Integrating an intervention
program to eliminate and
prevent bullying
Margaretha Strandmark
Professor
Karlstad University, Sweden
The research group – a collaboration
between Public Health Sciences and
Nursing
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GullBritt Rahm, Lic.
psychotherapist PhD
Ingrid Rystedt, MD, PhD
Gun Nordström, RN,
Professor
Bodil Wilde-Larsson, RN
Professor
Margaretha Strandmark,
RN, Professor
Definition of bullying
Repeated, systematic,
negative, hostile and unethical 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
A collaborative intervention
study, step by step
Step 1
Mapping
the bullying
problems
Step 2
Exploration
of existing
strategies
and
routines
Step 3
Development and
implementation of the
intervention
Step 4
Evaluating of
the results
and the
implementation
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.
Questionnaires
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Nordic Questionnaire for Psychological and Social
Factors at work, QPSNordic34+
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Sense of Coherence, SOC13
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Health Index, HI
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The Negative Acts Questionnaire, NAQ-22R
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General Health Questionnaire, GHQ-12
Sample and response rate
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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).
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.
Prevalence of bullied employees
from NAQ-22R
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Between 33-44 points (occupational
bullying, developing bullying)
8.5%
> 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%
Additional separate questions
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Reported being bullied
4.1%
Reported having witnessed
bullying
21.9%
Reported having ever been bullied
38.2%
Correlations between NAQ-22R
(bullying) and QPS-34 (work
environment)
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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.
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.
The second step
The aim was to explore existing strategies
and routines to prevent and manage
bullying.
Method
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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)
Findings
Bullying A hidden
problem
Routines
Work
environment
program
An
acknowledged
problem
Identification
Strategies
Avoiding
Choice of solution
Categories
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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 chief’s
and co-workers’ responsibility
The choice of solution – split the group, and/or
work through of the occurrences
BULLYING AS THE TOP OF AN ICEBERG
Acknowledgement
Hidden
•Identification
• Choice of solution
•Avoiding
• Work
environment
program
The third step
The aim was to, in collaboration with the
workplaces, develop and implement an
intervention program to prevent and
eliminate bullying
Research approach and sample
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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 nurse’s assistants.
Interested employees voluntarily enrolled themselves in
the focus groups upon our presentation of the project.
Individual and focus group
interviews
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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).
Preliminary findings
Zero-tolerance
Zero-tolerance
Zero-tolerance
Value-system
Atmosphere
Organization
Head
Co-workers
Zero-tolerance
Group collaboration
Awareness
Conflict solving
Zero-tolerance
Zero-tolerance
Zero-tolerance
Zero-tolerance (no bullying)
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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.
The role of the head of the ward
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The head of the ward
has a keyrole as the
spider in the web.
In this role she/he
collaborate with coworkers and the
remaining
organization.
The actors’ roles
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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.
Categories
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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.
Intervention program
From the findings of the interviews an
intervention was developed.
a) From the first focus group we gave a halfday lecture at the workplaces about
bullying, conflict management,
communication and a feeling of shame.
b) We also discussed in small groups with all
employees based on playing-cards
containing bullying situations and possible
solutions.
With-holding of information
Bullied of a co-worker
Control of the chief
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 coworkers’ 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.
Follow-up the action plan at the
workplaces
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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.
Conclusion
Zero-tolerance against bullying shall be
prevailed. The head of the ward, the coworkers 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.
Evaluation of the results and the
implementation
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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.
Thank you for your attention!