In the past decades, the rising presence of workplace bullying for the nursing profession has been recognized within the Australian health care organization (Hartin, Birks & Lindsay, 2018). A survey which was conducted in Victoria indicates that 52% of nurses had witnessed bullying behaviour in workplace setting (Farrel & Shafiei, 2012). Workplace bullying is an occupational health safety challenge, which has been defined as systematic and repeated abusive mistreatment, to an individual with main consequences of negative impact on individual’s work performance and health (Arnetz, Fitzpatrick, Cotten, Jodoin & Chang, 2019). Based on the multifactorial and multiclausal nature of workplace bullying, it is clear that its contributors are perceived differently across cultures (Kemp, 2014).
In Australian context, the pervasive nature of bullying is ingrained into the organizational culture of nursing professions, which has been labelled as toxic, hostile and detrimental (Hartin et al., 2018). The contributor of such workplace culture has been identified as the differentials of power between the nurses who hold different or equal positions (Hartin et al., 2018). Additionally, the displayed aggression towards one another has been suggested as a common form of workplace bullying behaviour in Australian nursing profession (CITE). The oppression theory has been adopted as the theoretical ground for aggressive bullying behaviour towards peers among nurses in previous literatures (Embree, Bruner & White 2013; Griffin & Clark, 2014; Griffin, 2004; Jonason, 2015).
Based on this theory, the nursing profession is conceptualised as an oppressed group, as they are often placed at the bottom of the hierarchy of organizational culture for health care sector (Logan & Malone, 2017). Consequently, such unequal power balance in the workplace can cause the sense of powerless for nurses, which lead to aggressive behaviour towards each other as a result of being members of the oppressed group (Hammond, Bronner, Bays, Wilcox & Smith, 2017). This type of aggressive bullying behaviour has been described as lateral violence (Griffin & Clark, 2014). Failure of addressing such bullying behaviour can produce an adverse impact on the physical and mental health of nurses, which further lead to low job satisfaction and work performance. As a result, the intervention is needed to prevent the manifestation of lateral violence among Australian nursing professions and achieve equal power gradient in the work environment.
In order to balance the power dynamic in work environment, the intervention need to focus on individual level, as the individual nurses plays an important role in changing the workplace culture (Griffin & Clark, 2014). Previous studies conducted on prevention of lateral violence using primary strategies, which concentrate on generating contextual changes with employee training and educational workshops, to equip nurses with strategies for workplace bullying (Escartin, 2016). The study by Griffin (2014) indicate that the cognitive rehearsal program as a primary prevention can effectively decrease the likehood of lateral violence through improving nurses’ ability of identifying bullying behaviour, as well as confronting the offender.
The intervention is constructed as 2 hours’ session with two sections. The first portion is one hour educational session on knowledge about common bullying behaviour, such as lateral violence, as well as the negative impact of workplace bullying on nursing practise. This section can increase nurses’ awareness of lateral violence, to be able to identify such bullying behaviour in work environment. The increased awareness for nurses can also decrease the workplace bullying because nurses may change their own behaviours which they identify as bullying behaviour. The second hour is conducted on interactive instruction, which utilise cognitive rehearsal technique to practice the appropriate response to common form of lateral violence. The cognitive rehearsal technique has been applied in behaviour therapy, which can assist individuals to change their behaviour or response to events through learning and practicing the instruction of certain response (Cognitive Behavioural Therapy Techniques, 2011).
The bullying management skill of nurses can therefore be increased through the cognitive rehearsal of adequate response. Moreover, the cognitive rehearsal intervention provides the environment for nurses to practice the adequate response before actual use, which can support their confidence in performing the response in difficult bullying situations.
The efficacy of cognitive rehearsal intervention has been indicated in subsequent studies (Embree et al., 2013; Hammond et al., 2017; Stagg, Sheridan, jones & Speroni, 2011, 2013). In the study conducted by Embree et al. (2013), the trends of the result showed increased awareness of lateral violence for nurses after the intervention. Hammond et al. (2017) applied a similar cognitive rehearsal method and reported a significant increase in self-empowerment and self-esteem among nurses through the intervention, to further result in an improved attitude to the dominant group.
Regarding to both pilot studies by Stagg et al, (2011 & 2013), a significant improvement was found in nurses’ ability of recognising and responding bullying behaviour. Most studies are longitudinal studies with actual application of cognitive rehearsal intervention that secure the reliability of the result. The longitudinal study focuses on collecting data from the same sample repeatedly over a specific period of time. The pre-test and post-test are included in all studies to assess the difference on dependent variables which is related to the application of intervention.
However, several limitations of the methodology for most of studies are identified. First, small simple size of non-randomised sample is collected in all studies, which restricted to different forms of nursing profession. Such sample can hinder the generalization of study results to other populations. Second, the result analysis in most studies replied on quantitative procedures without the application of qualitative study, such as personal interviews. Third, merely two waves of data are collected in all studies that can affect the interpretation on the causal relationship of the conclusion. Furthermore, it is noteworthy that the primary function of cognitive rehearsal intervention is practising the adequate response to deal with a situation between two individuals when workplace bullying occurs.
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