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Annotated Bibliographies for Literature Appraisal
Stacy Anders
Oklahoma Wesleyan University
NURS8603 Scholarship for Nursing Practice
Dr. Dawn Julian
November 13, 2022
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Annotated Bibliographies for Literature Appraisal
The annotated bibliography is a list of research resources with a descriptive paragraph.
Creating an annotated bibliography aims to prove that good primary research articles are used to
support further study on a potential topic. The topic of incivility in nursing is dated back many
years. There is evidence of incivility or bullying behaviors between nurses across all continents
and countries. This annotated bibliography gives a broad spectrum of the topic and potential
measurement tools that can measure incivility in the workplace. Another source for studying a
topic is identifying and cementing a clinical site and preceptor. This author met with an approved
preceptor and clinical facility site to research nurses about incivility. The discussion included
potential project implementation dates, an ideal sample size of registered nurses, and classroom
space. A key component to a successful research study is a willingness for success from
everyone involved, with positive results impacting patient outcomes.
Annotated Bibliography
Al Omar, M., Salam, M., & Al-Surimi, K. (2019). Workplace bullying and its impact on the
quality of healthcare and patient safety. Human Resources for Health, 17(1), 1–8.
https://doi.org/10.1186/s12960-019-0433-x
This study identified several factors in workplace bullying (WPB) behaviors.
Among them were stress, work performance, and communication between participants
and their patients. Most healthcare practitioners worry about WPB, especially when it
negatively impacts quality patient care and safety. Those with advanced education and
less experienced respondents were more worried, along with previous exposure to WPB.
Respondents felt that instruction on recognizing and handling bullying behaviors was
helpful. They felt scripting techniques in responses to WPB or role-playing during
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controlled education sessions effectively gave them approaches when encountering
bullying behaviors.
This cross-sectional study was conducted across four hospitals in Saudi Arabia to
examine the correlation between the perceptions of bullying behaviors and whether it
affects patient care and safety that healthcare practitioners provide. Houck and Colbert
developed a validated tool that included responses rated on a 5-point Likert scale and
converted to a percentage mean score, then compared across the participant’s
characteristics using regression analyses. Mann-Whitney test was used to evaluate the
median of scores, and the Z-score was presented with a sample size of more than 30. One
thousand seventy-four respondents completed the questionnaire. The median percentage
of worrying about workplace bullying was 81.7%. One of the limitations of this study
was the four hospitals surveyed belonged to the same healthcare system. In addition,
many of the respondent’s native languages are not English, and they may have
misinterpreted some statements. Some practitioners may not have answered the survey
honestly due to the study’s sensitive topic. It is possible that practitioners may have been
on vacation or not accessed the email link.
Alquwez, N. (2020). Examining the influence of workplace incivility on nurses’ patient safety
competence. Journal of Nursing Scholarship, 52(3), 292–300.
https://doi.org/10.1111/jnu.12553
This quantitative study assessed the clinical nurses’ workplace experiences of
bullying behaviors and causes on the nurse’s competence of patient safety. The study
revealed incivility received by other nurses negatively impacts patient safety.
Communication must be adequate to impact workplace incivility and patient safety
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positively. Education regarding disrespect with uncivil persons and training on
professional values can benefit the healthcare provider. In addition, healthcare leadership
should develop policies to improve nurses’ patient safety competence by addressing
uncivil acts in healthcare settings.
Two hundred sixty-one nurses in two healthcare facilities completed a self-survey
using the Nurse Incivility Scale (NIS) and the Health Professional Education in Patient
Safety Survey (H-PEPSS). The mean age was 32.89 years, with 88% of respondents
being female. Eighty percent had their bachelor of science in nursing, and 89.7% worked
21 to 40 hours per week. Voluntary participants were informed of the study and
distributed across multiple hospital units. Multivariate multiple regression analysis
showed that general and nurse incivilities had multivariate impacts on the competence of
patient safety. The study had limitations, including a design flaw that inhibited causal
testing relationships between variables. Mixed-method techniques are recommended for
future studies on this topic. Also, the measurement of incivility was self-reported and
based on the nurses’ perceptions.
Ayakdaş, D., & Arslantas, H. (2018). Colleague violence in nursing: A cross-sectional study.
Journal of Psychiatric Nursing, 9(1), 36–44. https://doi.org/10.14744/phd.2017.52724
This cross-sectional study focused on peer-to-peer violence in nursing from a
combination of university and research hospital nurses. It revealed forty-seven percent of
nurses had experienced peer-to-peer violence. In addition, there were reports of jealousy,
rivalry, novice nurse experience differences, patient overload unfairness, political view
differences, and physical appearance differences. Some encountered attacking behaviors
such as humiliation and degradation. Additionally, most participants worked harder in
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response to violent behavior to avoid further violence. Follow-up statements of the study
included that perhaps incivility could be decreased if the nurses were armed with the
resources and techniques to respond to bullying behaviors.
The study used a sociodemographic questionnaire, workplace psychological
violence behavior assessment, and development scale. The timeline for the research was
between March and August 2013. The sample collected used a G power analysis program
with a 95% confidence interval and 80% power. The number of population samples
needed was 779 persons. One thousand three hundred seventy-six nurses were informed
of the study and participated voluntarily, being identified using a simple random number
table. Each participating hospital was divided into six groups of various departments.
Limitations of the study included a timeline of one year and responses of nurses in the
study sample to the scales used in the data collection tools. Future studies should include
the amount, causes and effects, and characteristics of peer-to-peer violence.
Berry, P., Gillespie, G., Fisher, B., Gormley, D., & Haynes, J. (2016). Psychological distress and
workplace bullying among registered nurses. OJIN: The Online Journal of Issues in
Nursing, 21(3). https://doi.org/10.3912/ojin.vol21no03ppt41
A significant finding in this study was that workplace bullying (WPB)
corresponds to stress, anxiety, and PTSD symptoms unrelated to race, education, gender,
or prior history of being bullied. 1/3 of the nurses reported being bullied at least two
times a week, with more than 50% feeling targeted and unable to defend themselves.
Nurses are not immune to prolonged WPB behaviors. Healthcare organizations must
create a safe and healthy work environment for their staff. Providing education and
resources about incivility behaviors can help deescalate WPB behaviors. In addition,
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confronting WPB behaviors immediately before they get out of control can help ward off
unwanted behaviors.
This sequential quantitative dominant mixed method study was performed over
two phases to measure psychological distress and WPB behaviors in registered nurses
participating in the first phase in 2010. 75% of the nurses agreed to participate in the
second phase approximately 18 months after the first survey. Respondents received
instructions on a five-component internet survey with a unique identifier number. Thirtyseven nurses met the survey criteria, including working on the same unit at the same
employment as they were during the first survey. Some of the surveys used were the
Negative Acts Questionnaire (NAQ) to measure exposure to workplace bullying behavior
and the Perceived Stress Scale to perceive stress over a specified amount of time.
Additionally, the State Anxiety Trait Anxiety Inventory to measure how respondents
“feel right now” and the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian
Version (PCL-C) screening for PTSD were given to the respondents. Finally, a
demographic survey for acquiring prior work history on the employed unit, previous
bullying outside of the workplace, age, gender, and ethnicity was applied to the study. A
limitation of this study was the sample size. It did not represent how all nurses would
respond to WPB behaviors. Additionally, nurses who may have experienced being
uncomfortable may have opted not to participate.
Feeg, V. D., Mancino, D. J., & Kret, D. D. (2021). First job workplace stressors for new nurse
graduates in their own words: A secondary analysis. Nursing Education Perspectives,
43(1), 30–34. https://doi.org/10.1097/01.nep.0000000000000894
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This qualitative research aimed to understand better the new graduate nurse in
their work environment and their perception of stressors during the role transition into the
registered nurse. New graduate nurses planned to find balance and reported feelings of
environmental stress, high self-expectations, and relationships with others that affected
their job performance. Results proved that new graduate nurses feel the stressful
environment as a barrier to their transition to the registered nurse role. The stress of
interpersonal interactions documented fears with other nurses during the transition.
Reports of “feeling picked on," “being eaten by the nurses," “if you are not friends, you
get the worst patients,” and “nurses are rude and condescending during reports” were
common statements in the responses. These statements and more indicated increased
perceived stress and affected their workplace environment making the new graduate
nurse unprepared for complex circumstances. Seasoned nurses must do better with easing
the transition of new graduate nurses into the registered nurse role. One way to do this is
to decrease their stress, decrease the incivility and bullying behaviors of seasoned nurses,
and provide education and resources to the new graduate nurse so they can learn to cope
with the stressor of the new work environment. Establishing anti-bullying programs,
residencies, and support teams can help with the common theme of nurses eating their
young.
One thousand four hundred and fifty-six responses of a qualitative survey style
with a content analysis approach were received from new graduate nurses graduating in
the 2017 academic year within the previous 6 to 12 months. The study survey was
administered through SurveyMonkey to a list obtained from the National Student Nurses
Association (NSNA). The survey included 18 items labeled as perceived job stressors
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with an open-ended question asking participants to “describe what is stressful in your
job.” Researchers studied written narrative statements to collect common statements into
categories that can be further associated with themed descriptors. Respondents described
the nurse/patient ratio as the most frequently stressed, followed by high standards, and
fear of making mistakes. Limitations in this study included using a dataset for a
secondary analysis tool collected for a primary purpose that offset the potential
generalization. It focused only on the qualitative component related to the stress of the
new job. This study confirmed that incivility and bullying are still present in the current
job setting.
Nielsen, M., Matthiesen, S., & Einarsen, S. (2010). The impact of methodological moderators on
prevalence rates of workplace bullying. A meta-analysis. Journal of Occupational and
Organizational Psychology, 83(4), 955–979. https://doi.org/10.1348/096317909x481256
The focus of this study was to examine how different measurement methods and
sampling techniques contribute to the prevalence of workplace bullying. This study
identified that bullying behaviors are a widespread problem in the work environment
regardless of where a person is employed. Workplace bullying is a shared expression that
includes various forms of abuse and ill-treatment. The prevalence of bullying behaviors
differs among different countries and can vary in the same country, depending on where
someone resides. It is important to remember that the definition of bullying is a situation
where a person is regularly exposed to hostile acts over time. Many measurement
methods are used to determine the prevalence of bullying behaviors, but specific
measurement tools can influence the prevalence rates. Reliable and valid ways to assess
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workplace bullying are essential to developing and implementing effective intervention
strategies to prevent workplace bullying.
One hundred-two estimates of bullying from 86 independent samples were
collected and compared utilizing meta-analysis. On average, the independent samples
provided an assessment of a 14.6% of prevalence of workplace bullying. Methodological
moderators influenced the estimated rates. A rate of 11.3% was found for studies
investigating self-labeled victimization from bullying, whereas behavior measure studies
resulted in 14.8%. A difference of 8.7% points was found between randomly and nonrandomly sampled studies. Geographical differences influenced findings on bullying
behaviors.
Notelaers, G., Van der Heijden, B., Hoel, H., & Einarsen, S. (2018). Measuring bullying at work
with the short-negative acts questionnaire: Identification of targets and criterion validity.
Work & Stress: An International Journal of Work, Health & Organisations, 33(1), 58–75.
https://doi.org/10.1080/02678373.2018.1457736
This study investigated the psychometric properties of the abbreviated version of
the Negative Acts Questionnaire, known as the Short Negative Acts Questionnaire
(SNAQ). The current research shows practical and theoretical support for the validity of
the SNAQ as a measure of exposure to severe and occasional bullying. The SNAQ has
similar properties as the full version of the NAQ. The findings of this study suggest that
utilizing a short measure of workplace bullying methods could be used in general surveys
of psychosocial work environments where questionnaire space is limited. It is
recommended that practitioners who suspect workplace bullying use the Negative Acts
Questionnaire-Revised (NAQ-R) rather than the SNAQ for future studies.
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The sample of 7790 persons was selected from a more extensive database by
determining the absence of criterion variables needed to examine the psychometric
qualities of the SNAQ. The final sample was Belgian employees from 38 organizations
across sectors of industrial, private service, central public service, healthcare services,
railway sectors, and schools. Forty percent of the respondents were at least 45 years of
age. There were more male respondents, and 25% had supervisory responsibilities.
Approximately 66% had a tenure of 15 or more years. Fifty percent worked the day shift,
while the rest had other work arrangements. Single-item measures and scales were used
to collect data with specific questions regarding satisfaction in the job, recovery needs,
self-perceived health, somatic symptoms, absenteeism due to illness, and presenteeism,
along with the SNAQ survey. Despite many respondents, it was not representative of the
Belgian workforce. There was an overrepresentation of men, private sector employees,
supervisors, and those with advanced education. Another find included an
underrepresentation of employees who work only during regular office hours, which
skewed the results. In addition, the SNAQ properties need to be reviewed further in other
samples due to the limited use of the SNAQ survey in other studies.
Pérez-Fuentes, M., Gázquez, J. J., Molero, M., Oropesa, N. F., & Martos, Á. (2020). Violence
and job satisfaction of nurses: Importance of a support network in healthcare. The
European Journal of Psychology Applied to Legal Context, 13(1), 21–28.
https://doi.org/10.5093/ejpalc2021a3
This cross-sectional study examined the relationship between peer-to-peer
violence toward nursing staff and job satisfaction. Nurses are at the most significant risk
of experiencing threats to physical integrity and verbal violence. A higher incidence of
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workplace bullying is because their work environment involves continuous, direct contact
with people. In addition, they are also exposed to violence from their co-workers through
bullying, intimidation, and horizontal violence, usually generated by a power imbalance.
This behavior causes embarrassment, susceptibility, and weakness in the victims limiting
their ability to develop competency and defend themselves. This study confirmed a
correlation between bullying behaviors and job satisfaction among nurses. The incidence
of incivility and bullying behaviors could be decreased with education and training on
learning how to respond effectively.
One thousand three hundred fifty-seven nurses were administered the Spanish
version of the Negative Acts Questionaire (NAQ), the Healthcare-Workers Aggressive
Behavior Scale-Users (HABS-U), the Brief Perceived Social Support Questionnaire, and
the Overall Job Satisfaction survey. All the surveys administered showed that the
reliability indices were optimum and had good internal consistency. Participation was
voluntary, and respondents were informed of the study and its purpose. The results
revealed that workplace bullying and peer-to-peer violence by co-workers and family
members directly affected internal and external job satisfaction. This outcome suggests a
need to integrate a stable healthcare system to improve nurses’ job satisfaction by
protecting them against the adverse effects of workplace violence. The limitations of this
study revealed the type of relationship and contact with co-workers are different in
healthcare units. Variable data collection would interest future studies with direct
consequences of aggression. Additionally, there were more women participants than men,
which should be considered with generalized findings.
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Van de Vliert, E., Einarsen, S., & Nielsen, M. (2013). Are national levels of employee
harassment cultural covariations of climato-economic conditions? Work & Stress: An
International Journal of Work, Health & Organisations, 27(1), 106–122.
https://doi.org/10.1080/02678373.2013.760901
This study collected survey data from 44,836 employees across 44 countries using
the Negative Acts Questionnaire-Revised (NAQ-R) that revealed a cultural in-group
orientation was associated with lower employee harassment. Workplace environments
reported more bullying behaviors in poorer countries with colder-than-temperate winters
and hotter-than-temperate summers or both. Workforces with a low prevalence of
employee harassment were primarily found in South and Northwest Europe and North
and South America. Education and training resources specific to bullying behaviors
focusing on victims and perpetrators may be helpful.
Convenience and random sampling included employees and managers of various
organizations. The study withdrew five countries from the pool of participants because of
fewer than 35 respondents. Data from the World Values Surveys were used to validate
the estimations while using the regression equation for the sample of 44 countries. The
results provided that employee harassment is more prevalent in countries with either
survival or self-expression cultures than in countries with cultures that are intermediate
between the two climate extremes. Group culture and patterns of organizational tolerance
and policies play a part in workplace environments with harassment and bullying.
Examining this study between climate and economic hardships and employee harassment
may show a correlation with an increase in aggression. Limitations of the study included
working with biased convenience samples of nations and employees. There was no
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indication that the 44 countries’ samples did not represent a broader group of countries
for cultural in-group orientation, climate demands, and national wealth. The study
assumed that all the country’s employees were equally competent in providing
information about the characteristic cultural level of harassment. No systematic
distinction was made between mild and severe harassment acts, even though more severe
actions have larger weights and come later in escalating harassment.
Warrner, J., Sommers, K., Zappa, M., & Thornlow, D. K. (2016). Decreasing workplace
incivility. Nursing Management, 47(1), 22–30.
https://doi.org/10.1097/01.numa.0000475622.91398.c3
This intervention-based study was performed to determine if training and scripted
responses to bullying behavior influence incivility awareness levels. It included a pre-and
post-survey with education between the surveys and a final survey two months posttraining. The study concluded that increased awareness of incivility occurred after
training. Incivility can affect the nurse’s mental health, decrease productivity, and lead to
patient safety issues. Providing awareness education and role-playing scenarios with
scripted techniques and resources can help reduce perceptions of uncivil behavior.
The Nurse Workplace Scale (NWS) was used to measure a sense of
empowerment in all healthcare providers on a 60-bed inpatient unit, including RNs,
patient care techs, therapists, case managers, and management team members. Training
occurred over a two-week time frame with 45-minute intervention sessions. The result
included higher participation in the first pre-and post-survey rather than the two-month
post-survey due to occurring in combination with training sessions. The majority of
responses were from female, full-time RN staff. The strengths of this study were that the
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staff felt like incivility behaviors decreased when they used the resource tools provided in
the training sessions. Limitations to the study were the lack of role-playing scenarios in
the training sessions and considering an alternative method to providing the two-month
post-survey because of significantly lower participation.
Conclusion
After completing the annotated bibliography on incivility and bullying behaviors, this
author recognizes that the research represents a small sample of the available literature on
incivility. This assignment provided insight into the literature on incivility, and this author
believes there is enough primary evidence to support further study. A common theme from the
findings was that incivility occurs in the nursing profession and multiple workplace populations
worldwide. Education and training that includes situational scripts and role-playing appear to be
effective strategies for preventing, confronting, and managing incivility in the workplace. It is
essential to have a valid measurement tool when researching this topic to understand better the
underlying issue of incivility and bullying behaviors in the workplace. Administering a valid
perception measurement tool for bullying behaviors in the workplace and developing an
incivility training program may help decrease the incidence of hostile acts in an acute healthcare
facility. Increasing awareness of bullying behaviors and providing evidence-based education to
nurses experiencing incivility with other nurses will reduce the incidence and add to our
collective nursing profession.