Developing and integrating
an intervention program to
prevent and combat bullying
in daily practice
Margaretha Strandmark K
The research group – a
collaboration between Public
Health Sciences and Nursing
GullBritt Rahm, Lic.
Ingrid Rystedt, MD, PhD
An intervention study in collaboration
Ongoing during four years
Granted by AFA Insurance
A part of a larger research
Definition of bullying
negative, hostile and/or
unethical actions over
time, where one of the
participants is in a
and cannot defend
her/himself towards the
others or the group.
Olweus 1992; Björkqvist et al.,
1994; Leyman, 1996.
In collaboration with the workplaces, develop and
implement an intervention program to prevent
and combat bullying.
Research approach and sample
The research approach was participatory and
Based on questionnaire scores and the presence of
bullying problems, workplaces were selected, in
collaboration with the upper level managers: two
eldercare wards and one geriatric psychiatric ward.
Targeted occupational included assistant nurses,
nurses, physicians, physiotherapists, occupational
therapists, counselors and nurse’s assistants.
Interested employees voluntarily enrolled in the
focus groups upon our presentation of the project.
Individual and focus group
In the first focus group, we investigated how
bullying was manifested in the workplace.
In the second focus group, we focused on
intervention components which prevented
and combatted bullying.
In the third focus group, we discussed the
suggestions concerning the presented action
plan, based on the previous interviews.
The interviews were analyzed according to
Grounded Theory methodology (Charmaz
Zero-tolerance (no bullying)
• The actors consist of the head of the
wards, co-workers and the remaining
• Work with the value-system, to be aware
of the bullying, an open atmosphere,
group collaboration, and conflict
resolution are requirement to attain zero-
tolerance against bullying.
These categories consist of a connection
between feelings and rational arguments.
Sometimes, there are discrepancies
between the ideal and the reality.
The head of the ward has an intermediate
position in which she/he will be a listener, be
emphatic, be resolute and call for demands.
The co-workers have a responsibility to
behave professionally towards patients,
clients and the head of the ward.
The executive level of the organization is a
‘black box’, and the co-workers experience
unfairness concerning staffing, work load,
The actors’ roles
A humanistic value system
• Respect others’ opinions, not listen to rumour
• Tolerate that people are different
• Concern about the others, be more sensitive,
and engage in an empathic view
• Reducing the values of depreciate and
disloyalty against established decisions show
a contradiction and disrespect
Awareness about bullying
Behavior – rumor, deceit, stigmatization,
freezing out, own interpretation
Feelings – alone, outside, insulted,
deterioated self-esteem, afraid, angry
Cause – not work well, different, push
away people, go their own way
Conscious malevolent or un-conscious
An open or concealed
Open – allowable environment, safety
in the group, talk freely
Concealed – stuck in the walls, pressed
atmosphere, afraid, un-safety,
Collaboration within the group
and between groups
Support over limits
Creation of mutual routines
Put the foot down
Play down with humor
Not increase the conflict
From the findings of the interviews an
intervention was developed. Desires from the
first focus group.
a) a half day lecture about bullying, conflict
management, communication, feeling of
b) we also discussed in small groups with all
employees using playing-cards containing
bullying situations and possible solutions.
Example from the playing cards
’Mobilizing against bullying’
Situation: You see a colleague in the corridor, far
away. Suddenly, the colleague changes the direction
and takes the step downstairs without looking at you.
How do you react?
a)Ask the colleague if she/he did not see you.
b)Become sad and say nothing.
c)Complain on the colleague to other colleagues.
c) From the separate interviews and the two first focus
groups interviews a suggustion for a concrete action
plan was compiled.
The plan included the value-system, the recognition of
bullying and the calling out of problems, a treatment
which creates confidence and trust, conflict
management, the roles of supervisor’s and the co-
workers’, the dynamics of group processes, and the
arenas to keep the discussions alive.
c) The action plan has been presented and discussed
in the steering groups at the workplaces.
Follow-up the action plan at the
All employees shall sign the action plan.
New co-workers are assigned a mentor.
The head of the ward is responsible for
the plan is followed.
The participants of the focus groups are
responsible for keeping the discussions
Zero-tolerance against bullying shall prevail.
Through a humanistic value-system, the head
of the ward, the co-workers and the remaining
organization work together towards this goal,
by being aware of the bullying, having an open
atmosphere and good collaboration in groups,
and by resolving conflicts. These factors are
necessary to prevent and combat bullying.
Thank you for your attention!