullying in emergency and critical care nursing in Cyprus. Hence, the data from the study can be used to assess the effectiveness of existing anti-bullying policies in healthcare institutions in the area.

The purpose of the study is to explore bullying and mobbing among nursing practitioners in clinical settings. The primary objective is to investigate “workplace bullying occurrence and related factors in Greek-Cypriot nurses employed in private and public emergency (emergency departments [EDs]) and critical care settings (intensive care units [ICUs], coronary critical care units [CCCUs])” (Aristidou et al., 2020, p. 162). The authors want to find out how frequently nurses become victims of bullying in a proposed environment as well as what factors contribute to the occurrence of workplace hostility and intimidation.

The issue explored in the second article is a lack of supportive professional environments for newly licensed nurses due to the frequent occurrence of workplace hostility and intimidation in healthcare organizations. The significance of Thompson and George’s (2016) study is in its relatively novel idea to assess the efficiency of online nursing education as a method to battle bullying. The authors note the cyclical nature of such an approach as “in an academic-service partnership, nurse leaders within healthcare organizations then can build on this foundation and help newly licensed nurses continue to develop skills required to address bullying behaviors” (Thompson & George, 2016, p. 412). Thus, it is evident that the research is targeted at young nursing students, who are the future of the medical practice.

The main purpose of the research is to investigate the use of an online educational framework as a strategy to acquaint nursing students with the topic of workplace hostility. The primary objective of the study is “to examine the effect of the module on their self-efficacy related to bullying behavior as they transitioned from the academic setting to the professional practice environment” (Thompson & George, 2016, p. 412). The researchers want to answer the question of whether an online module is the right format to be an effective educational technique for future nursing professionals.

Answering My PICOT Question

I chose the studies by Aristidou et al. (2020) and by Thompson and George (2016) in order to address the issue I am focusing on in my research. My PICOT question is “In an emergency department setting, what is the effect of an anti-bullying educational intervention targeted at nursing personnel on new hires compared with no intervention within the first year?” While the article by Aristidou et al. (2020) helps to assess the effectiveness of anti-bullying workplace policies in critical care, the findings of Thompson and George (2016) contribute to an existing discussion of anti-bullying education in nursing. It is important to note that Thompson and George focus on implementing an online program among nursing students and compare their attitudes before and after the intervention. In my case, the nursing staff is targeted although the effect of the intervention is assessed among new hires. While Aristidou et al. (2020) evaluate existing anti-bullying policies, my research centers around active participation in the educational programs of nursing staff. In addition, unlike both studies chosen for this critical appraisal paper, my research aims to examine the long-term impact of a nursing intervention, which is why I have chosen a one-year time frame.

Method of Study

The choice of a study design is extremely important to determine its methodology, including sampling and data analysis. Aristidou et al. (2020) used a descriptive, cross-sectional correlation design for the study, while Thompson and George collected both quantitative and qualitative data using a pre-post intervention evaluation method. Research conducted by Aristidou et al. (2020) implied “a questionnaire package including the Workplace Violence in the Health Sector-Country Case Studies Research Instruments (WVHS-CCSRI): Part A (Personal and workplace data) and Part C.II (Mobbing/Bullying)” (p. 164). Thompson and George (2016), on the other hand, chose to integrate a pre-post evaluation survey, which consisted of checkboxes and open-ended questions. It is evident that the studies do not focus on the same research groups since they address different issues.

Although the formats are distinct, both groups of researchers relied on self-reported data. It presents a limitation in data triangulation via colleagues or nomination strategies for both studies. In addition, using a voluntary questionnaire resulted in a low response rate, which could be considered a significant limitation of the method used by Aristidou et al. (2020). As for Thompson and George (2016), the small sample size and lack of diverse demographic distribution among the participants are the main disadvantages of the authors’ chosen method. The benefits include cost- and time-efficiency of surveys for Thompson and George (2016), as well as extensive flexibility of data assessment facilitated by the use of questionnaires for Aristidou et al. (2020). Although both research groups recognize the limitations of their work, they fail to justify their choices of using a certain methodology.

Results of Study

It is crucial to examine the key findings of both studies in order to determine their implications in nursing practice. Aristidou et al. (2020) report that “68.1% (N = 77) of the participants reported direct experience of workplace bullying as victims, while 57.5% (N = 65) reported experience of witnessing workplace bullying in others (indirect exposure)” (p. 162). These results suggest that workplace hostility in healthcare organizations prompts a reassessment of preventive strategies, which is an important implication for practice. Thompson and George (2016) conclude that “post-scores (mean=32.1, SD=3.7) were significantly higher than pre scores (mean=29.6, SD=3.6), t=7.052, df=39, p<0.001),” which proves that online educational strategy is associated with a significant improvement in self-efficacy (p. 414). The nursing implication for this study is an affirmation of online anti-bullying education being a crucial factor in an effective workplace transition for new nursing professionals.

Ethical Considerations

Two of the most important ethical considerations in conducting research is ensuring participants give consent and taking appropriate measures to keep the collected data confidential. Protecting the privacy of participants is essential in ensuring the integrity of the research process. Aristidou et al. took both the ethical considerations into account and presented potential participants with an informative consent letter and a questionnaire. The letter “described the purpose and procedures of the study, encompassed giving information about assurance of anonymity, the confidentiality of information, and voluntary nature of participation” (Aristidou et al., 2020, p. 164). The questionnaire, on the other hand, allowed nurses to express their concerns and contact the main researcher. Thompson and George (2016) had no section dedicated specifically to the ethical implications of their study, which is a disadvantage compared to Aristidou et al. (2020). However, Thompson & George (2016) mention that potential participants have been introduced to the study’s intent, which could be considered a resemblance to the informed consent process. As for confidentiality, the authors noted that the collected data was stored in password-protected files although they failed to address the nuances of publication of key findings.


Aristidou, L., Mpouzika, M., & Karanikola, M. (2020). Exploration of workplace bullying in emergency and critical care nurses in Cyprus. Connect: The World of Critical Care Nursing, 13(4), 162-174. Web.

Thompson, R., & George L. E. (2016). Preparing new nurses to address bullying: The effect of an online educational module on learner self-efficacy. MEDSURG Nursing, 25(6), 412-432. Web.

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