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Roll No. 1440
Sabeen Mustafa
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mental health and academic
The impact of bullying on the

achievement of nursing students

 Abstract
Purpose: This study aimed to determine the prevalence of
bullying and identify the perpetrators of bullying among nursing
students. Further, the impact of bullying on their mental health
and academic achievement was also examined.
Design and Methods:
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A cross‐sectional correlational design was adopted. A total of 180

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undergraduate nursing students completed an electronic

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questionnaire.
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Results: Approximately half of the participants had experienced

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at least one or more bullying behaviors on a daily or weekly basis
during nursing education. Classmates were the most frequently
reported perpetrators of bullying behaviors. Bullying experience
was associated with poor psychological health and perceived
stress. A lower grade point average emerged as a significant
predictor of exposure to bullying behaviors.
 WHAT IS Bullying
“The repetitive, intentional hurting of one person or group by another
person or group, where the relationship involves an imbalance of
power.”
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“Bullying is an ongoing and deliberate misuse of power in relationships

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through repeated verbal, physical and/or social behavior that intends

to cause physical, social and/or psychological harm. It can involve an
individual or a group misusing their power, or perceived power, over
one or more persons who feel unable to stop it from happening.”
 Bullying in clinical setting
Bullying is prominent in clinical settings, because nursing students visit
several hospitals as a part of their training and are observed and
influenced by staff nurses and other healthcare team members.
Therefore, nursing students are vulnerable to horizontal and vertical
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bullying, especially because of the shortage of staff nurses and

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increase in workload in clinical settings. Consequently, nursing students

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are required to meet unrealistic expectations, and shoulder additional

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burdens when compared to other university students.

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The literature indicates that bullying behaviors are commonly tolerated
by nursing students in clinical settings. This lead to the development of
negative attitudes toward clinical practice, weaken their intentions to
become nurses, and negatively influence their general physical and
psychological well‐being.
 Bullying in Academic environment
• Bullying behaviors are prevalent also in academic environments.
Students may be bullied by faculty members, clinical instructors,
and administrative staff, who are supposed to serve as good role
models. However, they abuse their power, establish their
superiority, and control their students to be acting like assertive.

• Academic dependence is a cause of bullying against students

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because there is a power imbalance between students and their
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faculty members. Therefore, students cannot defend their rights

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against their perpetrators

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• Exposure to bullying as a serious painful experience can lead to
serious problems among college students and have detrimental
effects on their physical, psychological, and mental wellbeing. If
these conditions are left undiagnosed and untreated, the affected
individual may experience psychosomatic symptoms such as
anxiety, a loss of self‐control, depression, poor self‐confidence, and
posttraumatic stress disorder. In addition to poor academic
achievement dropping out, and students may also engage in risky
behaviors (e.g., addiction) or attempt suicide.
 1.1 Significance of this study

 Examine the occurrence of bullying

 Existing gaps between bullying‐related policy and practice
 How such policies should be enforced to minimize these gaps.
 The findings will help policymakers formulate preventive
antibullying strategies.

2 | LITERATURE REVIEW
 In sum, this study aimed to determine the prevalence, frequency,
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and perpetrators of bullying among university nursing students and
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investigate the impact of bullying on their mental health and

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academic achievement.

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 2 |Literature Review
The existing literature was systematically searched using databases of Science
Direct, Medline, CINAHL, Google Scholar, and PubMed, articles published in
English. Search keywords were bullying, nursing students, mental health, and
academic achievement.

• Studies highlighted the higher prevalence of bullying in clinical training

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settings as a stressful unsafe work environment that negatively affects

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trainers.
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• Recently, literature focused on bullying in academia where differing

perceptions and misinterpretations of policy, procedures, and other work‐
related expectations can lead to bullying behaviors against students
 3.1 | Study objectives
This study aimed to examine the prevalence, frequency, and
perpetrators of bullying among nursing students and examine the impact
of bullying on their mental health and academic achievement.

3 | PARTICIPANTS

Introduction
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6 |Conclusion

4 | RESULTS
5|Discussion

3.2 | Research questions

• What is the prevalence of bullying behaviors experienced by nursing
students?
• Who are the most likely perpetrators of bullying towards nursing
students?
• What are the frequencies of bullying behaviors experienced by nursing
students?
• Is there a relationship between student nurses’ exposure to bullying
behaviors and their psychological wellbeing and academic
achievements?
 3.3 | Research design
A cross‐sectional descriptive correlational research design was adopted,
and an electronic questionnaire was used to collect data.

3.4 | Target population and sample

All undergraduate nursing students who were enrolled in the nursing
program (levels 4–8) offered by the nursing department at jouf

3 | PARTICIPANTS
university during the 2019–2020 academic year were contacted through

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6 |Conclusion

4 | RESULTS

email and Blackboard.

5|Discussion

3.5 | Sampling technique

A convenience purposive sample of students who met the inclusion
criteria was recruited.

3.6 | Inclusion and exclusion criteria

All the participants met the following inclusion criteria: Male and female
enrolled in nursing programs, at jouf university undergone clinical
training for at least 3 months, and willing to participate in this study. The
online invitation included information about the nature and aims of this
study and assured the participants of confidentiality and anonymity.
Consenting participants completed an online questionnaire.
 3.7 | Sample
The authors contacted the students and requested them to participate in
this study. A total of 331 male and female undergraduate nursing
students were enrolled in a university that offered 4‐year nursing
program during academic year 2019–2020. According to Raosoft,22 the
sample size was 180 students (fresh students were not included in the
sample as they did not have clinical practice experiences). This means

3 | PARTICIPANTS
that 180 students or more were needed to have a confidence level of

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6 |Conclusion

4 | RESULTS

95%, and the real value is within ±5% of the measured value
5|Discussion

3.8 | Instruments
A five‐section questionnaire was used to address the study objectives.
Study tools administered in Arabic version to ensure students’
understandability of items. This version was tested for structure and
clarity in a pilot study for 10% of study participants (18 nursing students),
and no revisions to the questionnaire were indicated. Data from the pilot
study were excluded.
 3.10 | Bullying experience
Bullying experience was assessed using the Negative Acts Questionnaire
(NAQ), which has been developed by Cooper et al.23 and Celik and
Bayraktar.
3.11 | General psychological health
The General Psychological Health Questionnaire was used to assess
psychological symptom severity. This questionnaire has been developed

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by Daradkeh et al. and used with Saudi samples.

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6 |Conclusion

4 | RESULTS
5|Discussion

3.12 | Sense of coherence (SOC)

The 13‐item SOC Scale, which has been developed by Antonovsky,28 was
used to assess one's global outlook on life.

3.13 | Perceived stress

The Perceived Stress Scale, which has been developed by Sheu et al.,29
was used to assess the level and type of stress experienced by nursing
students.
 3.14 | Data collection and sample recruitment
After ethical approval was obtained from the ethics committee of the
university, an email, which contained the link to the electronic
questionnaire, was sent to all nursing students who had completed
levels 4–8 of the nursing program. The email invited them to participate
in the study, provided them with information about the study's purpose,
design, and benefits, and assured them of the voluntariness of

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participation and freedom to withdraw at any time. Submitted responses

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4 | RESULTS

were stored in a drive.

5|Discussion

3.15 | Data analysis

Data were entered into spreadsheets and analyzed using SPSS version
20.0 (IBM Corp.). Descriptive statistics (frequencies, means, and
standard deviations) were computed to examine participant
demographic characteristics, and χ 2 analysis was conducted to examine
group differences in the study variables. Moreover, the relationship
between bullying experience, psychological health, SOC, perceived
stress, and academic achievement was examined by conducting
Pearson's correlation analysis. Multiple regression analysis was
conducted to identify the predictors of bullying experience.
 4.1 | Participant characteristics

As shown in Table 1, more than half

of the participants were female
(58.3%). The mean age of the
sample was 22.2 years (SD = 1.67). A

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6 |Conclusion

4 | RESULTS
majority of the students were single
5|Discussion

(84.4%). Approximately half of them

reported a high income level. The
GPAs of approximately two‐ thirds
(66.1%) of the students ranged from
above 3.74 to above 4.5.
 4.1 | Participant characteristics

As shown in Table 1, more than half

of the participants were female
(58.3%). The mean age of the
sample was 22.2 years (SD = 1.67). A

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Introduction
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6 |Conclusion

4 | RESULTS
majority of the students were single
5|Discussion

(84.4%). Approximately half of them

reported a high income level. The
GPAs of approximately two‐ thirds
(66.1%) of the students ranged from
above 3.74 to above 4.5.
 4.2 | Bullying behaviors
As shown in Table 2, approximately half
(42.8%) of the sample had encountered
one or more of 13 bullying behaviors on a
daily or weekly basis during the past 3
months.

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6 |Conclusion

4 | RESULTS
5|Discussion

4.3 | Perpetrators of bullying

As shown in Table 3, classmates
(41.1%), staff nurses (39.4%), clinical
instructors (37.2%), patients (35%),
and physicians (31.7%) were the most
frequently reported perpetrators of
bullying. In contrast, administrative
staff (17.8%), faculty members
(23.3%), and patient relatives (26.1%)
were less frequently reported as
perpetrators of bullying
 4.4 | Correlations between the study variables
Table 5 shows that poor psychological health (r = 0.241, p ≤ 0.05) and
perceived stress (r = 0.598, p ≤ 0.05) were significantly related to bullying
experience. Exposure to bullying was negatively related to SOC (r = −0.213, p ≤
0.05). Perceived stress was negatively associated with academic achievement (r
= −0.193, p ≤ 0.05) and SOC (r = −0.256, p ≤ 0.05).

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6 |Conclusion

4 | RESULTS
5|Discussion

4.6 | Predictors of bullying

Multiple regression analysis was
conducted to identify the predictors of
bullying. Both simple and multiple logistic
regression analyses were conducted. The
results (Table 6) indicated that a lower
GPA, lower levels of interesting in nursing
education, and an older age were
significant predictors of bullying behaviors
6 |Conclusion

Discussion already discussed in along with results

5|Discussion

4 | RESULTS
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Introduction
ONCLUSION
ery important to ensure a healthy and safe environment to educate train nurses
om they will frontline the health service in the future. In this study, bullying was
fied as a problem experienced by nursing students during their education and
ng. Bullying experience was associated with poor psychological health and
ived stress. Classmates and clinical nurses were the most frequently reported
etrators of bullying behaviors, whereas administrative staff and faculty members
the least commonly reported perpetrators. A lower GPA, lower levels of interest

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Introduction
6 |Conclusion

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4 | RESULTS
rsing education, and an older age emerged as significant predictors of bullying.

5|Discussion
fore, college of nursing can hold the keys to modifying the learning

Conclusion
onment to facilitate respectful and dynamics interactions in learning settings.
Study limitations
though this study has yielded much‐needed findings and makes an important

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ibution to the literature, it has the following limitations:
ta were collected using self‐report measures.
NAQ assesses student perceptions. Thus, actual behaviors were not assessed.
over, the perceptions of clinical instructors, faculty members, and clinical nurses
not assessed. Therefore, future research should use different data collection
ods.
 Study limitations
s study was conducted using a sample of students recruited from only one
ge. Therefore, the present findings cannot be generalized to the larger nursing
nt population. Future studies should recruit participants from a larger number
rsing colleges and different settings.
e participants were recruited using a nonprobability sampling method
enience sampling). Therefore, they may not have been representative of the
student population.

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Introduction
6 |Conclusion

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4 | RESULTS
5|Discussion
Conclusion
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d conceptual framework. Education. 2016; 136(3):299‐306.
bel M, Fehr F. “They can crash you”: nursing student experiences of bullying and
ole of faculty. J Nurs Educ Practice. 2018;8: 66‐76.
ith R, Gillespie G, Brown K, Grubb P. Seeing students squirm: nursing students’
iences of bullying behaviors during clinical rotations. J Nurs Educ.
55(9):505‐513.

3 | PARTICIPANTS

Introduction
AND METHODS
6 |Conclusion

4 | RESULTS
hatziioannidis I, Bascialla F, Chatzivalsama P, Vouzas F, Mitsiakos G. Prevalence

5|Discussion
s and mental health impact of workplace bullying in the neonatal intensive care

Conclusion
nvironment. BMJ Open. 2018;8:018766.
mo R, Dumlao T, Figuerres N. The victims and the bullies: perceptions, factors
oping strategies. IMRaD J. 2019;2:32‐37.

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llari R. Nursing students’ experiences of work place violence during clinical
ments: a qualitative study. Glo Adv Res J Med and Med Sci. 2016;5(8):228‐236.