الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Workplace bullying (WPB) was
a
common problem in many organizations all over
the world across multiple sectors. (31) WPB is a social and organizational problem within
the health care arena, individuals particularly staff nurses, are at risk for WPB. (232) WPB is
considered a serious issue affecting the nursing profession, as bullying is present in all
work environments and nurses are on the frontline of health care and have the closest
contact with coworkers, supervisor, patients, and their relatives.(130) The antecedent of
WPB involves personal and environmental factors. Personal and environmental factors
include individual characteristics and environmental factors involving disruptive work
environment, Organizational culture, and leadership factors, and misuse of power, the
consequence of these antecedents affects staff nurses‟ wellbeing, organization, and patient
care.
Aim of the study:
This study aims to: Investigate the relationship between workplace bullying and
quality of nursing work life in the intensive care units at Damanhour Chest and Fever
Hospitals.
Setting of the study:
This study was conducted at the Intensive Care Units at the main two hospitals at El-
Beheira governorate namely: Chest Hospital and Fever Hospital. Which are affiliated to
Ministry of Health and Population. These hospitals were selected because they have
different qualifications of nurses, as there are Technical Nursing Institute Diploma , and
Bachelor Science in Nursing (BScN), have the largest number of bed capacity as well as
are affiliated during pandemic COVID19 period. The Chest Hospital with bed capacity
around 160 beds, the Intensive Care Unit (ICU) with bed capacity (38beds) classified as
follow: first floor includes ICU 1 and ICU 2 with bed capacity 7 and 15 respectively and
second floor include ICU 3 with bed capacity 16 beds. While, the Fever Hospital with bed
capacity (150beds). The ICU include 20 beds classified as follow: general ICU with bed
capacity 14 beds in the third floor and COVID19 ICU with bed capacity 6 beds in the
fourth floor.
Subjects of the study:
The subject of this study included all staff nurses who were working in the
previously mentioned setting with experience more than 6 months (n=145), who were
available during the time of data collection and willing to participate in this study. They
were distributed on the study setting as follows:
1. ICU Chest Hospital 85 staff nurses classified as 30 professional nurses and 55
technical nurses.
2. ICU Fever Hospital 60 staff nurses classified as 20 professional nurses and 40
technical nurses
Summary
49
Tools: Two tools were used in order to conduct this study.
Tool I: The Negative Act Questionnaire (NAQ):
This tool was developed by Einarsen, Hoel and Notelaers (2010) (224) It was used to
assess type of bullying and to measure level of exposure to repeated bullying behaviors in
the last 6 months among nurses. It consists of three main dimensions with 22 items as
follows: person and work- relating bullying (17 items); physical and psychological
intimidation bullying (3 items); and occupational devaluation (2 items). The responses
were measured on 5-point Likert scale ranging from never (1) to daily (5) for the 22 items.
The overall score ranged from 22 to110 and was categorized as follows; low level of
exposure to workplace bullying as perceived by staff nurses ranged from22-50; moderate
level of exposure to workplace bullying ranged from 51-80; and severe level of exposure to
workplace bullying ranged from 81-110.
Tool II: Quality of Nursing Work Life Instrument (QNWL):
This tool was developed by Brooks etal., (2007) (225) It was used to assess quality of
work life among nurses. It consists of four dimensions with 42 items as follows: work life
/home life (7 items); work design (10items); work context (20 items); and finally work
world (5 items). The responses were measured on 3-point Likert scale ranging from
Disagree (1) to agree (3). The overall score of level of Quality of Nursing Work Life
Instrument (QNWL) ranged from 42to 126 and categorized as follow; poor quality of
nursing work life ranged from 42-69 as perceived by staff nurses; fair quality of nursing
work ranged from 70-97; and good quality of nursing work life ranged from 98-126.
In addition, staff nurses‟ personal and work-related characteristics data sheet was
developed by the researcher to collect data from nurses such as age, gender, marital status,
educational qualifications, years of experience in nursing, current hospital experience,
working hours per week and source of bullying behaviors as reported by staff nurse.
Methods
1) An official permission was obtained from the Dean of the Faculty of Nursing,
Damanhour University, and the responsible authorities of the study settings at
Damanhour chest and fever Hospital, after explanation of the purpose of the study.
2) The two tools were translated into Arabic by the researcher and were submitted
into both Arabic and English languages to a jury consists of five experts in the field
of the study at the Faculties of Nursing, Alexandria, and Damanhour University to
test its content validity and translation. They were: one professors, one assist
professor and two lecturers from nursing administration department, Faculty of
Nursing Alexandria University, and one assist professor from nursing
administration
department,
Faculty
of
Nursing
Damanhour
University.
Accordingly, the necessary modifications were done based on their opinions.
(appendix IV)
3) The two tools were tested for its reliability (the impact factor of the workplace
bullying scale(NAQ) and the quality of nursing working life instrument(QNWL)=
0.835,0.920 respectively.
Summary
50
4) pilot study was carried out on 10% of staff nurses (n=15), who were excluded from
the study sample; in order to check and ensure the clarity, feasibility and
applicability of the tools and identify obstacles and problems that may be
encountered during data collection and the necessary modifications were done.
Data collection:
Data were collected from the staff nurses through distribution of self -administered
questionnaire after explaining the aim of the study at the work settings using the
previously mentioned tools. Instructions were given before the distribution of the
questionnaire.
The questionnaire was completed in the presence of the researcher to ensure the
objectivity of staff nurses‟ responses, non-contamination of their opinions, and to
check that all items were answered.
Answering the questionnaire took approximately15- 20 minutes. Data collection took
a period of three months starting from 15/ 1/2021 - 11/4/2021.All questions were
answered, and explanations were given accordingly.
Ethical considerations:
The research approval was obtained from the ethical committee at the Faculty of
Nursing-Damanhour University, prior to the start of the study.
An informed written consent was obtained from the study subjects after explanation
of the aim of the study.
Privacy and confidentiality regarding data collected were maintained and assured
Right to refuse to participate or withdraw from the study at any time were ensured
during the study.
Anonymity of the study subject was considered
The following were the main results of the present study:
1. The result shows that nearly half(49 % )of the studied nurses were in the age
between 20 -30 years old, slightly above one third of them (35.9%) were in the age
group 30- 40 years old, meanwhile 2.1% were in the age group ranged from 50
years old and more. The majority of the studied nurses (84.8 %) were female. In
relation to their marital status, it was found that slightly above three quarters of
them (79.3 %) were married. also, illustrates that more than half of the studied
nurses ( 65.5 %) held Technical Nursing Institute Diploma. While, slightly more
than one third (34.5%) of them held bachelor science in nursing (BScN)degree
2. The result indicated that slightly above one third of them (37.2 %) had years of
experience in nursing ranged from 5 -10 years, and 33.1 % had years of experience
ranged from 5-10 years in the current working hospital. In relation to working hours
per week, the vast majority of the studied nurses (93.1%) working 36 hours and
above per week. As regard to source of bullying behaviors as perceived by staff
Summary
51
nurses, slightly more than three quarters (75.9 %) of them reported that bullying
persons were related to administrators, while the rest of them reported that bullying
person was related to colleagues, patients and relatives (45.5%, 35.9%)
respectively.
3. The study confirmed that total level of exposure to workplace bullying behaviors
was moderate 79.3%. The highest workplace bullying dimension as perceived by
the studied nurses was related to physical and psychological Intimidation 65.67%,
while the lowest dimension as perceived by them was related to occupational
devaluation 60.60%.
4. The total level of studied nurses‟ quality of work life was moderate 55.9% with
mean percent score 71.83%
5. The highest mean scores of quality of work life as perceived by the studied nurses
was related to work world dimension (11.18 ± 2.117) with mean percent score
74.53%. On the other hand, the lowest dimension was related to work design (21.17
± 3.810) with mean percentage score 70.57%.
6. The result specified that there was no statistically significant correlation between
workplace bullying and quality of work life among the studied nurses.
The findings of this study lead to the following recommendations:
A. The hospital administrators should:
Adopt zero tolerance policies that include appropriate investigation and due process
necessary to provide adequate safeguards to nurses and others who are accused of
WPB.
Hold mediation and reconciliation programs to intervene and achieve harmony
among nurses whose relationships have been affected by workplace bullying to
ensure peaceful and adequate communication between them.
Promote a culture of safety that encourages open and respectful communication
among all healthcare providers.
Encourage victims to report incidence of bullying behaviors in the hospitals to
functional disciplinary committees.
Protect nurses who report incidences of workplace bullying from further attacks by
the bully.
B. Nurse managers should:
Encourage staff nurses to adhere to policy and procedure that prevent workplace
bullying
Provide support, psychological counseling, and comprehensive care for nurses‟
victim of bullying and inform nurses about their rights to create a positive
atmosphere for nurses.
Summary
52
Design manual/brochure to identify the antecedents behavior of workplace bullying
from nurses to nurses, manger to nurses, from patient to nurse and from relative to
nurses.
Provide workshops for nurse about coping strategy to manage workplace bullying.
Conducting training program to nurses to raise their awareness about sign and
symptoms of workplace bullying, consequence of WPB on personal health as well as
actions that will prevent and stop any abuse.
Provide substantial freedom, independence, and discretion to nurses in scheduling
their work.
C. Nurses should:
Attend workshops for nurse about coping strategy to manage workplace bullying.
Encourage nurses to document the incident of bullying and submitted it to first line
nurse manager.
Provide emotional support to a co-worker immediately following an attack,
determining what should be done for them.
Pay attent opinions and suggestions to avoid the bullying reaction of the patient and
their relatives in the case of ignorance.
Conduct training program for staff nurses about bullying and different strategies to
deal with it, including verbal, nonverbal and writing down techniques.
Further researches are needed to:
Identify the effective strategies to eliminate bullying behaviors.
Investigate the impact of workplace bullying on the patient safety and organizational
outcomes.
Investigate relationship between nurses‟ exposure to workplace bullying and their
organizational citizenship behaviors.
Determine the effect of implementing WPB behavior training program on the nurses‟
QNWL.
Factors associated with WPB among nurses.
References
53
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