The Relationship Between Bullying and Selected Nursing Student Outcomes (Anxiety, Stress, Performance) as Mediated by Self-Efficacy: Testing a Theoretical Model

Abstract

Bullying is a prevalent issue within the nursing profession and nursing education. Decades of research have reported that student nurses are being exposed to and experience bullying in clinical learning environments. The literature has identified that these bullying experiences can negatively impact student nurses (s) performance and mental health. The development of self-efficacy within these learning environments, recognized as a critical part of the learning process according to Bandura's Social Cognitive theory, may have a mitigating impact on the effect of bullying. As such, it is paramount to address this bullying issue to ensure that students have an optimal learning experience and that their self-efficacy is nurtured. The current study was aimed to test a theoretical model that includes self-efficacy as a mediator between the relationship between bullying and behavioural responses (anxiety, stress, performance). Data were collected during the COVID-19 pandemic, where students had a clinical placement in a simulated and/or patient care setting. To test the theoretical model, structural equation modelling techniques were used. Findings identified that bullying remains an issue in the clinical learning environment and that intersectionality plays a role in the student nursing learning experience. The finalized model identified a positive direct relationship between bullying and behavioural outcomes (anxiety, stress, performance). Self-efficacy was a partial mediator between bullying to, stress and anxiety, but not performance. A metaparadigm of student educational experience was conceptualized, demonstrating that student nurses must have healthy, positive relationships with their educator(s) for the student to develop healthy self-efficacy, leading to improved mental health and academic performance. The findings of this study suggest that more work is needed to mitigate the gaps when it comes to enhancing no-tolerance policies and developing resources that would support educators in cultivating healthy, safe learning environments for students, especially students who are representative of various intersectionalities.