Bullying en el medio ambiente de trabajo de la enfermería: revisión integrativa

Revisión integradora, realizada entre abril y diciembre de 2018, mediante la combinación de los descriptores "bullying / bullying" AND "enfermería / enfermería / enfermera" AND "lugar de trabajo / lugar de trabajo". Se identificaron 224 estudios, de los cuales 38 cumplieron con los criterios de inclusión.

Resultados:

Los estudios sobre el bullying de enfermería presentaron tres enfoques principales relacionados con la prevalencia en la práctica de enfermería, las repercusiones para la salud y el desarrollo profesional, y la construcción de modelos teóricos para las variables de entorno de bullying y trabajo de enfermería.

Conclusión:

El acoso es un comportamiento negativo presente en el entorno de la práctica de enfermería y tiene un impacto directo en el desempeño profesional, lo que afecta la salud general y el desempeño profesional. A pesar de ser un comportamiento con potencial negativo reconocido en el entorno laboral, pocos estudios proponen acciones efectivas para prevenir o controlar este fenómeno en las instituciones de salud.

Palabras clave:
Acoso escolar; Enfermería; Lugar de trabajo; Literatura de revisión como asunto

First author, year and country	Objectives	Main results
Logan(²⁰20. Logan TR, Michael Malone D. Nurses' perceptions of teamwork and workplace bullying. J Nurs Manag. 2018;26(4):411-9. doi: https://doi.org/10.1111/jonm.12554 https://doi.org/10.1111/jonm.12554... )2018 USA	Exploring nurses' perceptions of teamwork and workplace harassment.	Two-thirds of nurses reported the presence of important variables such as leadership, trust and communication in their teams. One-third of the nurses reported being bullied and half observed others being intimidated.
Yun(²¹21. Yun S, Kang J. Influencing factors and consequences of workplace bullying among nurses: a structural equation modeling. Asian Nurs Res. 2018;12(1):26-33. doi: https://doi.org/10.1016/j.anr.2018.01.004 https://doi.org/10.1016/j.anr.2018.01.00... )2018 Korea	Build and test a model outlining factors related to moral harassment	A relationship-oriented organizational culture had a direct effect on harassment, and harassment had a direct effect on the experience mediated by positive psychological capital. Harassment also had an indirect effect on the intention to leave the workplace.
Savaşan(²²22. Savasan A, Özgür G. The relationship between personality characteristics and workplace bullying of nurses. J Psychiatric Nurs. 2018; 9(1):29-35. doi: https://doi.org/10.14744/phd.2017.66487 https://doi.org/10.14744/phd.2017.66487... )2018 Turkey	Examining the relationship between personality characteristics and bullying	Significant negative, albeit weak correlations were found between Hacettepe Personality Inventory scores (general, personal and social adjustment points) and bullying scores.
Olender(²³23. Olender L. The relationship between and factors influencing staff nurses' perceptions of nurse manager caring and exposure to workplace bullying in multiple healthcare settings. J Nurs Adm. 2017;47(10):501-7. doi: https://doi.org/10.1097/NNA.0000000000000522 https://doi.org/10.1097/NNA.000000000000... )2017 USA	Examining the relationship between team members' perceptions of moral harassment	A significant inverse relationship was found between nursing managers and exposure to bullying in the workplace. Sex, work environment and high workload influenced these findings.
Olsen(²⁴24. Olsen E, Bjaalid G, Mikkelsen A. Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: a study among hospital nurses. J Adv Nurs. 2017;73(11):2709-19. doi: https://doi.org/10.1111/jan.13337 https://doi.org/10.1111/jan.13337... )2017 Norway	Further understand workplace harassment and relate it to the work climate.	Most of the characteristics of the work climate influenced moral harassment in the workplace. Bullying played a mediating role in most dimensions of the work climate, such as performance, satisfaction and the ability to work.
Kang(²⁵25. Kang J, Kim JI, Yun S. Effects of a cognitive rehearsal program on interpersonal relationships, workplace bullying, symptom experience, and turnover intention among nurses: a randomized controlled trial. J Korean Acad Nurs. 2017;47(5):689-99. doi: https://doi.org/10.4040/jkan.2017.47.5.689 https://doi.org/10.4040/jkan.2017.47.5.6... )2017 Korea	Investigate the effects of a cognitive testing program on moral harassment	After the intervention, significant differences were found in interpersonal relationships and turnover intention for the experimental groups and the waiting list. However, no significant difference was found for moral harassment between the two groups.
An(²⁶26. An Y, Kang J. Relationship between organizational culture and workplace bullying among Korean nurses. Asian Nurs Res. 2016;10(3):234-9. doi: https://doi.org/10.1016/j.anr.2016.06.004 https://doi.org/10.1016/j.anr.2016.06.00... )2017 Korea	Identify the relationship between organizational culture and the bullying experience	The prevalence was 15.8%. Multivariate analysis revealed that the chances of being bullied were 2.58 times higher among nurses in a hierarchy-oriented culture than among nurses in a relationship-oriented culture.
Blackwood(²⁷27. Blackwood K, Bentley T, Catley B, Edwards M. Managing workplace bullying experiences in nursing: the impact of the work environment. Public Money Manage. 2017;37(5):349-56. doi: https://doi.org/10.1080/09540962.2017.1328205 https://doi.org/10.1080/09540962.2017.13... )2017 New Zealand	Investigate the role of workplace factors in bullying behavior	A number of work environment factors affect the efficacy of bullying intervention in the nursing workplace.
Karatza(¹⁴14. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying among the nursing staff of Greek public hospitals. Workplace Health Saf. 2017;65(2):57-64. doi: https://doi.org/10.1177/2165079916657106 https://doi.org/10.1177/2165079916657106... )2017 Greece	Identify the impact of bullying on nursing professionals	One-third of the nurses reported bullying in the last six months. The impact of bullying on nurses varied depending on the family support or the friendly environment provided to cope with moral harassment in the workplace.
Nwaneri(²⁸28. Nwaneri AC, Onoka AC, Onoka CA. Workplace bullying among nurses working in tertiary hospitals in Enugu, southeast Nigeria: implications for health workers and job performance. J Nurs Educ Pract. 2017;7(2):69-78. doi: https://doi.org/10.5430/jnep.v7n2p69 https://doi.org/10.5430/jnep.v7n2p69... )2017 Nigeria	Assess the occurrence and effects of bullying among nurses.	The prevalence among nurses who worked in tertiary hospitals was reported as high. The effects of bullying on nurses include anger, the desire to travel abroad because of the feeling that the prevalence is lower, frustraton and tense social relations among coworkers.
Ma(²⁹29. Ma SC. Hospital nurses' attitudes, negative perceptions and negative acts regarding work-place bullying. Ann Gen Psychiatry. 2017;16:33. doi: https://doi.org/10.1186/s12991-017-0156-0 https://doi.org/10.1186/s12991-017-0156-... )2017 Taiwan	Explore the relationships between negative perceptions and negative acts on bullying	80% of nurses experience bullying at some point in their professional lives. The consequences of bullying are severe psychological trauma; low self-esteem; depression and anxiety; post-traumatic stress; physical disease; financial loss and eventual inability to work.
Bardakci(³⁰30. Bardakçi E, Günüsen NP. Influence of workplace bullying on Turkish nurses' psychological distress and nurses' reactions to bullying. J Transcul Nurs. 2016;27(2):166-71. doi: https://doi.org/10.1177/1043659614549073 https://doi.org/10.1177/1043659614549073... )2016 Turkey	To determine the effects of bullying on the psychological distress of nurses.	Nurses with master’s degrees were more exposed to bullying. The nurses exposed to bullying had higher levels of psychological distress and preferred to keep quiet about it. The nursing managers were the main bullies.
Tee(³¹31. Tee S, Üzar YO, Russell MW. Workplace violence experienced by nursing students: a UK survey. Nurse Educ Today. 2016;41:30-5. doi: https://doi.org/10.1016/j.nedt.2016.03.014 https://doi.org/10.1016/j.nedt.2016.03.0... )2016 England	Explore and describe the incidence and experiences of bullying in nursing.	Around 42.18% of respondents reported they had suffered intimidation/harassment in the current year. One-third (30.4%) witnessed others being harassed and 19.6% of the incidents involved more experienced nurses.
Fang(³²32. Fang L, Huang SH, Fang SH. Workplace bullying among nurses in South Taiwan. J Clin Nurs. 2016;25(17-18):2450-6. doi: https://doi.org/10.1111/jocn.13260 https://doi.org/10.1111/jocn.13260... )2016 China	Investigate bullying among nurses.	The general mean of bullying was 1.47, showing that the frequency was between never and not at the time. Nurses from emergency rooms were more exposed to bullying. Harassment at work has been associated with years of experience.
Giorgi(³³33. Giorgi G, Mancuso S, Perez FF, D'Antonio AC, Mucci N, Cupelli V, et al. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160-8. doi: https://doi.org/10.1111/ijn.12376 https://doi.org/10.1111/ijn.12376... )2016 Italy	Develop a bullying model focused on the interaction between bullying and burnout	Bullying was a partial mediator of the relationship between organizational climate and burnout. Bullying affected health only when mediated by burnout.
Karatza(¹¹11. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying and general health status among the nursing staff of Greek public hospitals. Ann Gen Psychiatry. 2016;15:7. doi: https://doi.org/10.1186/s12991-016-0097-z https://doi.org/10.1186/s12991-016-0097-... )2016 Greece	Investigate the relationship between bullying and the general health status of nursing	30.2% reported having been psychologically harassed in their workplaces in the previous six months and their general health status had worsened.
Oh(³⁴34. Oh H, Uhm DC, Yoon YJ. Factors affecting workplace bullying and lateral violence among clinical nurses in Korea: descriptive study. J Nurs Manag. 2016;24(3):327-35. doi: https://doi.org/10.1111/jonm.12324 https://doi.org/10.1111/jonm.12324... )2016 Korea	Identify individual and institutional characteristics for moral harassment	Negative affection, individualism and work in hospital specialty units predict bullying. Individualism, negative affection, type of hospital and working hours predicted verbal abuse, while the workplace was significantly associated with lateral violence.
Oh(³⁵35. Oh H, Uhm D, Yoon Y. Workplace bullying, job stress, intent to leave, and nurses' perceptions of patient safety in South Korean hospitals. J Nurs Res. 2016;65(5):380-8. doi: https://doi.org/10.1097/NNR.0000000000000175 https://doi.org/10.1097/NNR.000000000000... )2016 Korea	Test a model that relates bullying with stress, intent to quit employment and adverse events.	Bullying and stress at work and the intention to leave were associated with adverse outcomes of patients from the perspective of the interviewed nurses.
Berry(³⁶36. Berry PA, Gillespie GL, Fisher BS, Gormley D, Haynes JT. Psychological distress and workplace bullying among registered nurses. Online J Issues Nurs. 2016 [cited 2019 Jan 20];21(3). Available from: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Articles-Previous-Topics/Psychological-Distress-and-Workplace-Bullying.html http://ojin.nursingworld.org/MainMenuCat... )2016 USA	Determine the differences in perceived stress, state of anxiety, post-traumatic stress and bullying.	Significant differences regarding perceived stress, anxiety and post-traumatic syndrome were reported by people with frequent exposure to bullying at work.
Yokoyama(³⁷37. Yokoyama M, Suzuki M, Takai Y, Igarashi A, Noguchi-Watanabe M, Yamamoto-Mitani N. Workplace bullying among nurses and their related factors in Japan: a cross-sectional survey. J Clin Nurs. 2016;25(17-18):2478-88. doi: https://doi.org/10.1111/jocn.13270 https://doi.org/10.1111/jocn.13270... )2016 Japan	Explore the association between bullying and work environment factors	18.5% of the nurses reported bullying. A logistic regression analysis indicated that bullying was associated with low scores in two domains of the work environment: capacity of the nursing manager, leadership and support of nurses and adequacy of personnel and resources.
Blackstock(³⁸38. Blackstock S, Harlos K, Macleod MLP, Hardy CL. The impact of organisational factors on horizontal bullying and turnover intentions in the nursing workplace. J Nurs Manag. 2015;23(8):1106-14. doi: https://doi.org/10.1111/jonm.12260 https://doi.org/10.1111/jonm.12260... )2015 Canada	Examine the impact of organizational factors on bullying and its effect on the intention to quit the job.	Informal organizational alliances and improper use of organizational processes/procedures favored the increase in horizontal bullying, which, in turn, predicted the intention to quit the job.
Ganz(¹⁰10. Ganz FD, Levy H, Khalaila R, Arad D, Bennaroch K, Kolpak O, et al. Bullying and its prevention among intensive care nurses. J Nurs Scholarsh. 2015;47(6):505-11. doi: https://doi.org/10.1111/jnu.12167 https://doi.org/10.1111/jnu.12167... )2015 Israel	Describe the prevalence of bullying and its preventive measures.	29% reported that they were victims of bullying. Bullying levels were low to moderate. The level of prevention was weak or moderate. The higher the level of bullying, the lower the level of prevention.
Laschinger(³⁹39. Laschinger HKS, Nosko A. Exposure to workplace bullying and post-traumatic stress disorder symptomology: the role of protective psychological resources. J Nurs Manag. 2015;23(2):252-62. doi: https://doi.org/10.1111/jonm.12122 https://doi.org/10.1111/jonm.12122... )2015 Canada	Examine the relationship between harassment and post-traumatic stress disorder and psychological capital.	Regression analysis revealed that the most frequent exposure to harassment at work was significantly related to the symptomatology of post-traumatic stress disorder, regardless of the level of the disorder.
Allen(⁴⁰40. Allen BC, Holland P, Bus B, Reynolds R. The effect of bullying on burnout in nurses: the moderating role of psychological detachment. J Adv Nurs. 2015;71(2):381-90. doi: https://doi.org/10.1111/jan.12489 https://doi.org/10.1111/jan.12489... )2015 Australia	Examine the relationship between bullying and burnout and the effect of psychological distancing	Bullying was associated with burnout. Psychological distancing did not significantly moderate the relationship between bullying and burnout.
Wright(⁴¹41. Wright W, Khatri N. Bullying among nursing staff: relationship with psychological/behavioral responses of nurses and medical errors. Health Care Manage Rev. 2015;40(2):139-47. doi: https://doi.org/10.1097/HMR.0000000000000015 https://doi.org/10.1097/HMR.000000000000... )2015 USA	Examine the relationship between three types of bullying with psychological/behavioral responses	Person-related bullying showed significant positive relationships with psychological/behavioral responses and medical errors. When related to work, bullying showed a significant positive relationship with psychological/behavioral responses, but not with medical errors. Feeling physically intimidated was not significant for any outcome.
Ekici(⁴²42. Ekici D, Beder A. The effects of workplace bullying on physicians and nurses. Aust J Adv Nurs. 2014 [cited 2019 Jan 12];31(4):24-33. Available from: http://www.ajan.com.au/Vol31/Issue4/31-4.pdf http://www.ajan.com.au/Vol31/Issue4/31-4... )2014 Turkey	Evaluate bullying and its effects on the performance and depression of physicians and nurses	No significant differences were found between physicians and nurses in terms of bullying, however, an association was found between performance, depression and the violent behaviors experienced.
Esfahani(⁴³43. Esfahani AN, Shahbazi G. Workplace bullying in nursing: the case of Azerbaijan province, Iran. Iran J Nurs Midwifery Res. 2014 [cited 2019 Jan 20];19(4):409-15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145498/ https://www.ncbi.nlm.nih.gov/pmc/article... )2014 Iran	Examine bullying in the workplace among a group of Iranian nurses.	Only 9% of the nurses had been frequently exposed to bullying, 22% reported having been victims of bullying occasionally and 69% had never been exposed to bullying in the last year.
Etienne(⁴⁴44. Etienne E. Exploring workplace bullying in nursing. Workplace Health Saf. 2014;62(1):6-11. doi: https://doi.org/10.1177/216507991406200102 https://doi.org/10.1177/2165079914062001... )2014 Alaska	Assess the perception of nurses regarding exposure to harassment	48% of the nurses admitted they had been victims of bullying in the previous six months. Being ignored or excluded were the most common negative experiences in the workplace.
Ovayolu(⁴⁵45. Ovayolu O, Ovayolu N, Karadag G. Workplace bullying in nursing. Workplace Health Saf. 2014;62(9):370-4. https://doi.org/10.3928/21650799-20140804-04 https://doi.org/10.3928/21650799-2014080... )2014 Turkey	Determine whether nurses are intimidated by other team members.	44% of the nurses reported experiencing one or more types of bullying in the last 12 months.
Schlitzkus(⁴⁶46. Schlitzkus LL, Vogt KN, Sullivan ME, Schenarts KD. Workplace bullying of general surgery residents by nurses. J Surg Educ. 2014;71(6):e149-54. doi: https://doi.org/10.1016/j.jsurg.2014.08.003 https://doi.org/10.1016/j.jsurg.2014.08.... )2014 USA	Determine whether nurses bully surgery residents.	The nurses bullied the surgery residents and 30.2% reported intimidation in the workplace.
Yun(⁴⁷47. Yun S, Kang J, Lee YO, Yi Y. Work environment and workplace bullying among Korean intensive care unit nurses. Asian Nurs Res. 2014;8(3):219-25. doi: https://doi.org/10.1016/j.anr.2014.07.002 https://doi.org/10.1016/j.anr.2014.07.00... )2014 Korea	Examine the relationship between perception of the work environment and moral harassment	94.0% reported at least one negative act in the last six months. The prevalence of harassment was 17.2%, according to criteria for assessing bullying. Significant negative correlations were found between the work environment and harassment.
Fontes(¹⁶16. Fontes KB, Santana RG, Pelloso SM, Carvalho MDB. Fatores associados ao assédio moral no ambiente laboral do enfermeiro. Rev Latino-Am Enfermagem. 2013;21(3):758-64. doi: https://doi.org/10.1590/S0104-11692013000300015 https://doi.org/10.1590/S0104-1169201300... )2013 Brazil	Identify nurses who are subject to bullying and associated factors.	11.56% were victims of bullying in the last 12 months. The nurse's profile was characterized by having children, practicing in public health, working at the institution for one to three years and perceiving oneself as bullied.
Vogelpohl(⁴⁸48. Vogelpohl DA, Rice SK, Edwards ME, Bork CE. New graduate nurses' perception of the workplace: have they experienced bullying? J Prof Nurs. 2013;29(6):414-22. doi: https://doi.org/10.1016/j.profnurs.2012.10.008 https://doi.org/10.1016/j.profnurs.2012.... )2013 USA	Investigate bullying among new graduates.	Nurses, physicians or relatives of patients were the main sources of bullying, and 29.5% of the nurses considered leaving the nursing profession.
Berry(⁴⁹49. Berry PA, Gillespie GL, Gates D, Schafer J. Novice nurse productivity following workplace bullying. J Nurs Scholarsh. 2012;44(1):80-7. doi: https://doi.org/10.1111/j.1547-5069.2011.01436.x https://doi.org/10.1111/j.1547-5069.2011... )2012 USA	Determine the prevalence and effects of moral harassment in the work of new graduates.	44.7% reported bullying and 55.3% reporting no bullying. The individuals who bullied were primarily more experienced nursing coworkers (63%). The productivity of the nurse was negatively affected
Gaffney(⁵⁰50. Gaffney DA, DeMarco RF, Hofmeyer A, Vessey JA, Budin WC. "Making things right: nurses' experiences with workplace bullying - a grounded Theory." Nurs Res Pract. 2012;2012:243210. doi: https://doi.org/10.1155/2012/243210 https://doi.org/10.1155/2012/243210... )2012 USA	Report the experiences of nurses regarding workplace harassment.	When nurses were confronted with harassment in the workplace, they became involved in a process of doing things right, they put bullying in context and they evaluated the situation, acted and judged the results of their actions.
Farrel(⁵¹51. Farrel GA, Shafiei T. Workplace aggression, including bullying in nursing and midwifery: a descriptive survey (the SWAB study). Int J Nurs Stud. 2012;49(11):1423-31. doi: https://doi.org/10.1016/j.ijnurstu.2012.06.007 https://doi.org/10.1016/j.ijnurstu.2012.... )2012 Australia	Report the nature and extent of aggression and bullying.	52% reported some form of aggression. 36% suffered violence mainly from patients or their visitors/relatives and 32% from coworkers or their managers/supervisors.
Laschinger(⁵²52. Laschinger HKS, Wong CA, Grau AL. The influence of authentic leadership on newly graduated nurses' experiences of workplace bullying, burnout and retention outcomes: a cross-sectional study. Int J Nurs Stud. 2012;49(10):1266-76. doi: https://doi.org/10.1016/j.ijnurstu.2012.05.012 https://doi.org/10.1016/j.ijnurstu.2012.... )2012 Canada	Test a model that relates leadership to the experiences of new graduates regarding moral harassment	Authentic leadership had a negative direct effect on workplace harassment that had a direct positive effect on emotional exhaustion. Authentic leadership, moral harassment and emotional exhaustion had significant direct effects on job satisfaction and a lesser desire to quit work.
Hutchinson(¹⁷17. Hutchinson M, Wilkes L, Jackson D, Vickers MH. Integrating individual, work group and organizational factors: testing a multidimensional model of bullying in the nursing workplace. J Nurs Manag. 2010;18(2):173-81. doi: https://doi.org/10.1111/j.1365-2834.2009.01035.x https://doi.org/10.1111/j.1365-2834.2009... )2010 Australia	Test a multidimensional model of workplace bullying.	The study emphasizes a strong relationship between organizational characteristics, bullying and the resulting consequences. An incremental relationship was found between the latent factors in the model and indicate the direction of the relationship between the three organizational factors, bullying and the resulting consequences.

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[1] Corresponding author:
Roberta Nazario Aoki: E-mail: rubi.rc@bol.com.br