OBJECTIVE: The aim of this literature review was to examine the most current research regarding effective, evidence-based programs for reducing incivility among the healthcare team, particularly nurses. BACKGROUND: Incivility in the work environment is linked to a variety of negative outcomes, including diminished productivity, impaired judgement, and reduced employee retention. Incivility is especially detrimental to the healthcare team because it is correlated with decreased quality of patient care and increased medical errors. Despite regulations and statements made by the Joint Commission and the American Nurses Association to combat this serious problem, incivility continues to plague healthcare. METHODS: CINAHL and MEDLINE databases were reviewed for interventions to reduce incivility or bullying. Articles that evaluated interventions for practicing nurses were included in the review. RESULTS: The majority of studies evaluated training programs based on cognitive theory or cognitive rehearsal training as an intervention for incivility or bullying. Most studies showed positive correlations between the intervention and reducing incivility or bullying in some areas, however, results were inconsistent, most evidence ranked low and most studies shared sub-optimal quality. CONCLUSION: Most current studies towards reducing incivility in the healthcare team are poorly designed for demonstrating causation. More research is required to examine effective, evidence-based solutions for cultivating civility. Research must distinguish independent variables, incorporate teams instead of individuals, and fit into the structure of the work environment that it is serving.

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While empathy is widely understood as a multifaceted construct and an important component of prosocial behavior, its role is less certain with regard to aggressive and bullying behavior in schools. In an effort to further the bully-prevention-and-intervention initiative, the validity of the Interpersonal Reactivity Index (IRI)--a self-report assessment that aims to evaluate both cognitive and affective components of empathy--was examined to determine its potential effectiveness as a screener to inform intervention for school-age youth. It is hypothesized that the IRI may insufficiently assess students' true empathic capacity due to the social desirability bias inherent in self-report scales, particularly with a youth population. The present study uses a correlational design to separately examine the strengths of the relationships between individuals' self-reports of cognitive and affective empathy on the IRI and respective criterion measures, social cognitive processing tasks and physiological responses to emotion-eliciting stimuli. Reliability analyses were also conducted to determine whether the IRI measures cognitive and affective empathy as separate constructs with a school-age population. It was hypothesized that individuals' self-reports of cognitive empathy would be strongly, positively related to performance on social cognitive processing tasks, and that students' self-report of affective empathy would yield weaker correlations with physiological responses to emotion-eliciting stimuli due to the social desirability bias inherent to the scale. Children in grades three though eight (n= 37) participated in the current study. Youth were recruited from an afterschool program and a summer camp from a parochial elementary school in a city in Pennsylvania. Students were asked to complete the IRI self-report scale. Two social cognitive processing tasks from the NEPSY-II were administered as a criterion measure for self-report of cognitive empathy. Change in fingertip temperature was measured during the viewing of two video vignettes to observe physiological response to emotion-eliciting stimuli as a criterion measure for affective empathy. While some strong, positive correlations were observed between male students' responses within the cognitive and affective empathy subscales of the IRI and performance on criterion measures, no positive correlations were observed between female students' self-reports of empathy and performance on criterion measures. Reliability analyses yielded no sufficient distinction between self-reports of affective and cognitive empathy. / School Psychology

Bullying is a major issue facing school systems today. It is important to explore the extent to which school counselors feel confident in providing interventions to address bullying. This research study is designed to fill a gap in the current school counseling literature regarding our understanding of school counselors' self-efficacy to address bullying in elementary schools. The following research questions will guide the study: 1. What is the elementary school counselor's perceived self-efficacy for providing bullying interventions in an elementary school setting, as measured by the Counselor Self-Efficacy and Bullying Interventions Scale (CSBI)? 2. What is the elementary school counselor's perceived self-efficacy regarding his or her counseling skills as measured by the Counseling Self-Estimate Inventory (COSE)? 3. To what extent are (a) years of experience in the field, (b) years of training, (c) bullying-intervention training in graduate school, and (d) participation in professional development activities and/or in-services predictive of a counselor's self-efficacy for providing bullying interventions? Responses from 126 elementary school counselors employed at a large suburban school district in the Mid-Atlantic region were used to explore overall counselor self-efficacy and counselor self-efficacy related to bullying interventions. The Counseling Self-Estimate Inventory (COSE; Larson et al., 1992), and Counselor Self-Efficacy and Bullying Interventions Scale(CSBI adapted from King et al., 1999) were the instruments used to answer the research questions. Participants reported a high (M =185) overall self-efficacy as well as a high (M =71.2) self-efficacy for providing bullying interventions. However, only one variable, years of experience, was found to significantly predict efficacy expectations (B = 0.25, p <.01) and outcome values (B = 0.21, p <.05); none of the variables were found to significantly predict outcome expectations (r-squared=0.06, n.s). / Ph. D.

Helping and aggressing behaviors are important to study in adolescence because they relate to adaptive and maladaptive developmental outcomes. These behaviors take place within the social context and their impact may be determined by the nature of the dyadic relationship between the agent and the recipient of the behavior. Relative power may be a critical aspect of dyadic relationships as evidenced by the research on bullying and related outcomes. However, a review of the helping and aggression literatures shows that relative power between agents and recipients of behavior has largely been neglected, perhaps because measurement approaches focus on individual tendencies over time rather than single behaviors at one point in time. I propose a theory that includes relative power as a critical dimension in the conceptualization of aggression and helping in dyadic interactions. I define dyadic interpersonal behavior based on two bipolar continua: impact (extremely beneficial impact [helping] through no impact to extremely harmful impact [aggressing]) and relative power imbalance between dyad members (lower-power through balanced-power to higher-power). In this dissertation, I tested whether my theory fits with adolescents' conceptualizations of helping and aggressing behavior in dyads using a mixed-methods approach. Focus group data collection occurred from two sessions with 13 and 11 adolescents in order to create gender-relevant and school-relevant vignettes of helping and aggressing behavior. Vignettes varied in intensity of impact (extremely beneficial, moderately beneficial, neutral, moderately harmful and extremely harmful), relative power between agent and recipient (i.e., high to high, low to low, high to low, and low to high power dyads), and power type (i.e., academic power and social power). The quantitative phase involved the rating of paired vignettes based on similarity by 203 students from the same high school as the focus group participants. Similarity scores were aggregated within gender and the type of power (academic or social). Multidimensional scaling (MDS) was used to test whether the proposed theory of power-relevant helping and aggressing is supported by adolescents' similarity ratings. The models of boys' interpersonal behaviors show three-dimensional solutions whereas those for girls reflect four-dimensional solutions. The first dimension of benefit and harm, which was proposed in my theory, emerged in all four sets of analyses (academic-boys; academic-girls; social-boys; social-girls). The secondary dimension proposed in the theory, relative power, only emerged for girls in regard to social power, as the fourth dimension in that solution. Qualitative analyses of focus group transcripts suggest that school atmosphere, power in the school, and bullying were primary themes salient in adolescents' thinking about helping and aggressing behavior. Relative power did not emerge as a theme or a concept in these qualitative analyses, suggesting that relative power is not a salient concept in adolescent thinking for helping and aggressing. Thus, neither quantitative nor qualitative analyses support the secondary dimension proposed in my theory. This mixed-methods study advances theory and research by: 1) demonstrating that adolescents conceptualize helping and aggressing as opposite ends of a single dimension at the behavioral level, 2) demonstrating that power at the individual level with a group referent and collective dyadic power are more salient than relative power in adolescents' perceptions of helping and aggressing behavior, and 3) situating the conceptualization and measurement of interpersonal behavior within the relational context. / Ph. D.

The increase in bullying and its detrimental impacts threaten children's healthy development across the world; however, little research has examined multi-factors related to bullying. Guided by ecological theory, this study examined ecological factors that related to children's bystander and defender behavior when they witness bullying. Considering the role of culture and maternal emotion socialization in children's socio-emotional development, cultural differences in the relation of maternal emotion socialization on children's reactions to bullying through their empathy were investigated. Children (10-12 years old) and their mothers in the United States (n=165) and South Korea (n=158) participated in an online survey. Mothers completed the Coping with Children's Negative Emotions to assess maternal unsupportive and supportive reactions to their children's emotions. Children reported on their empathy (i.e., personal distress and empathic concern) using the Interpersonal Reactivity Index and on their bystander/defender behaviors using the Types of the Conformity Groups in Bullying. For bystander behavior, mothers' unsupportive reactions were significantly correlated with children's bystander behavior through empathic concern in both cultures. Personal distress mediated the relation of maternal unsupportive reactions to bystander behavior only in the American sample. For defender behavior, American mothers' supportive reactions directly predicted defender behavior whereas the effect of Korean mothers' supportive reactions on defender behavior was mediated by empathic concern. More personal distress was related to more defender behavior in the American sample while less personal distress was related to more defender behavior in the Korean sample. Results of this study supported cultural differences in the relation of maternal emotion socialization to children's reaction to bullying. American children were more likely to help the victim when their mothers supported their negative emotions. For Korean children, mothers' supportive reactions were related to their prosocial behavior through their empathic concern. However, in both cultures, children's empathic concern was a significant mediator in the relation between maternal unsupportive reactions and bystander behavior. This finding may provide educational guidance to bullying intervention programs across cultures. / Doctor of Philosophy / More than one out of five students in the United States and more than one out of ten students in South Korea experience bullying. The detrimental effects of bullying can affect not only victims and bullies but also classmates who witness the bullying. I examined factors that related to bystander behavior (ignoring or staying away from bullying) and defender behavior (helping the victim or actively endeavoring to stop bullying) in bullying to help in efforts to stop bullying. Because positive emotional experiences with mothers can help children develop empathy and empathy tends to elicit helping behavior, I examined how mothers' reactions to their children's negative emotions were related to children's bystander behavior and defender behavior through their empathic abilities. However, research and theories on bullying has been predominantly focused on Western populations. My study addressed this gap, examining cultural differences in the relations between the United States and South Korea to bring attention to the role of culture in parents' emotional socialization and children's development. Results from this study will help schools and communities to provide culturally sensitive bullying intervention programs with parents. Children (10-12 years old) and their mothers in the United States (n=165) and South Korea (n=158) participated in an online survey. Mothers were asked about ways that they react to their children's negative emotions. Mothers' unsupportive reactions refer to minimization, distress and punitive reactions when their children express negative emotions. Mothers' supportive reactions mean maternal comforting, acknowledgement, and encouragement of children's negative emotions. In the online survey, children reported on their empathy and reactions when they witness bullying. Cultural differences in the relations were confirmed. American children were more likely to help the victim when their mothers supported their negative emotions. For Korean children, mothers' supportive reactions were related to their defender behavior through their empathic concern. However, in both countries, the more mothers displayed supportive reactions, the more children reported empathic concern; children's empathic concern was an important bridge between maternal unsupportive reactions and bystander behavior.

Bullying can be defined as repeatedly harming others verbally, emotionally, or physically. There has been past research on the relationship between bullying and aggression; this prior research has concluded that bullies have high levels of aggression and are more likely to be aggressive adults. It has also been reported that victims have lower aggression levels than bullies in young adulthood (Olweus, 1993). It is because of events such as the Columbine high school shooting that this study is being conducted. The purpose of this research is to reevaluate aggression levels in both bullies and their victims. It seems that the attitudes of today's bullies and their victims have changed, specifically the victim's aggression patterns. This study will reevaluate bully and victim aggression levels and compare them to past data as well as show the comparison of the results between the groups within the study. The results of this research may redirect the attention of bullying intervention and prevention to a new group of individuals, the victims.

Cyberbullying is an alarming phenomenon affecting the lives of adolescents across the country. Traditional bullying has moved from the playground to cyberspace. This online environment allows perpetrators to attack their victims beyond the walls of school, twenty-four hours a day. Advancements in and access to technology have made electronic communication the preferred method for adolescents to socialize. Although email, texts, social media sites, and websites were created to ease communication, some adolescents are using these tools to harass and harm their peers. The purpose of this study was to gain a deeper understanding of the existence and prevalence of Cyberbullying in middle schools across Region VII in southwest Virginia. Cyberbullying policies and strategies used to address Cyberbullying were examined. The experiences of middle school principals with Cyberbullying incidents were explored. The aim of this study was to address the following three research questions: 1. What is the status of Cyberbullying in Region VII of southwest Virginia? 2. What are middle school principals' perspectives regarding their schools' effectiveness in responding to Cyberbullying? 3. What are middle school principals' recommendations to strengthen Cyberbullying policies and procedures? A quantitative method was chosen and a survey was conducted with the goal of adding to the literature that existed on Cyberbullying in public schools. Through the development and administration of a survey, quantitative data was collected. A quantitative analysis was conducted using descriptive statistics. The study adds to the current empirical research base on Cyberbullying in middle schools, especially in the rural area of a state. The perceptions of principals working in middle schools are valuable. This study tapped into this knowledge base and added to the literature on Cyberbullying by providing insights into the feelings and perceptions of administrators. Analyzing the experiences of the participants provided valuable information for those interested in learning more about Cyberbullying in middle schools in southwest Virginia. Findings of the study include information for Region VII of southwest Virginia on the status of Cyberbullying, middle-level schools' effectiveness in responding to Cyberbullying, and principals' recommendations to strengthen Cyberbullying policies and procedures. Based on the survey results, it is clear that Cyberbullying existed within the school systems in the region. Cyberbullying incidents occurred both at school and away from school. The largest percentage of these incidents occurred in the seventh and eighth-grades. Survey data indicated gender played a role in Cyberbullying with female students having the most reported incidents. Bullying prevention programs were being implemented in most school systems and schools in this region, and, in some cases, Cyberbullying was specifically addressed. In school systems and schools where no bullying or Cyberbullying prevention programs were implemented, overwhelmingly, principals felt they should be. Data revealed most principals found it difficult to identify Cyberbullying instances but believed they did report Cyberbullying incidents consistently. Most principals felt their school system's Cyberbullying policies were effective in dealing with Cyberbullying incidents, that the policies did not need revision, and that no additional policies were needed. Most principals felt Cyberbullying consequences implemented at their school effectively deterred Cyberbullying. Three strategies were identified by more than fifty percent of principals that would help in deterring Cyberbullying incidents. These strategies were increased parental involvement, encouraging students to report Cyberbullying, and anti-bullying education. / Ed. D. / Cyberbullying is an alarming phenomenon affecting the lives of adolescents across the country. Cyberbullying refers to any threats by one student toward another through on-line means including texting, emails, or other social media networks. Traditional bullying has moved from the playground to cyberspace. Advancements in and access to technology have made electronic communication the preferred method for adolescents to socialize. Although email, texts, social media sites, and websites were created to ease communication, some adolescents are using these tools to harass and harm their peers. The purpose of this study was to gain a deeper understanding of the existence and prevalence of Cyberbullying in middle schools across Region VII in southwest Virginia. Fortyone middle schools are identified within Region VII which contains 19 school divisions. Findings from the survey include information for Region VII of southwest Virginia on the status of Cyberbullying, middle-level schools’ effectiveness in responding to Cyberbullying, and principals’ recommendations to strengthen Cyberbullying policies and procedures. Based on the survey results, it is clear that Cyberbullying existed within the school systems in the region. Cyberbullying incidents occurred both at school and away from school. The largest percentage of these incidents occurred in the seventh and eighth-grades. Survey data indicated gender played a role in Cyberbullying with female students having the most reported incidents. Bullying prevention programs were being implemented in most school systems and schools in this region, and, in some cases, Cyberbullying was specifically addressed. In school systems and schools where no bullying or Cyberbullying prevention programs were implemented, overwhelmingly, principals felt they should be. Data revealed most principals found it difficult to identify Cyberbullying instances but believed they did report Cyberbullying incidents consistently. Most principals felt their school system’s Cyberbullying policies were effective in dealing with Cyberbullying incidents, that the policies did not need revision, and that no additional policies were needed. Most principals felt Cyberbullying consequences implemented at their school effectively deterred Cyberbullying. Three strategies were identified by more than fifty percent of principals that would help in deterring Cyberbullying incidents. These strategies were increased parental involvement, encouraging students to report Cyberbullying, and antibullying education.