Development and validation of the physician self-efficacy to manage emotional challenges Scale (PSMEC)

BACKGROUND

Medical students experience emotional challenges during their undergraduate education, often related to work-based learning. Consequently, they may experience feelings of uncertainty and self-doubt, which can negatively affect their well-being. Therefore, it is crucial to support students' development of their ability to manage distressful situations. Self-efficacy beliefs may be a central aspect of supporting them in this development, and have been shown to relate to resilient factors such as students' motivation, learning, and well-being.

METHODS

We constructed a scale to measure medical students' physician self-efficacy to manage emotional challenges during work-based learning, the PSMEC scale. The aim of the present study was to evaluate some of the psychometric properties of the PSMEC scale. The scale consists of 17 items covering five subscales: (1) medical knowledge and competence, (2) communication with difficult patients and delivering bad news, (3) being questioned and challenged, (4) educative competence in patient encounters, and (5) ability to establish and maintain relationships with healthcare professionals. Data were collected from 655 medical students from all seven medical schools in Sweden. To investigate the scale's dimensionality and measurement invariance with regard to gender and time in education, single and multiple group confirmatory factor models were estimated using techniques suitable for ordered categorical data. Measures of Cronbach's alpha were calculated to evaluate internal consistency.

RESULTS

The scale showed good internal consistency on both the global dimension and the five subdimensions of self-efficacy. In addition, the scale was shown to be measurement invariant across genders and times in education, indicating that the scale means of male and female medical students and the scale means of students at the middle and end of their education can be compared.

CONCLUSIONS

The physician self-efficacy to manage emotional challenges scale demonstrated satisfactory psychometric properties, with regards to dimensionality, internal consistency, and measurement invariance relating to gender and time in education, and this study supports the usefulness of this scale when measuring self-efficacy in relation to emotional challenges.

Shaping Citizenship in the Classroom: Peer Influences on Moral Disengagement, Social Goals, and a Sense of Peer Community

Despite the important role of peers in the social process of classroom citizenship, the peer influence related to moral disengagement, social goals, and a sense of peer community remain unclear. To this end, it was examined to what extent youth become similar to their friends in moral disengagement, social goals, and a sense of peer community. Participants were 283 South Korean third to sixth graders (Mage = 9.60 years, SD = 0.97; 51.6% girls) who completed an online survey for moral disengagement, social goals, the sense of peer community and friendship network across the beginning (Time 1) and end (Time 2) of the school semester (September to December). Longitudinal social network analyses indicated that youth became more similar to their friends concerning moral disengagement and a sense of peer community, but did not select friends based on these aspects. The strength of these influence effects varied in terms of different levels of these aspects. Specifically, youth were more likely to become similar to their friends at lower levels of moral disengagement. Youth tended to be similar to the friends' level of sense of peer community. This tendency was relatively strong at the lowest and the highest levels of a sense of peer community. Future research should address the role of friendship in shaping classroom citizenship and the importance of classroom daily teaching practice in youth citizenship development.

Sex and Racial/Ethnic Differences in School Security Measures, Bullying Victimization, and Perceived School Safety: Implications for Pediatric Health Care

INTRODUCTION

Using the 2017 National Crime Victimization Survey dataset, this study examined the association between the types of school security measures and students' bullying victimization and perceived school safety.

METHOD

Using logistic regression and ordinary least square regression analyses, the study addressed whether these associations vary by sex and race/ethnicity, as most research has treated sex and race/ethnicity as covariates.

RESULTS

The study found that none of the security measures were associated with bullying victimization among the total sample. However, there were sex and racial differences in the association between security measures and bullying victimization. There were also sex and racial/ethnic variations in the association between security measures and perceived school safety.

DISCUSSION

Scholars, health care practitioners, and policymakers must reflect and reconsider whether increasing school security and control would contribute to the safety and well-being of racial/ethnic minority students in school.

Proposing and testing the pathways from bullying victimization to bringing a weapon to school

OBJECTIVE

The current study examined whether bullying victimization was associated with bringing a weapon to school, fully or partly mediated by feeling unsafe in school, negative future education orientation, and skipping school.

METHOD

Data from 6199 students (12-18 years old), who had filled out the 2017 School Crime Supplement to the National Crime Victimization Survey, were analyzed.

RESULTS

The results showed a positive association between bullying victimization and bringing a weapon to school. The link was both direct and indirect through the mediating roles of feeling unsafe in school, having a negative future education orientation, and skipping school.

CONCLUSION

Thus, victims of bullying tended to feel unsafe in school, have a negative future education orientation, and skip school-all of which were positively associated with bringing a weapon to school.

The impact of emotionally challenging situations on medical students' professional identity formation

In their interactions with patients and health care professionals during work-based learning, medical students are known to experience emotionally challenging situations that can evoke negative feelings. Students have to manage these emotions. Students learn and develop their professional identity formation through interactions with patients and members of the healthcare teams. Earlier studies have highlighted the issues involved with processing emotionally challenging situations, although studies concerning learning and professional identity formation in response to these experiences are rare. In this study, we explored medical students' experiences of emotionally challenging situations in work-based learning, and the impact these experiences had on forming medical students' professional identities. We conducted an analysis of narrative data (n = 85), using a constructivist grounded theory approach. The narratives were made up of medical students' reflective essays at the end of their education (tenth term). The analysis showed that students' main concern when facing emotionally challenging situations during their work-based education was the struggle to achieve and maintain a professional approach. They reported different strategies for managing their feelings and how these strategies led to diverse consequences. In the process, students also described arriving at insights into their own personal needs and shortcomings. We consider this development of self-awareness and resulting self-knowledge to be an important part of the continuously ongoing socialization process of forming a professional identity. Thus, experiencing emotionally challenging situations can be considered a unique and invaluable opportunity, as well as a catalyst for students' development. We believe that highlighting the impact of emotions in medical education can constitute an important contribution to knowledge about the process of professional identity formation. This knowledge can enable faculty to provide students with more effective and sufficient support, facilitating their journey in becoming physicians.

Parenting practices, bullying perpetration, and conduct problems among Ukrainian children

BACKGROUND

Positive and consistent parenting practices are associated with the positive mental health of children. However, little is understood about the implications of the Russian military invasion on family dynamics in Ukraine.

OBJECTIVE

This research aims to estimate the prevalence of childhood conduct disorder (CD) and bullying perpetration and their association with parenting practices among Ukrainian children living in proximity to the war.

PARTICIPANTS AND SETTING

The sample included 2763 Ukrainian children ranging in age from 10 to 17 years (M = 12.6, SD = 1.23), 56.23 % girls. Children attended public secondary schools in Eastern Ukraine, mostly in Kharkiv and Kharkiv oblasts (regions).

METHODS

Children reported on sociodemographic characteristics, parenting practices, CD, and bullying perpetration using smartphones, computers, or tablets, at home or in school IT classrooms. Data were collected on a secure online platform.

RESULTS

Children reported teasing (23.68 %), spreading rumors (24.51 %), helping to harass (17.31 %), threatening to hurt or hit (21.65 %) other students, breaking rules (28.13 %), getting in fights (17.13 %), cheating (43.16 %), and being spanked by parents (30 %). Also, 1.83 % of girls and 3.43 % of boys met a borderline cutoff for CD. Lack of parent involvement was associated with increased CD and bullying risks. Poor parent monitoring, inconsistent discipline, and corporal punishment were associated with increasaed CD but not with bullying. CD mediated the association of poor monitoring, inconsistent discipline, and corporal punishment with bullying.

CONCLUSION

Parental involvement, monitoring, consistent discipline, and avoidance of physical punishments are important practices that can reduce disruptive behavior and aggressive tendencies among Ukrainian children affected by the Russian war.

Pathways from Polyvictimization to Offline and Online Sexual Harassment Victimization Among South Korean Adolescents

This study aimed to investigate the association between polyvictimization and offline and online sexual harassment and whether the association might be mediated by internalizing problems, low school satisfaction, and dropping out of school. The analytic sample was derived from the Children and Youth Rights Survey in South Korea. It consisted of 6353 adolescents' responses to the sexual harassment question and a set of other questions in the middle and high school questionnaires. The findings showed a direct association between polyvictimization and offline and online sexual harassment. Adolescents who were polyvictimized were more likely to be victims of both forms of sexual harassment. Furthermore, polyvictimization was positively related to dropping out of school, which was positively associated with offline sexual harassment. The findings from the study have significant implications for future research and practice.

Defending or Remaining Passive as a Bystander of School Bullying in Sweden: The Role of Moral Disengagement and Antibullying Class Norms

The overall aim of the present study was to examine whether moral disengagement and perceptions of antibullying class norms at individual level and at class level were associated with defending and passive bystanding in school bullying among school-age children. More specifically, we investigated the extent to which moral disengagement would contribute to explain defending and passive bystanding, after controlling for sex and perceptions of antibullying class norms at individual level and at class level. A total of 789 Swedish students (aged 10-14) from 40 middle school classes filled out a self-report survey. The findings revealed that girls and students who were less prone to morally disengage, and who perceived that their classmates endorsed more antibullying norms, were more likely to defend victimized peers. Students who were more inclined to morally disengage and perceive that classmates do not condemn bullying were more likely to act as passive bystanders. In addition, classes with higher levels of antibullying class norms were more likely to show higher rates of defending and lower rates of passive bystanding compared to the other classes. The findings suggest that schools and teachers need to develop educational strategies, methods, and efforts designed to make students aware of moral disengagement and to reduce their likelihood of morally disengaging in bullying situations. The present findings also point to the importance of teachers establishing class rules against bullying together with the students.

Downward Spiral of Bullying: Victimization Timeline From Former Victims' Perspective

The present study aimed to investigate how those who had been chronic victims of bullying perceive their bullying experience from their initial attacks to their bullying exit, how they understood processes and actions causing a situation to become progressively worse, and how they interpreted their own coping behaviors. Nine individuals who were victimized for at least 6 years were interviewed. The grounded theory approach was used to analyze the data, which generated a grounded theory of the downward spiral of bullying, demonstrating hidden aspects of bullying-the victim's inner process as a response to external victimizing and accompanying events. The interdependence of those processes is presented in a timeline to show their cumulative nature as new vicious circles of bullying involving maladaptive coping strategies (e.g., self-blame), which form an overriding pattern of behavior that renders victims unable to break it even if they enter a new peer group. In terms of policy implications, the findings suggest the need to introduce school transition programs supporting school adaptation, identify chronic victims, and take every victimhood narrative seriously.

Racial Discrimination to Bullying Behavior among White and Black Adolescents in the USA: From Parents' Perspectives

The present study proposes and tests pathways by which racial discrimination might be positively related to bullying victimization among Black and White adolescents. Data were derived from the 2016 National Survey of Children’s Health, a national survey that provides data on children’s physical and mental health and their families. Data were collected from households with one or more children between June 2016 to February 2017. A letter was sent to randomly selected households, who were invited to participate in the survey. The caregivers consisted of 66.9% females and 33.1% males for the White sample, whose mean age was 47.51 (SD = 7.26), and 76.8% females and 23.2% males for the Black sample, whose mean age was 47.61 (SD = 9.71). In terms of the adolescents, 49.0% were females among the White sample, whose mean age was 14.73 (SD = 1.69). For Black adolescents, 47.9% were females and the mean age was 14.67(SD = 1.66). Measures for the study included bullying perpetration, racial discrimination, academic disengagement, and socio-demographic variables of the parent and child. Analyses included descriptive statistics, bivariate correlations, and structural path analyses. For adolescents in both racial groups, racial discrimination appears to be positively associated with depression, which was positively associated with bullying perpetration. For White adolescents, racial discrimination was positively associated with academic disengagement, which was also positively associated with bullying perpetration. For Black adolescents, although racial discrimination was not significantly associated with academic disengagement, academic disengagement was positively associated with bullying perpetration.

Validation of a Scale for Assessing Bystander Responses in Bullying

BACKGROUND

This study sought to analyse the metric properties of the scores obtained with an adaptation of the Student Bystander Behaviour Scale (SBBS; Thornberg & Jungert, 2013) in Spanish primary-school students and to examine the types of responses students reported as witnesses to school bullying, along with their relationship to empathy.

METHOD

The Spanish adaptation of the SBBS and a self-report questionnaire about empathy were given to 1108 primary-school students, aged 9-11 years old (48.4% girls) in Asturias (Spain). The students were from 29 schools, selected by simple random sampling from all of the primary schools in the region.

RESULTS

Exploratory and confirmatory factor analysis indicated that the adapted version, like the original SBBS, measured three types of witness response to school bullying: defender, passive, and pro-bully. Most students reported that they defended, or would defend, the victim. This trend was more marked in those who had not witnessed bullying. The type of response to bullying was related to empathy, positively with defender responses, and negatively with passive and pro-bully responses.

CONCLUSIONS

The scores from the adapted version of the SBBS demonstrated metrics of reliability and validity suitable for identifying the type of response to school bullying from primary-school students.

Longitudinal Links of Individual and Collective Morality with Adolescents' Peer Aggression

Adolescents' aggressive behavior has been often linked to biases in morality. However, limited knowledge is available regarding the relative strength of different moral correlates, both at the individual and class-level, in predicting different types of aggressive behavior over time. To address this gap, the present study tested the prospective associations of moral identity and moral disengagement with reactive and proactive aggression in a short-term longitudinal study. The sample consisted of 1158 Italian adolescents (48.7% females; M_age = 13.6 years, SD = 1.1). Participants completed self-report measures of moral identity, moral disengagement, perceived collective moral disengagement in the fall, and reactive and proactive aggression in the fall and in the spring. Multivariate multilevel analysis indicated that, at the individual level, after controlling for the stability of aggressive behavior, T2 (Time 2) reactive aggression was higher for students who reported lower moral identity and higher moral disengagement at T1 (Time 1). For proactive aggression, a significant interaction effect indicated that the negative association between T1 moral identity and T2 aggression was apparent only at high levels of T1 moral disengagement. Moreover, proactive aggression was significantly predicted by higher perceived collective moral disengagement. At the class-level, T1 collective moral disengagement helped explain between-class variability of T2 reactive and proactive aggressive behavior. How these results expand previous research on morality and aggressive behavior and their potential implications for prevention and intervention programs is discussed.

Individual Moral Disengagement and Bullying Among Swedish Fifth Graders: The Role of Collective Moral Disengagement and Pro-Bullying Behavior Within Classrooms

School bullying is a complex social and relational phenomenon with severe consequences for those involved. Most children view bullying as wrong and recognize its harmful consequences; nevertheless, it continues to be a persistent problem within schools. Previous research has shown that children's engagement in bullying perpetration can be influenced by multiple factors (e.g., different forms of cognitive distortions) and at different ecological levels (e.g., child, peer-group, school, and society). However, the complexity of school bullying warrants further investigation of the interplay between factors, at different levels. Grounded in social cognitive theory, which focuses on both cognitive factors and social processes, this study examined whether children's bullying perpetration was associated with moral disengagement at the child level and with collective moral disengagement and prevalence of pro-bullying behavior at the classroom level. Cross-level interactions were also tested to examine the effects of classroom-level variables on the association between children's tendency to morally disengage and bullying perpetration. The study's analyses were based on cross-sectional self-report questionnaire data from 1,577 Swedish fifth-grade children from 105 classrooms (53.5% girls; M_age = 11.3, SD = 0.3). Multilevel modeling techniques were used to analyze the data. The results showed that bullying perpetration was positively associated with moral disengagement at the child level and with collective moral disengagement and pro-bullying behavior at the classroom level. Furthermore, the effect of individual moral disengagement on bullying was stronger for children in classrooms with higher levels of pro-bullying behaviors. These findings further support the argument that both moral processes and behaviors within classrooms, such as collective moral disengagement and pro-bullying behavior, need to be addressed in schools' preventive work against bullying.

Contact with migrants and perceived school climate as correlates of bullying toward migrants classmates

This study investigates whether the quantity and quality of contact with migrants and perceiving that cultural diversity is accepted at school (as a dimension of the perceived school climate) are associated with perpetrating bullying toward migrant classmates. Quantity and quality of contact are also examined as moderators of the association between perceived cultural acceptance at school and bullying toward migrant students. One hundred and sixty-six adolescents (M_age = 16.26; SD = 1.53) belonging to the societal majority group answered a battery of self-report measures. Bullying migrant peers was associated with more negative quality of the contact. Bullying migrants was also associated with lower perceived acceptance of cultural diversity at school for the adolescents reporting higher levels of contact with migrants at school. The role of contact in explaining bullying toward migrant peers is also discussed in light of possible interventions.

The links between students’ relationships with teachers, likeability among peers, and bullying victimization: the intervening role of teacher responsiveness

Highly responsive teachers tend to foster behaviors that are low in conflict and high in prosociality, among their students, leading to a positive classroom climate and to a decrease in bullying victimization. However, little is known about the interaction between teacher responsiveness and both student–teacher, and student–student relationship characteristics, in influencing students’ bullying victimization at school. Here, we examined student–teacher relationship quality and students’ likeability among peers as predictors of in-school victimization. Additionally, we investigated the moderating role of teacher responsiveness over this link. Study sample consisted of 386 early-adolescent students (55.2% female, mean age [SD] = 12.17 [0.73]) and 19 main teachers (females, n = 14). Findings indicated that students’ exposure to victimization was positively associated with student–teacher conflict and negatively associated with likeability among classroom peers. Teacher responsiveness did not show a significant direct association with bullying victimization. However, when teachers showed high responsiveness, the strength of the association between student–teacher conflict and students’ likelihood of bullying victimization was slightly increased. The present study highlights the importance of considering the role of teacher responsiveness when modeling the link between student and teacher relationship quality and in school bullying victimization.

Moral disengagement and verbal bullying in early adolescence: A three-year longitudinal study

This three-year longitudinal study examined both within- and between-person effects of moral disengagement on verbal bullying perpetration in early adolescence. Data came from the first four waves (T1-T4, Grades 4 to 7) of an ongoing longitudinal project examining social and moral correlates of bullying in Swedish schools. Participants included 2432 Swedish early adolescents (52% girls; M_age at T1 = 10.55 years). Students completed self-report measures of verbal bullying perpetration and moral disengagement. Results of a multilevel growth model showed that verbal bullying increased over time (regression coefficient for Grade was b = 0.04, SE = 0.01, p < .001). Additionally, the verbal bullying trajectories of participants with higher average levels of MD were higher (regression coefficient for MD¯ was b = 0.28, SE = 0.02, p < .001) and steeper (regression coefficient for the Grade ×MD¯ interaction was b = 0.02, SE = 0.01, p = .018), indicating that these students scored higher on verbal bullying in general and increased more in verbal bullying over time, compared to students with lower levels of average MD. Variations around one's own mean of MD over time was also significantly associated with concurrent changes in verbal bullying (regression coefficient for time-varying MD was b = 0.21, SE = 0.01, p < .001).

A work motivational grounded theory study of workers in caring roles

The aim of this study was to examine and construct a theoretical model of key elements that care workers perceive to have an impact on their autonomy, cohesion, and work motivation. Grounded theory was used for data collection and analysis. There were 20 participants from social welfare service, geriatric care, and women's aid settings (women = 18, men = 2, mean age = 37.6). The analysis resulted in the following categories: (a) Being-a-Cohesive-Team; (b) Agency-Making; (c) Living-Up-to-Expectations; and (d) Developing-Support-and-Feedback. The results identified potential interactions between these factors and suggested how they influenced each other, showing how cohesion, autonomy, and motivation are interdependent and amplified.

Cyberbullying and cybervictimization among preadolescents: Does time perspective matter?

Time perspective has been recognized as an important psychological dimension with a pervasive and powerful influence on human behavior. To the authors' knowledge, no studies have focused on the relationship between time perspective and cyberbullying behavior. The first aim of this research is to fill this gap by investigating the relationship between different time perspectives and both cyberbullying and cybervictimization among 6th to 8th grade students. The second objective was to investigate the relationship between time perspective, cyberbullying behaviors, peer problems, and the quality of relationship with teachers. A sample consisting of 403 students aged between 11 and 14 years from Italian middle schools (56% females, mean age = 12.2 years) were recruited. Participants filled in a self-report questionnaire measuring cyberbullying and cybervictimization as well as the Time Perspective questionnaire. The analyses showed the presence of significant correlations between time perspective and both cyberbullying and cybervictimization. In particular, cybervictimization showed a quite large positive correlation with a past-negative orientation and a negative correlation with past-positive orientation. Instead, the involvement in active cyberbullying was positively correlated with a past-negative orientation and negatively correlated with future orientation. The findings advance the understanding of psychological factors influencing cyberbullying during early adolescence and suggest the importance of past-positive and past-negative orientations in accounting for both active cyberbullying and cybervictimization. As expected, future orientation appeared to represent a protective factor against involvement in cyberbullying behaviors.

Situationally Selective Activation of Moral Disengagement Mechanisms in School Bullying: A Repeated Within-Subjects Experimental Study

With reference to social-cognitive theory, the aim of the present study was to examine whether school students' tendency to display different moral disengagement mechanisms varies according to different social cues in hypothetical events in which they are engaged in bullying behavior. A repeated within-subjects experimental design was adopted. A total of 706 Swedish students (aged 10-20) from 75 classrooms responded to four verbal bullying vignettes by filling out a self-report survey. The results showed changes in moral disengagement mechanisms across the bullying situations. For instance, moral justification, victim blaming, and dehumanization scored higher in the mean victim condition and lower in the likable victim condition than in the other two conditions. Diffusion of responsibility was higher in the group conformity condition than in the other conditions. The findings also revealed differences in the levels of moral disengagement mechanisms within the bullying conditions. For example, euphemistic labeling and displacement of responsibility scored higher than the other mechanisms in the laughing audience condition. Victim blaming scored higher than the other mechanisms in the mean victim condition. Dehumanization, victim blaming, and moral justification scored lowest while euphemistic labeling was higher than most of the other mechanisms in the likable victim condition.

Standing up for the victim or supporting the bully? Bystander responses and their associations with moral disengagement, defender self-efficacy, and collective efficacy

The aim of the current study was to examine whether moral disengagement and defender self-efficacy at individual level and collective efficacy to stop peer aggression at classroom level were associated with defending and reinforcing in school bullying situations in late childhood. Self-reported survey data were collected from 1060 Swedish students from 70 classrooms in 29 schools. Multilevel analysis found that greater defender self-efficacy at individual level and collective efficacy to stop peer aggression at classroom level were associated with greater defending. We also found that greater moral disengagement and less (but very weakly) defender self-efficacy at individual level and less collective efficacy to stop peer aggression at classroom level were associated with greater reinforcing. The positive relationship between moral disengagement and reinforcing and the negative relationship between defender self-efficacy and reinforcing were less strong in classroom high in collective efficacy to stop aggression.

Exploring Sex Differences in the Association between Bullying Involvement and Alcohol and Marijuana Use among U.S. Adolescents in 6th to 10th Grade

Objectives: The aim of the current study was to examine whether different types of involvement in bullying, together with a set of social-ecological correlates, were associated with alcohol and marijuana use for female and male adolescents. Methods: This study utilized data derived from the U.S. division of the 2005-2006 Health Behavior in School-Aged Children (HBSC) study, which include 7,084 U.S. 6^th-10^th graders (3,353 males and 3,731 females) in public and private schools. Results: The results showed that although some forms of involvement in bullying were associated with alcohol and marijuana use, some of these associations became non-significant when the social-ecological covariates were included in the models. The final logistic regression models revealed that being a traditional bully-victim increased the risk of alcohol use for males while being a traditional bully and cyber victim increased the risk of alcohol use for females. In addition, being a cyberbully increased the risk of marijuana use for males. While parental monitoring decreased the risk, delinquent peers increased the risk of both alcohol and marijuana use for both sexes. Parent/guardian support decreased the risk of alcohol use for females. The likelihood of alcohol use and marijuana use increased with age for both sexes, while being an African American was linked with a lower risk of alcohol and marijuana use among males. Conclusions/Importance: Our findings demonstrate the importance of examining the link between bullying involvement and substance use, together with social-ecological correlates for female and male adolescents.

Emotional challenges of medical students generate feelings of uncertainty

OBJECTIVES

Health care students face many situations during their education that might be emotionally challenging. Students are confronted with illness, suffering, death, patient treatment dilemmas, and witnessing unprofessional behaviour on the part of health care professionals. Few studies have focused on what these experiences lead to in relation to the process of becoming a professional. The purpose of the study was to explore medical students' main concerns relating to emotionally challenging situations during their medical education.

METHODS

A constructivist grounded theory approach was used to explore and analyse medical students' experiences. Data were gathered by means of focus group interviews, including two interviews in the middle and two interviews at the end of the students' undergraduate programme. A total of 14 medical students participated.

RESULTS

Students' main concerns relating to emotionally challenging situations were feelings of uncertainty. These feelings of uncertainty concerned: (i) insufficient knowledge and skills; (ii) the struggle to manage emotions in patient encounters; (iii) perceived negative culture and values amongst health care professionals and in the health care system, and (iv) lacking a self-evident position on the health care team. The first two aspects relate to uncertainties concerning their own capabilities and the other two aspects relate to uncertainties regarding the detached medical culture and the unclear expectations of them as students in the health care team.

CONCLUSIONS

In the process of becoming a physician, students develop their professional identity in constant negotiation with their own perceptions, values and norms and what they experience in the local clinical context in which they participate during workplace education. The two dimensions that students have to resolve during this process concern the questions: Do I have what it takes? Do I want to belong to this medical culture? Until these struggles are resolved, students are likely to experience worry about their future professional role.

Individual and Classroom Social-Cognitive Processes in Bullying: A Short-Term Longitudinal Multilevel Study

The aim of this study was to examine whether individual and classroom collective social-cognitive processes (moral disengagement and self-efficacy) were associated with bullying perpetration among schoolchildren. An additional aim was to examine whether changes in these processes from grade 4 (Time 1) to grade 5 (Time 2) were associated with a change in bullying perpetration. Self-reported survey data were collected from 1,250 Swedish students from 98 classrooms. Results of multilevel analysis indicated that individual and classroom collective moral disengagement (CMD) were positively associated with bullying, and defender self-efficacy (DSE) was negatively associated with bullying. The effect of changes in individual moral disengagement on changes in bullying was positive, and the effects of changes in DSE and classroom collective efficacy on changes in bullying were negative. Thus, the findings demonstrate the changeability of moral disengagement, DSE and collective efficacy over time, and how these changes are linked to changes in bullying perpetration.

Moral Disengagement of Pure Bullies and Bully/Victims: Shared and Distinct Mechanisms

The vast majority of adolescents recognize that bullying is morally wrong, yet bullying remains a problem in secondary schools, indicating young people may disengage from their moral values to engage in bullying. But it is unclear whether the same mechanisms enabling moral disengagement are active for bully/victims (who both bully and are bullied) as for pure bullies (who are not targets of bullying). This study tested the hypotheses that mechanisms of moral disengagement, including blaming the victim and minimizing the impact of bullying, may operate differently in bully/victims compared to pure bullies. From a sample of 1895 students from grades 7-9 (50.6% female; 83.4% from English speaking homes), 1870 provided self-reports on bullying involvement and mechanisms of moral disengagement associated with bullying. Two cut-offs were compared for bullying involvement (as perpetrator and as target of bullying) during the previous school term: a conservative cut-off (every few weeks or more often) and a liberal cut-off (once-or-twice). Using the conservative cut-off, both pure bullies and bully/victims enlisted moral disengagement mechanisms to justify bullying more than did uninvolved students and pure victims, with no significant difference in scores on any of the moral disengagement scales between pure bullies and bully/victims. For the liberal cut-off, bully/victims reported lower overall moral disengagement scores than did pure bullies, and specifically less distortion of consequences, diffusion of responsibility, and euphemistic labeling. This study advances bullying research by extending the role of moral disengagement in bullying episodes beyond pure bullies to victims, both pure victims and bully/victims. Examination of specific moral disengagement mechanisms and the extent of involvement in bullying enabled a more nuanced differentiation between the bullying groups. These results will inform future interventions aimed at reducing the use of moral disengagement mechanisms that sustain bullying and victimization. Targeted interventions are needed to challenge specific moral disengagement mechanisms from the perspectives of pure bullies and bully/victims.

Bullying bystander behaviors: The role of coping effectiveness and the moderating effect of gender

Researchers have suggested that bystander behaviors and victim coping play an important role in counteracting the negative effects of bullying. The current study investigated the relationship between students' ratings of coping effectiveness when addressing bullying and their behaviors as bystanders when witnessing bullying. Surveys were administered in a Midwestern, suburban school district. Some associations between perceptions of coping effectiveness and bystander behavior supported our hypotheses (e.g., constructive coping associated with defending bystander behaviors, externalizing associated with pro-bullying behaviors). However, some findings did not support hypothesized relationships. For example, higher ratings of effectiveness for cognitive distancing as a coping strategy were associated with increased defending behaviors as a bystander. Gender moderated some of these relationships. Pro-bullying bystander behavior was associated with increased ratings of cognitive distancing and decreased reports of constructive coping effectiveness for girls. Implications for future research and practice are discussed.

Empathy and defending behaviours in school bullying: The mediating role of motivation to defend victims

BACKGROUND

The literature indicates that separate significant links exist in adolescence between empathy, cognitive and affective motivation to defend victims, and behavioural problems in bullying episode in schools.

AIMS

The aim of the study was to investigate the relationship between empathy, motivation to defend, and defending behaviour in bullying situations. The hypothesis focuses on the possible role of autonomous motivation in the association between empathy and defending attitudes.

SAMPLES AND METHODS

Data were collected from 430 Italian adolescents (48.4% male, 51.6% female) who completed a questionnaire in their schools. The mean age of the participants was 13.1 years (SD = 2.1).

RESULTS

Results showed that empathy significantly predicts defending behaviour and also has a significant effect on extrinsic, introjected, and intrinsic motivation to defend. Autonomous motivation, in turn, has a mediating role in the relationship between empathy and defending behaviour.

CONCLUSIONS

Our study suggests the importance of focusing on empathy and on developing autonomous motivation to defend in children, to raise spontaneous defending attitudes against bullying.

Re-negotiating agency - patients using comics to reflect upon acting in situations of abuse in health care

Background

There is a growing body of international research that displays the prevalence and character of abuse in health care. Even though most of these studies are conducted from a patient perspective little is known about how patients conceptualize their agency in relation to such situations. This study aimed to explore how patients reason about their potential to act in abusive situations.

Methods

Qualitative interviews were conducted with thirteen patients in Sweden. Central in the interviews were three comics, inspired by Boal’s Forum Theatre and part of an earlier online intervention study in which the informants had participated. Each comic showed a situation in which a patient feels abused, and on the opposite side were suggestions for how the patient could act in response. Informants were asked to reflect about situations of abuse and in specific upon the comics. We used the methodology of constructivist grounded theory throughout the study, including the analysis.

Results

It appeared that the informants constantly re-negotiated their and other patients’ agency in relation to the specifics of the event, patients’ and staff’s responsibilities, and the patients’ needs and values. This process questions views of agency as fixed and self-evident, and can be understood as part of changing discourses about patients’ social role and possibilities to organize their care. Using a feminist theory of power we expected the informants to elicit instances of resistance to domination, which is central to the comics. While doing that, the informants also hinted at parallel stories of empowerment and less visible forms of agency in spite of domination.

Conclusion

The current analysis showed different ways in which the informants constantly re-negotiated their agency in potentially abusive situations. Not only did the informants engage in reflections about immediate responses to these untoward situations, they also engaged in thoughts about strategies that could protect them and counteract abuse in health care over the long-term. This opens up for future research into ways patients organize their care and identify threats and barriers to the care they need, which could be valuable knowledge for care quality improvement.

Authoritative classroom climate and its relations to bullying victimization and bystander behaviors

Authoritative school climates have been associated with less school bullying and other antisocial behaviors. However, studies focusing on the classroom level, as well as on bystander behaviors, are lacking. The aim of the current study was to examine whether authoritative classroom climates were associated with bullying victimization and various bystander behaviors (reinforcer, outsider, and defender behaviors) in school bullying. We included gender as a covariate at the individual and classroom levels. Participants were 1540 5th-grade students (824 girls) from 104 classrooms in Sweden who completed a questionnaire. The findings revealed that girls and students in classes with greater authoritative classroom climates were more inclined to defend. Boys reinforced more as did students in classes with more boys and more authoritative classroom climates. Boys showed more outsider behaviors as did students in classes with less authoritative classroom climates. Students in classrooms with less authoritative climates were victimized to a higher degree. Thus, the current findings suggest that a warm, caring, supportive, controlled, demanding, and cohesive classroom climate should be considered a vital protective factor against bullying victimization and negative bystander responses, and a facilitator of defending and supporting victims.

‘It Depends’: A qualitative study on how adolescent students explain bystander intervention and non-intervention in bullying situations

The aim of the current study was to examine how junior high school students interpret, motivate, and explain various bystander behaviors in bullying situations. The participants were 17 junior high school students recruited from four schools in Sweden. Semi-structured interviews were conducted and analysed with grounded theory methods. The analysis generated a conceptual model of bystander interpreting–considering process in school bullying. A core category named ‘it depends’ was developed to explain how the participants in the study motivated their own and their peers’ actions as bystanders in various bullying situations. Whether they intervened or not depended on how they interpreted the situation in terms of: (a) seriousness of the situation, including trivialization; (b) social relationships with the involved; (c) locus of responsibility, including displacement of responsibility, and victim blame; (d) social status; (e) perception of risk; and (f) defender self-efficacy. The implications of these results for bullying prevention and intervention efforts are discussed.

Getting angry matters: Going beyond perspective taking and empathic concern to understand bystanders' behavior in bullying

The present study examined the relations between different empathic dimensions and bystanders' behavior in bullying. Specifically, the indirect effects of empathic concern and perspective taking via empathic anger on defending and passive bystanding were tested in a sample of Italian young adolescents (N = 398; M_age = 12 years, 3 months, 47.2% girls). Path analysis confirmed the direct and indirect effects, via empathic anger, of empathic concern and perspective taking on bystanders' behavior, with the exception of the direct association between perspective taking and passive bystanding that was not significant. Our findings suggest that considering empathic anger together with empathic concern and perspective taking could help researchers to better understand the links between empathic dispositions and bystanders' behavior in bullying.

Classroom relationship qualities and social-cognitive correlates of defending and passive bystanding in school bullying in Sweden: A multilevel analysis

Using the social-ecological and social cognitive theories as integrated guiding frameworks, the present study examined whether moral disengagement and defender self-efficacy at the individual level, and moral disengagement, quality of teacher-student relationships and quality of student-student relationships at the classroom level were associated with passive bystanding and defending in bullying situations. Participants were 900 Swedish students from 43 classrooms, ranging in age from 9 to 13years. Multilevel regression analyses revealed that passive reactions by bystanders were associated with greater moral disengagement and less defender self-efficacy. Defending, in turn, was associated with less moral disengagement and greater defender self-efficacy and classroom student-student relationship quality. Furthermore, students who scored high in moral disengagement were even less prone to defend victims when the classroom student-student relationship quality was low, but more prone to act as defenders when the classroom student-student relationship quality was high. In addition, the negative association between defender self-efficacy and passive bystanding was stronger both in classrooms with higher student-student relationship quality and in those with lower class moral disengagement. Implications for prevention are discussed.

Callous-Unemotional Traits, Harm-Effect Moral Reasoning, and Bullying Among Swedish Children

Background

Although callous-unemotional (CU) traits have been associated with bullying among children and adolescents, relatively little is known about whether each of the three sub-constructs of CU traits—callous, uncaring, and unemotional—are associated with bullying when they are considered concurrently in the analysis.

Objective

This study was the first to examine in a single model whether callous, uncaring, and unemotional traits are directly related to the perpetration of bullying and to harm-effect moral reasoning in bullying among children as well as whether these three CU traits are indirectly related to bullying mediated by harm-effect moral reasoning.

Methods

Self-reported data on CU traits, harm-effect moral reasoning in bullying situations, and bullying perpetration were collected from 381 children from 13 schools in Sweden. Structural equation modeling was used to test the hypotheses.

Results

When all three sub-constructs of CU traits were included in a single model, greater callousness and uncaring were directly associated with greater bullying. In contrast, greater harm-effect moral reasoning was associated with less bullying. Moreover, greater callousness and unemotional were indirectly associated with greater bullying through the reduced use of harm-effect moral reasoning.

Conclusions

Our findings demonstrate that all three CU traits are important to address, although their associations with bullying took some different paths, and that callousness appears to be the most important CU trait in relation to bullying.

Early adolescents' motivations to defend victims in school bullying and their perceptions of student-teacher relationships: A self-determination theory approach

The aim of this study was to investigate whether various dimensions of student-teacher relationships were associated with different types of motivation to defend victims in bullying and to determine the association between these types of motivations and various bystander behaviors in bullying situations among early adolescents in Italy. Data were collected from 405 Italian adolescents who completed a survey in their classroom. Results showed that warm student-teacher relationships were positively associated with defending victims and with autonomous motivation to defend victims. In contrast, conflictual student-teacher relationships were positively associated with passive bystanding and with extrinsic motivation to defend victims. Different forms of motivation to defend were found to be mediators between student-teacher relationship qualities and bystander behaviors in school bullying. Our findings suggest that teachers should build warm and caring student-teacher relationships to enhance students' autonomous motivation to defend victims of bullying as well as their inclination to defend the victims in practice.

Understanding Ecological Factors Associated With Bullying Across the Elementary to Middle School Transition in the United States

This study examines sociodemographic characteristics and social-environmental factors associated with bullying during the elementary to middle school transition from a sample of 5th-grade students (n = 300) in 3 elementary schools at Time 1. Of these, 237 participated at Time 2 as 6th-grade students. Using cluster analyses, we found groups of students who reported no increase in bullying, some decrease in bullying, and some increase in bullying. Students who reported increases in bullying also reported decreases in school belongingness and teacher affiliation and increases in teacher dissatisfaction. Students who reported decreases in bullying also reported decreases in victimization. These findings suggest that changes across the transition in students' relations to school and their teachers are predictive of changes in bullying.

School bullying and the mechanisms of moral disengagement

The aim of the present study was to examine to what degree different mechanisms of moral disengagement were related to age, gender, bullying, and defending among school children. Three hundred and seventy-two Swedish children ranging in age from 10 to 14 years completed a questionnaire. Findings revealed that boys expressed significantly higher levels of moral justification, euphemistic labeling, diffusion of responsibility, distorting consequences, and victim attribution, as compared with girls. Whereas boys bullied others significantly more often than girls, age was unrelated to bullying. Moral justification and victim attribution were the only dimensions of moral disengagement that significantly related to bullying. Furthermore, younger children and girls were more likely to defend victims. Diffusion of responsibility and victim attribution were significantly and negatively related to defending, while the other dimensions of moral disengagement were unrelated to defending.