Asian Nursing Research 12 (2018) 245e250

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Asian Nursing Research

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Research Article

Development of Instrument of Bullying Behaviors in Nursing

Education based on Structured Equation Modeling
Kamuran Cerit,1, *,* Sultan Türkmen Keskin,2 Dilek Ekici3
1
Nursing Department, Health Science Faculty, Suleyman Demirel University, Isparta, Turkey
2
Nursing Department, Health Science Faculty, Ankara University, Ankara, Turkey
3
Nursing Department, Health Science Faculty, Gazi University, Ankara, Turkey

a r t i c l e i n f o s u m m a r y

Article history: Purpose: Bullying behaviors experienced during nursing education negatively affect students, educators,
Received 14 September 2017 quality of training, and patient care. The purpose of this study was to develop a valid, reliable, short, and
Received in revised form comprehensive scale to measure the bullying behaviors of nursing students in the education
16 July 2018
environment.
Accepted 23 July 2018
Methods: The Bullying Behaviors in Nursing Education (BBNE) tool was developed by adapting the
Workplace Psychological Violence Behaviors scale. The data were collected from 442 nursing students
Keywords:
from April to May 2017. The BBNE was tested using structural equation modeling, and validity and
bullying
nursing
reliability results were obtained. Moreover, complementary statistics were determined, and the violence
prevalence behaviors experienced by nursing students were reported.
reproducibility of results Results: The full BBNE scale, with 30 items and four factors, was not verified (c2/df ¼ 4.31); 12 items
students were excluded, and the modified structure with 18 items and four factors was verified (c2/df ¼ 2.60;
root-mean-square error of approximation ¼ .06). The scale's Cronbach's a coefficient is .88, and the
structure reliability is .92. Twenty-five percent of the 442 students scored 1 or higher in the total scale,
showing that they were subject to bullying behaviors.
Conclusion: The BBNE scale can be used to measure the bullying behaviors of nursing students in the
education environment. When such behaviors are identified, students can struggle on the personal and
organization level. Providing a safer and comfortable education environment for nursing students who
are the guarantee of the future of health care will positively affect the quality of education and patient
care in parallel.
© 2018 Korean Society of Nursing Science, Published by Elsevier Korea LLC. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction Studies show nursing students are commonly subject to

Bullying experienced by nurses has been an important problem
in the health field for many years [1,2]. A similar situation is
applicable for the education environment of nursing students [2,3].
Bullying is defined as a student constantly and repetitively being
subject to negative behaviors such as verbal, physical, relational,
and social exclusion in an education environment [4].
* Correspondence to: Kamuran Cerit, MSc, RN, Nursing Management Depart-
ment, Nursing Department, Health Science Faculty, Suleyman Demirel University,
32200 Çünür, Isparta, Turkey.
E-mail address: kamurancerit@gmail.com
*
ORCID: https://orcid.org/0000-0002-1234-4025
bullying behaviors both in the classroom and in the clinic envi-
ronment during their education [5e7]. Widespread bullying can
negatively affect nursing students' educational life and damage
their school and work success [8,9]. This also negatively affects the
quality of their education and of patient care in the clinic envi-
ronment [10]. Therefore, it is very important to identify and prevent
bullying behaviors among nursing students. This study has been
planned to develop a short, comprehensive, valid, and reliable scale
compatible with today's conditions to identify bullying behaviors
experienced by nursing students.
Bullying is an exclusion process in which an individual's ability
of self-expression is limited, his or her personality is humiliated
and redefined by stigmatizing, and identity is shaped accordingly.
In this process, individuals are subject to long periods of

https://doi.org/10.1016/j.anr.2018.07.002
p1976-1317 e2093-7482/© 2018 Korean Society of Nursing Science, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
246 K. Cerit et al. / Asian Nursing Research 12 (2018) 245e250
humiliation, scolding, ignoring, isolation, insult to personality and
professional status, loss of dignity, and other traumatizing behav-
iors [11e13]. Studies report that nursing students are subject to
mainly verbal violence [4,11,14], despising behaviors, and physical
abuse [14].
Experiences during nursing education negatively affect stu-
dents' education lives and preferences after graduation [5]. The
bullying behaviors experienced or witnessed by nursing students
during their education can even lead to their dropping out of school
before completing their education [5,7,15]. Moreover, the existence
of bullying in the education environment indicates that the envi-
ronment is not supportive or healthy.
The presence of psychological violence behaviors in the class-
room and clinic environments negatively affect the students, edu-
cators, and education quality [3,8]. Experiencing bullying can
damage a person's sense of self; cause negative professional
integrity and perceptions; and reduce motivation, performance,
ability to concentrate, self-confidence, and school and work success
[8,9].
A nursing student who is isolated from the education envi-
ronment, is not supported, does not question what is being done,
and who has a damaged self-confidence cannot develop the sense
of belonging to nursing education and the profession. Such stu-
dents have challenges in learning important theories, skills, atti-
tudes, and behaviors [16]. This also negatively affects the quality of
the nursing education in the clinic environment where patient
care is delivered [10].
Identification of bullying experienced by nursing students in
the education environment is very important for coping
with these behaviors on the individual and organizational level
[17]. Various scales in the literature identify bullying behaviors
experienced by nursing students [4,6,12]. In some studies, scales
without validity and reliability results were used to measure
bullying against nursing students [4,18]. In other studies, the
scales used to determine mobbing behaviors exposed on nurses
were used with nursing students without ensuring validity and
reliability [12]. The Bullying, Harassment, and Horizontal
Violence scale developed by Geller [6] only measures the hori-
zontal bullying behaviors exhibited by nursing students to each
other in the clinic environment. However, nursing students are
subject not only to horizontal bullying behaviors but also to
bullying behaviors from sources including physicians and nurses
in the clinic environment and educators in the education envi-
ronment [15].
Therefore, there is a need for a scale that enables the identifi-
cation of possible bullying behaviors from all kinds of sources in the
classroom and clinic environment, not only from colleagues in the
education environment. In conclusion, there is a need for a short,
comprehensive, valid, and reliable scale compatible with today's
conditions to identify bullying behaviors specifically experienced
by nursing students in the education environment.
For this purpose, items from the Workplace Psychological
Violence Behaviors (WPVB) scale were used. This scale was devel-
oped for nurses by Yıldırım and Yıldırım [19]; validity and reli-
ability of the scale was established by Dilek and Aytolan [20]. The
WPVB scale was identified as a valid and reliable scale that could be
adapted and used to identify bullying behaviors experienced by
nursing students in the education environment having been used
with nurses and physicians in different hospitals [21e23], with
different employee groups [24,25], and in academic environments
[26].
This study has been planned to develop a short, comprehensive,
valid, and reliable scale compatible with today's conditions to
identify bullying behaviors experienced by nursing students in the
education environment.
Methods
Design and samples
The study was conducted with nursing students enrolled in the
nursing department in two state universities that offer a 4-year
nursing education program. The study population comprised
1,889 undergraduates enrolled in the nursing department in the
Spring semester of the 2016e2017 academic year. The students
(N ¼ 442) who volunteered were accepted into the study from April
2016 to May 2017. There were 212 (11.2%) students from University
A and 230 (12.1%) from University B. The response rate is 23.3%.
Ethical considerations
Ethical approval of the study was obtained from the ethical board
of Ankara University (Approval no. 85434274-050.04.04/11957).
During collection of data, students were informed about the pur-
pose of the study and information confidentiality, and data were
collected with their consent.
Measurements
A two-part form was used to collect data. The first part included
questions about the demographic characteristics of students (e.g.,
grade, age, gender). The second part was composed of the Bullying
Behaviors in Nursing Education (BBNE) scale adapted from the
WPVB scale developed by Dilek and Aytolan [20] to identify
bullying behaviors experienced by nursing students in the educa-
tion environment. The WPVB scale uses 33 items and four factors to
identify bullying behaviors experienced at the workplace.
The first factor in the WPVB is isolation of individuals from work
and includes behaviors such as ‘not being informed about social
meetings’. Some of the behaviors under this factor were included
without change in the BBNE scale, and some items (e.g., ‘having
duties that you are responsible for taken from you and given to
others in lower positions’) not suitable for the factor were removed.
Moreover, behavior statements that can be encountered by stu-
dents such as ‘not being accepted to the group of friends’ were used,
and Factor 1 was called isolation of students from the education
environment (ISO).
The second factor of the original scale is “attack on professional
status” and includes behaviors such as “being forced to do a job that
will negatively affect your self-confidence”. Some of the items of
this factor were unchanged and included in the BBNE scale, and
suitable items such as ‘not being trusted in the competence related
to lectures’ also were included, and some items (e.g., ‘having you
feel like you and your work are being controlled’) not suitable for
the factor were removed. The new Factor 2 was called attack on
academic achievement (AA).
The third factor of the original scale is attack on personality
(PER) and includes items such as ‘talking in a humiliating and
degrading style’. In the BBNE scale, some items from this factor
were kept the same, and some items (e.g., ‘having unfair reports
written about you’) not suitable for the factor were removed, and
new items suitable for the factor (e.g., ‘being scolded loudly in
public’) were added; the name of the factor was not changed.
The fourth factor of the original scale is direct negative behav-
iors (NEG) and includes items such as ‘applying physical violence’.
In the BBNE scale, again some items were kept the same, and some
items (e.g., ‘preventing or forbidding coworkers from talking with
you’) not suitable for the factor were removed, and other items
suitable for the factor (e.g., ‘mild violence such as pushing with
hands and slamming the folder to intimidate’) were added; the
name of the factor was not changed.
 K. Cerit et al. / Asian Nursing Research 12 (2018) 245e250
A focus group interview was conducted with six nursing stu-
dents who were experiencing or had experienced bullying at
nursing school for preparing of the items of the BBNE scale. The
interview of the students was analyzed descriptively and system-
atically. According to the interview analysis, new 17 items were
added to the factors. After then, a plot study was conducted among
20 nursing students for determination of the items and under-
standing of the statements. By recommendations of the students,
two items were removed from the item pool, and three items were
rewritten as statements.
Fifteen items of the WPVB scale were included without change
in the BBNE scale. The BBNE scale adapted for nursing students
comprised 30 items in total, seven items in Factor 1 (ISO), seven
items in Factor 2 (AA), nine items in Factor 3 (PER), and seven items
in Factor 4 (NEG). A six-point Likert scale was used to define the
frequency of behaviors (0 ¼ never experienced, 1 ¼ experience for a
few times a year, 2 ¼ experience for a few times a month,
3 ¼ experience for a few times a week, 4 ¼ experience once a day,
and 5 ¼ experience a few times a day). The Cronbach's a coefficient
of the original scale is .93.
Data analysis
LISREL 8.80 (Scientific Software International Inc., Lincolnwood,
IL, USA) and SPSS 20.0 (IBM Inc., Armonk, NY, USA). software were
used for data analysis. The number, percentage, means, and stan-
dard deviations were calculated to determine the grade, gender,
and ages of the participants. A confirmatory factor analysis (CFA)
was run with LISREL to provide proof of the scale's construct val-
idity. The parameter estimations of the measurement tool were
obtained with CFA, and the statistically suitable measurement
model was determined. At this point, items which were not
considered statistically significant were excluded from the model,
recommended corrections were made, and goodness of fit indexes
(GFIs) of the measurement tool were obtained.
In assessment of model fit, researchers considered Chi-square
(c2)/degree of freedom (df), adjusted GFI (AGFI), GFI, normed fit
index (NFI), non-NFI (NNFI), comparative fit index (CFI), root-
mean-square error of approximation (RMSEA), and standardized
root mean square residual (SRMR) values. For reliability of the
measurement tool, Cronbach's a coefficients were obtained using
SPSS 20.0 software, and the construct reliability (CR) and the
average variance extracted values were calculated. Independent
samples t-test, analysis of variance, and Pearson correlation ana-
lyses were conducted for analysis of demographic data.
Results
The study population was divided almost exactly in half be-
tween University A (48.0%) and University B (52.0%). The mean age
Table 1 Characteristics of Nursing Students (N ¼ 442).
Characteristic Category n (%)
University A 212 48.0
B 230 52.0
Grade First 51 11.5
Second 79 17.9
Third 123 27.8
Fourth 189 42.8
Gender Women 380 86.0
Men 62 14.0
Age (yrs) 442 21.18 ± 1.61
Grade point average of 4 442 2.91 ± 0.35
Note. M ¼ mean; SD ¼ standard deviation; yrs ¼ years.
247
of the nursing students was 21.18 (±1.61), grade point average was
2.91 (±0.35) of 4, and 380 (86.0%) were women while 62 (14.0%)
were men (Table 1).
Confirmatory factor structure of the scale
A CFA was used to analyze if the structure with 30 items and four
factors (Model I) was not verified for nursing students. Considering
the fit indexes used to determine construct validity, the Model I c2/
df value was ¼ 1720.13/399 (4.31) and RMSEA ¼ .09 (Table 2). Ac-
cording to these results, it was determined that Model I did not
have good fitness.
The items for which error variances were related to each other
according to CFA correction indexes were excluded from the mea-
surement tool. When the errors of the items are correlated, the
model's theoretical structure is impaired because the assumption
that the variables of structural equation modeling are independent
from each other is violated.
In conclusion, 12 items were excluded from the measurement
model, and a measurement model with 18 items and four factors
was obtained. Three items were excluded from each factor. More-
over, the error variances of two items in Factor 1 were adjusted
according to modification recommendations. In the end, Model I
was modified and the new structure (Model II) was created.
The fit indexes of Model II were examined and showed that this
model demonstrated good fitness (Table 2). Table 3 provides
average points for items and factors as well as standardized loads, t
values, R2 values, and average points for the items in Model II.
The fit indexes of Model II were calculated. c2/df [330.62/127]
with a value of 2.60 (good fit), RMSEA ¼ .06 (good fit), SRMR ¼ .05
(GFI ¼ .92, and AGFI ¼ .90) as was perfect fitness (NFI ¼ .95,
NNFI ¼ .96, and CFI ¼ .97). The critical N value calculated for the
model is 222.92. The entire scale's extracted variance is 51.61%, and
the average variance extracted of all the factors in the scale is
provided in Table 4.
Findings about reliability of the scale
The Cronbach's a internal consistency coefficient for the BBNE
scale was calculated to be .88. The Cronbach's a for Factors 1e4
were .73, .77, .77, and .70, respectively. The CR of the scale is .92, and
the CR of factors varies between .70 and .78 (see Table 4).
Bullying behaviors experienced by nursing students
(prevalence).
Table 3 presents the average scores of the students on the BBNE
scale. The average score of the students on the total scale was
0.70 ± 0.61.
Distribution of the students who experience bullying a few times
(1 point) and more violent behaviors a year is provided in Figure 1.
Twenty-five percent of the students scored 1 or more points on the
total scale, and it was determined that they were subject to bullying
behaviors in the education environment. Evaluating the students
who scored 1 or more points on the factors, it was determined that
M ± SD
Table 2 Model Fit Indexes for Bullying Behaviors in the Nursing Education Scale.
Model c2/df RMSEA RMR/SRMR NFI/NNFI CFI GFI/AGFI
I (30 items and 4.31 .09 .09/.08 .90/.92 .92 .79/.76
four factors)
II (18 items and 2.60 .06 .06/.05 .95/.96 .97 .92/.90
four factors)
Note. AGFI ¼ adjusted goodness of fit index; CFI ¼ comparative fit index; GFI ¼
goodness of fit index; NFI ¼ normed fit index; NNFI ¼ non-normed fit index; RMR ¼
root mean square residual; RMSEA ¼ root-mean-square error of approximation;
SRMR ¼ standardized root mean square residual.
248 K. Cerit et al. / Asian Nursing Research 12 (2018) 245e250

Table 3 Items, Standardized Loads, t Values and R2 of Bullying Behaviors in the Nursing Education Scale.

Items M ± SD Standardized loads Standard errors t R2

Factor 1. Isolation of students from the education environment 0.43 ± 0.68

ISO1. Not being wanted in the study group related to the school or internship 0.37 ± 0.84 .55 .70 10.81 .30
ISO2. Not being accepted to the group of friends 0.37 ± 0.90 .67 .55 13.19 .45
ISO3. Being left alone during breaks 0.60 ± 1.11 .54 .71 10.19 .29
ISO4. Intentionally leaving the environment when you enter an environment 0.39 ± 0.78 .67 .55 13.34 .45
Factor 2. Attack on academic achievement 0.98 ± 0.97
AA1. Limiting self-expression 1.34 ± 1.37 .74 .45 16.94 .55
AA2. Not being trusted in the competence related to lectures 1.15 ± 1.27 .65 .58 14.14 .42
AA3. Being forced to do a job that will negatively affect your self-confidence 0.68 ± 1.12 .70 .51 15.74 .49
AA4. Constantly assigning tasks over the capacity 0.76 ± 1.23 .64 .59 13.92 .41
Factor 3. Attack on personality 0.96 ± 0.81
PER1. Not making eye contact while talking 1.67 ± 1.29 .41 .83 8.51 .17
PER2. Talking in a humiliating and degrading style. 0.88 ± 1.27 .70 .51 16.03 .49
PER3. Questioning your honesty and reliability 0.81 ± 1.16 .59 .65 12.88 .35
PER4. Being scolded loudly in public 0.73 ± 1.09 .65 .58 14.42 .42
PER5. Using degrading mimics or body language 0.89 ± 1.18 .67 .55 15.10 .45
PER6. Talking bad or unfounded behind you 0.79 ± 1.19 .60 .64 13.17 .36
Factor 4. Direct negative behaviors 0.32 ± 0.58
NEG1. Making practical jokes 0.65 ± 1.11 .50 .75 10.00 .25
NEG2. Being exposed to verbal or behavioral sexual implications 0.28 ± 0.83 .72 .49 15.11 .51
NEG3. Mild violence to intimidate (slamming a file, pushing with hands, and so forth) 0.27 ± 0.76 .65 .57 13.60 .43
NEG4. Being exposed to physical violence 0.09 ± 0.46 .61 .62 12.71 .38
Total scale score 0.70 ± 0.61

Note. M ¼ mean; SD ¼ standard deviation.

the nursing students experienced attack on academic achievement
the most (43.4%), then attack on personality (42.1%), isolation of
students from the education Environment (16.5%), and direct
negative behaviors (10.9%).
Considering the behaviors most experienced by students, it was
determined that 79.4% experienced ‘not making eye contact while
talking’, 62.4% experienced ‘limiting self-expression’, and 58.3%
experienced ‘not being trusted in the competence related to lec-
tures’. Students reported that they were exposed to these behaviors
by classmates, instructors, clinical nurses, patient's relatives, and
doctors.
No statistically significant difference was obtained between the
exposure of the nursing students in the study to bullying behaviors
by the school (t ¼ 0.13; p ¼ .895), grade (F ¼ 1.39; p ¼ .244), and
gender (t ¼ 1.82; p ¼ .073) (p > .05). No statistically significant
difference was obtained with the correlation analysis between
mean age (r ¼ .02; p ¼ .738), grade point average (r ¼ .05;
p ¼ .338), and being exposed to bullying (p > .05).
Discussion
Evaluation of validity and reliability of the scale
students from the education environment” factor was excluded
from the model owing to a low R2 value (.017) and a high error
variance (.90). In addition to that, two item from “isolation of stu-
dents from the education environment”, three items from “attack
on academic achievement”, two items from “attack on personality”,
and three items from “direct negative behaviors” were excluded
without making any correction because error variances of these
were found to be related to other items' error variances. One item
from “attack on personality” factor was excluded from the model
owing to a high error variance (.84). As a result, after 12 items were
excluded, the four-factor model composed of 18 items was
validated.
Model fit was evaluated using fit indices as recommended by
Schreiber et al [27]. To measure GFI for the recommended theo-
retical model, c2 (with associated degrees of freedom and p value),
relative c2 (c2/df < 5.00), RMSEA < .05, GFI > .90, AGFI > .90,
CFI > .90, NFI > .95, and SRMR < .08 are used [28]. Study results
show that the BBNE scale c2/df value is 2.60; RMSEA value is .06,
and the data exhibit good fitness with the new model. Considering
other fitness indexes related to the model, it was determined that
the model has good fitness.
It can be concluded that with a higher Cronbach's a coefficient in
a new model, the items in this scale are consistent with each other

The study was conducted to develop a valid and reliable mea-

surement tool to be used to identify bullying behaviors experienced
by nursing students. Therefore, the WPVB scale developed by Dilek Bullying Behaviours in Nursing Education
and Aytolan [20] was adapted, and a structure with 30 items and 100
90
four factors (Model I) was created, and validity and reliability an-
80
alyses were conducted. According to the adjustment indexes, 12
70
items were excluded, and a new structure (Model II) was created
60
with 18 items and four factors. One item in the “isolation of
50 43 42
40
30
Table 4 Reliability of Bullying Behaviors in Nursing Education. 16
20 10
Factor Construct reliability Average variance extracted Cronbach's a 10
0
Factor 1 .70 .37 .73
Factor 2 .78 .47 .77
ISO AA PER NEG
ISO AA PER NEG Poly. (ISO)
Factor 3 .78 .37 .77
Factor 4 .72 .39 .70
Figure 1. Prevalence of bullying behaviors in nursing education (%).
 K. Cerit et al. / Asian Nursing Research 12 (2018) 245e250
to the same extent and question the components of the same
property. The Cronbach's a coefficient of the BBNE scale is .88 and of
the factors is .70e.77. Accordingly, it was determined that the scale
was reliable.
Evaluation of the items and factors in the scale
University years are the years of transition from youth to
adulthood. In this period, some students leave their families, enter
a new environment, try to make friends, are left alone, and cope
with many challenges, including financial problems. The education
environment is an arena in which the student tries to survive. The
image of a student in the education environment depends on how
educators (academics, assistants, nurses, and so on) and friends
treat them in public. In the literature although more than half of
the students are reported to be exposed to violent behavior
[5,12,15], this ratio appears to be lower in this study. That may be
explained by the fact that nursing students cannot accurately
describe behaviors due to the lack of sufficient information about
bullying and as a result of the institution's normalization of the
bullying, students may regard these behaviors as part of their
education. It is also reported that bullying behaviors in organiza-
tions are related to the mentality and culture of the institutional
management [1,22]. With the differences in the literature, it is
seen that the students reported the source of bullying behaviors as
their classmates [4,15], instructors [4,8,12,15], clinical nurses
[2,8,11,12], patient relatives [2,8,11,12], and doctors [2,11,15]. The
results of the study on source of the bullying may be due to dif-
ferences in the definition of bullying behaviors and in the sampled
groups.
Bullying behaviors experienced by students in a university ed-
ucation environment prevent them from developing healthy re-
lations and is a continuous and persistent attack on their self-
confidence and self-respect. In this process, the students' ability
of self-expression is limited; they are continuously interrupted,
ignored, and excluded, and their identity is redefined accordingly.
In the literature, the reason for these behaviors is to rule, exclude
from the environment, or destroy [29]. Attackers who exhibit
bullying behaviors use various strategies. Some of these strategies
are passive, and some of them are direct negative, aggressive be-
haviors [17,30]. Direct negative behaviors can range from practical
jokes and mild violence to physical violence. As direct negative
behaviors are easy to distinguish and enable the victim to imme-
diately take measures for self-defense, it is hard for the attacker to
reach his or her target. Therefore, these behaviors are less preferred
by the attacker as demonstrated by the results of this study shown
in Figure 1 [8,15,17]. On the other hand, exposure of the victim to
direct negative behaviors indicates that the victim also is experi-
encing intensive bullying behaviors [31].
When passive-aggressive behaviors are considered separately,
they can be accepted as ordinary interactions of daily life. However,
the meaning and content of these behaviors continuously and
frequently repeated in the education environment change in time
and turn into consciously organized dangerous social relations.
Limiting the ability of self-expression; not being trusted in
competence related to lectures; being left alone during breaks; not
making eye contact while talking; not being included in the school,
internship, and friend group; and continuously being assigned
tasks over their capacity are examples of passive-aggressive be-
haviors. According to the findings of the study, students who were
exposed to bullying behavior were mostly subjected to the forms of
passive aggressive behavior such as, “not making eye contact while
talking” [8,12], “limiting self-expression”, and “not being trusted in
the competence related to lectures” [12,15], which are consistent
with literature. These attacks on personality and academic
249
achievement are more preferred by the attacker as demonstrated
by the results of this study shown in Figure 1 [8,12,15,17].
Moreover, passive-aggressive behaviors are manipulative be-
haviors in which the attacker is not at the forefront but exhibits
these behaviors under his or her control. Therefore, they are not
easily distinguished, and the attacker frequently displays kind be-
haviors to cover up the bad behaviors [31]. Thus, it becomes harder
for the victims to understand that they are victims of bullying, to
immediately distinguish the attacker, and to take timely measures.
In conclusion, aggressive behaviors are exhibited to isolate the
victim from the education environment and against his or her
personality and student status, and thus, the victim's public dignity,
self-respect, self-value, and self-confidence are damaged. In this
study, the behaviors most experienced by the students were attack
on academic achievement student status and manipulative be-
haviors against their personality. These behaviors are very hard to
prove as they do not leave concrete marks such as physical violence.
Study limitations
A vast majority of the nursing students enrolled in the univer-
sities where the study was conducted were not willing to be
involved in the study for various reasons. The study reached a total
of 23% of the students in both universities. Low participation is a
limitation of the study. The purpose of this study, however, is not to
measure the amount of the bullying experienced by the students.
But low or high reporting of behaviors by the students is not sig-
nificant for the analysis of the validity, reliability, and conceptual
construct of the scale [17,30]. In this study, the critical N value is
calculated as 222. The fact that 442 students took part in the study
demonstrates that a sufficient sample was obtained for data anal-
ysis in the study.
Data were collected from nursing students enrolled in two state
universities in the capital city of Turkey, Ankara. Therefore, results
are limited only to nursing students. Moreover, the study results
have country-specific cultural characteristics, and it is recom-
mended to test the results in different cultures.
Conclusion
It is very important to ensure a peaceful and safe education
environment to train nurses to whom we will entrust the health
service in the future. Bullying, however, negatively affects the
learning process of the individual. Bullying behaviors in the edu-
cation environment are not desirable as they negatively affect
students, educators, and education quality. Faculty, instructors,
nurse managers, and clinical nurses must implement strategies that
will end the bullying behaviors and promote a healthy work envi-
ronment. The most efficient way to reduce the impact of bullying is
to prevent it. For this reason, it is necessary to identify bullying
behaviors experienced by nursing students in the education envi-
ronment. There may also be strategies that could be implemented
to reduce the effect of bullying, including a supportive university
environment and teaching assertiveness. By doing these, it might
be possible to protect nursing students from bullying behaviors and
to prevent damages experienced in the education process. In the
study, the 18-item BBNE scale was considered sufficient, compre-
hensive, valid, and reliable in identifying the bullying behaviors
experienced by nursing students in the education environment.
Conflicts of interest
The author(s) declared no potential conflicts of interest with
respect to the research, authorship and/or publication of this
article.
250 K. Cerit et al. / Asian Nursing Research 12 (2018) 245e250
Acknowledgments
The authors would like to express their sincere appreciation to
the health professionals who participated in this study and experts
for their opinions.
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