Integrating an intervention program to eliminate and prevent bullying

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Integrating an intervention program to eliminate
and prevent bullying

• Margaretha Strandmark
• Professor
• Karlstad University, Sweden

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The research group a collaboration between
Public Health Sciences and Nursing

• GullBritt Rahm, Lic. psychotherapist PhD
• Ingrid Rystedt, MD, PhD
• Gun Nordström, RN, Professor
• Bodil Wilde-Larsson, RN Professor
• Margaretha Strandmark, RN, Professor

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Definition of bullying

• Repeated, systematic, negative, hostile and
  un-ethical actions over time, where one of the
  participant is in a disadvantage position and can
  not defend her/himself towards the other or the
  group. It is not bullying if the persons involved
  are equally strong or if it is a one-off
  situation.
• Olweus 1992 Björkqvist et al. 1994 Leyman, 1996

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A collaborative intervention study, step by step
Step 1 Step 2 Step 3 Step 4
Mapping the bullying problems Explorationof existing strategies and routines Develop-ment and implemen-tation of the interven-tion Evaluating of the results and the implemen-tation
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The first step

• The aim was to map bullying within the health and
  social care systems, and to investigate possible
  associations between bullying and psycho-social
  work environment, as well as health.

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Questionnaires

• Nordic Questionnaire for Psychological and Social
  Factors at work, QPSNordic34
• Sense of Coherence, SOC13
• Health Index, HI
• The Negative Acts Questionnaire, NAQ-22R
• General Health Questionnaire, GHQ-12

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Sample and response rate

• The questionnaires were sent out to 2810
  employees at wards at five hospitals and to
  elderly care settings in five municipalities.
• 1550 employees answered the questionnaires (55
  response rate).

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NAQ-22R divided in work-related and
personal-related items

• Examples of work-related questions
• Withholding of necessary information affecting
  the work ordered to work towards unreasonable
  and impossible goals.
• Examples of personal-related questions Repeated
  offensive remarks about your person, values, or
  private life silence or hostility as response to
  questions or attempts to conversation.

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Prevalence of bullied employees from NAQ-22R

• Between 33-44 points (occupational
• bullying, developing bullying) 8.5
• gt 45 points ( severe bullying) 2.3
• Exposed to at least one negative
• acts /week 18.5
• Exposed to at least two negative
  acts/week 6.8

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Additional separate questions

• Reported being bullied 4.1
• Reported having witnessed
• bullying 21.9
• Reported having ever been bullied
• 38.2

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Correlations between NAQ-22R (bullying) and
QPS-34 (work environment)

• Significant correlation between the questionnaire
  about negative actions and the questionnaire
  concerning work environment.
• The social/organization related questions have
  the strongest correlation with negative actions.

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Preliminary results based on a cluster analyses

• More severely bullied employees have reduced
  health and lower Sense of Coherence, as compared
  to employees who are less bullied.

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The second step

• The aim was to explore existing strategies and
  routines to prevent and manage bullying.

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Method

• In-depth interviews with 12 key persons from one
  hospital and two municipalities (managers at
  higher level, HR-partner, staff responsible
  related to work environment, union
  representatives, occupational health
  representatives)
• Content analysis (Graneheim Lundman 2004, Elo
  Kyngäs 2008)

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Findings
Bullying A hidden problem An acknowledged problem
Routines Work environment program Identification
Strategies Avoiding Choice of solution
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Categories

• Avoiding sweep the problem under the carpet and
  an un-clearly definition.
• Preventive work environment programs not
  specifically directed towards bullying, compiled
  documents an policies are put on the shelves,
  inadequate time for psychosocial questions
• Identifying and managing bullying exists, group
  pressure, different cultures, the chiefs and
  co-workers responsibility
• The choice of solution split the group, and/or
  work through of the occurrences

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BULLYING AS THE TOP OF AN ICEBERG
Acknowledgement

• Identification
• Choice of solution

Hidden

• Avoiding
• Work
• environment program

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The third step

• The aim was to, in collaboration with the
  workplaces, develop and implement an intervention
  program to prevent and eliminate bullying

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Research approach and sample

• The research approach was participatory and
  community based.
• Based on questionnaire scores workplaces were
  selected, in collaboration with the managers on
  upper level, two eldercare wards and one
  psychiatric ward for elderly, where bullying
  problem were presented.
• Occupational included assistant nurses, nurses,
  physicians, physiotherapists, occupational
  therapists, counsellors and nurses assistants.
• Interested employees voluntarily enrolled
  themselves in the focus groups upon our
  presentation of the project.

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Individual and focus group interviews

• In the first focus group. we investigated how
  bullying was manifested at the workplace.
• In the second focus group, we focused on the
  components in the intervention program which
  prevented and eliminated bullying.
• In the third focus group, we discussed the
  suggestions concerning the action plan that the
  researchers presented, based on the previous
  interviews.
• The interviews were analyzed according to
  Grounded Theory methodology (Charmaz 2006).

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Preliminary findings
Zero-tolerance
Zero-tolerance
Zero-tolerance
Value-system
Atmosphere
Organization
Zero-tolerance
Head
Group collaboration
Co-workers
Awareness
Conflict solving
Zero-tolerance
Zero-tolerance
Zero-tolerance
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Zero-tolerance (no bullying)

• The actors consist of the head of the wards,
  co-workers and the remaining organization.
• Work with the value-system, to be aware of the
  bullying, work against an open atmosphere, group
  collaboration and conflict resolution are
  requirement to attain zero-tolerance against
  bullying.

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The role of the head of the ward

• The head of the ward has a keyrole as the spider
  in the web.
• In this role she/he collaborate with co-workers
  and the remaining organization.

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The actors roles

• The head of the ward has an intermediate
  positions in which she/he will be a model,
  listening, emphatic, resolute and call for
  demands.
• The co-workers have a responsibility to behave
  themselves professionally towards patients,
  clients and the head of the ward.
• The executive level over the head of the ward is
  a black box, and experiences as unfairness
  concerning staffing, work loading, and
  employments.

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Categories

• A humanistic value system which is based on
  respect, tolerance and empathy.
• An open or a concealed atmosphere consist of
  possibilities to talk freely or to be stick in
  the walls.
• Collaboration within the group and between the
  groups included help over the limits, creation of
  mutual routines, building clicks and informal
  chiefs.

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Intervention program

• From the findings of the interviews an
  intervention was developed.
• From the first focus group we gave a half-day
  lecture at the workplaces about bullying,
  conflict management, communication and a feeling
  of shame.
• We also discussed in small groups with all
  employees based on playing-cards containing
  bullying situations and possible solutions.

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With-holding of information
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Bullied of a co-worker
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Control of the chief
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Intervention program

• c) From the separate interviews and the two first
  focus groups interviews a suggestion for a
  concrete action plan was compiled.
• The plan included the value-system, to recognize
  bullying and call out, treatment which creates
  confidence and trust, conflict management, the
  supervisors and co-workers roles, dynamic group
  processes, and arenas to keep the discussion
  alive.
• d) The action plan has been presented and
  discussed in the steering groups of the
  workplaces.

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Follow-up the action plan at the workplaces

• All employees shall sign the action plan.
• New co-workers are assigned a mentor.
• The head of the ward is responsible for the plan
  is followed.
• The participates of the focus groups are
  responsible to keep the discussion alive.

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Conclusion

• Zero-tolerance against bullying shall be
  prevailed. The head of the ward, the co-workers
  and the remaining organization work together
  against this goal through a humanistic
  value-system. To be aware of the bullying, to
  have an open atmosphere and a good collaboration
  in the groups is important for conflict
  resolution and prevention.

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Evaluation of the results and the implementation

• The same questionnaire will be sent out to the
  workplaces which have implemented the
  intervention, and to a similar comparison group,
  where no intervention has occurred.
• The fourth focus group interviews, we will
  discussed whether the implementation was
  succeeded.

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Thank you for your attention!