Open Access Research BMJ Open: first published as 10.1136/bmjopen-2017-018766 on 24 February 2018. Downloaded from Prevalence, causes and mental health impact of workplace bullying in the Neonatal Intensive Care Unit environment Ilias Chatziioannidis,1 Francesca Giuseppina Bascialla,2 Panagiota Chatzivalsama,2 Fotios Vouzas,3 Georgios Mitsiakos1 To cite: Chatziioannidis I, ABSTRACT Strengths and limitations of this study Bascialla FG, Chatzivalsama P, Objectives The aim of this study is to examine the et al. Prevalence, causes prevalence, to report barriers and mental health impact of ► This is the first study globally aiming to investigate and mental health impact bullying behaviours and to analyse whether psychological of workplace bullying in the workplace bullying in a neonatal intensive care support at work could affect victims of bullying in the Neonatal Intensive Care Unit context. healthcare workplace. environment. BMJ Open ► Workplace bullying is one of the main problems Design Self-administered questionnaire survey. 2018;8:e018766. doi:10.1136/ medical personnel faces in recent years and studying Setting 20 in total neonatal intensive care units in 17 bmjopen-2017-018766 its prevalence and its impact on behaviours is at the hospitals in Greece. top of the research agenda for many academics and ► Prepublication history for Participants 398 healthcare professionals (doctors, this paper is available online. practitioners in healthcare worldwide. nurses). To view these files, please visit ► The instrument used in the study does not provide Main outcome measures The questionnaire included the journal online (http:// dx. doi. substantial causal evidence or identification of risk information on demographic data, Negative Act org/ 10. 1136/ bmjopen- 2017- factors related to bullying in healthcare employees. 018766). Questionnaire-Revised (NAQ-R) behaviour scale, data on ► Issues of prevention and mechanisms of controlling sources of bullying, perpetrators profile, causal factors, and management of bullying were not included in Received 21 July 2017 actions taken and reasons for not reporting bullying, this study and this is a topic for a next research. Revised 11 November 2017 psychological support and 12-item General Health Accepted 4 January 2018 Questionnaire (GHQ-12) scores to investigate psychological distress. http://bmjopen.bmj.com/ Results Prevalence of bullying measured by the NAQ-R healthcare organisations.1–4 Bullying aggres- was 53.1% for doctors and 53.6% for nurses. Victims sive behaviour is defined by criteria as: inten- of bullying differed from non-bullied in terms of gender tion to cause harm or distress, imbalance and job experience, among demographic data. Crude of power between the bully (perpetrator, NAQ-R score was found higher for female, young and inexperienced employees. Of those respondents who aggressor) and the victim (target) and repeat- experienced bullying 44.9% self-labelled themselves as ability over time. The majority of definitions, victims. Witnessing bullying of others was found 83.2%. centres on the perception of the victim, but Perpetrators were mainly females 45–64 years old, most differ in terms of duration, frequency and on September 29, 2021 by guest. Protected copyright. 2 3 likely being a supervisor/senior colleague. Common behavioural acts. Additionally, bullying is reasons for not reporting bullying was self-dealing and fear characterised by persistency (in terms of dura- of consequences. Bullying was attributed to personality tion and frequency), by the victim’s inability trait and management. Those who were bullied, self- 1 to defend himself/herself and by the negative 2nd Neonatal Intensive Care labelled as a victim and witnessed bullying of others had 3 5–9 Unit, Faculty of Medicine, impact on the victim. higher GHQ-12 score. Moreover, psychological support at Bullying behaviour research is based Aristotle University, G.P.N. work had a favour effect on victims of bullying. Papageorgiou Hospital, mainly on two approaches: (1) the self-la- Conclusions Prevalence of bullying and witnessing were Thessaloniki, Greece belling, by asking the respondents if they 2 found extremely high, while half of victims did not consider 1st Psychiatric Clinic, Faculty perceive themselves as being bullied and (2) of Medicine, Aristotle University, themselves as sufferers. The mental health impact on G.P.N. Papageorgiou Hospital, victims and witnesses was severe and support at work the behavioural experience approach, based Thessaloniki, Greece was necessary to ensure good mental health status among on valid, well-structured, scientifically sound 3Department of Business employees. measure scales. Prevalence rates of work- Administration, University of place bullying depend on the methodology, Macedonia, Thessaloniki, Greece research design and cultural/geographical 8 10 Correspondence to INTRODUCTIOn characteristics. Therefore, bullying varies Dr Ilias Chatziioannidis; Workplace bullying has long been recognised among countries and working sectors; people drilias@ windowslive. com as a serious, disruptive problem in modern working in administration and services are Chatziioannidis I, et al. BMJ Open 2018;8:e018766. doi:10.1136/bmjopen-2017-018766 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2017-018766 on 24 February 2018. Downloaded from bullied more often than those in production, research and patient care, the current nationwide survey was or education.7 10–13 Nielsen et al in their met analytic conducted for workplace bullying in the Greek NICUs. study, with the self-labelled method with and without a The objectives of this study were: (1) to assess the prev- given definition of bullying found a prevalence of 11.3% alence of workplace bullying in the NICU environment and 18.1%, respectively, while the behavioural approach and to examine differences between employees; also to revealed a rate of 14.8%.14 assess witnessing of bullying (2) to investigate sources, Bullying behaviour is particularly high in healthcare characteristics of perpetrators and attitudes towards service. Prevalence in the health sector has been reported victims, (3) to examine the impact of bullying on health- from 3% to 8% up to approximately 40%, depending on care professional’s mental health and (4) to analyse the definition used.3 5 15 Reports from NHS trust showed whether psychological support at work can protect staff that a 1/3 among staff,3 44% of nursing staff,16 37% of from adverse effects of bullying. doctors in training15 had experienced bullying and from USA 84% of medical students suffered from mistreat- ment during medical school.17 More recently, surveys METHODS conducted between 2005 and 2011 for NHS staff showed Participants 2 a prevalence of 15%–18% that rose to 24% in 2012. An anonymous paper questionnaire was sent to physi- Despite public awareness, government funded research cians and nurses to all 635 healthcare professionals in and anti-bullying legislation, bullying still provokes 20 NICUs at 17 hospitals with a prepaid return envelope. serious problems, sometimes with detrimental effects Οther healthcare employees were excluded due to incon- on both staff’s mental health and quality of healthcare sistent presence in NICU’s everyday life. A covering letter in hospitals. Clinical impact of bullying in hospitals explaining the purpose of the study was also included and can cause psychosomatic symptoms among healthcare they received a reminder after approximately 4 weeks. professionals; victims of bullying suffer from anxiety, The questionnaire consisted of four sections. loss of self-control,17 depression, lower self-confidence,17 occupational job stress, job dissatisfaction,18 dissatisfac- Questionnaire tion with life,17 burnout syndrome,19 musculoskeletal Section 1 of the questionnaire collected information complaints, increased risk for cardiovascular disease, about the participant's job professional group, job grade, suicide attempts17 and drug abuse.20 21 Bullying is consid- qualifications/educational level, job contract, job time ered a long-lasting threat for psychological and health- experience in the field and hours worked/week. Data care problems as longitudinal designed studies have for gender, age, body mass index (BMI), physical activity, shown.12 20 22 smoking, drinking were also collected. Additionally bullying is associated with increased Section 2 included NAQ-R (Negative Acts Question- 1 23 abseentism, career damage, poorer job performance, naire-Revised) a bullying inventory. NAQ-R was translated http://bmjopen.bmj.com/ lower productivity resulting in poorer quality of healthcare from English into Greek language by team researchers services and patient care;2 8 in the health sector, bullied and a bilingual English teacher back translated the instru- doctors make more often medical errors while bullied ment. The retranslated English version and the original nurses may have lower levels of commitment and turn- were discussed to confirm agreement in each item for over.1 24–26 Bullying and related negative acts are reported linguistic equivalence. in many studies of physicians, nurses, medical personnel NAQ-R provides prevalence data for each of the 22 and staff working in intensive care units. The challenging negative behaviours as well as an overall mean score (for environment of neonatal intensive care units (NICUs) an objective approach of bullying). Respondents were on September 29, 2021 by guest. Protected copyright. exposes medical and nursing staff to stress