A Scoping Review of the Online Interventions by Nurses for Reducing Negative Impact of Bullying on Students

Introduction

Every year, more students are being bullied. According to data in 2017 from the United Nations Children’s Fund (UNICEF), 67 of her 100 students in 18 different nations have been bullied.¹ A study conducted by Latitude News in 40 countries found that most cases of bullying occur in Japan, Indonesia, Canada, South Korea, the United States and Finland. Up to 50% of her 13–15 year olds in Indonesia experience bullying.² Bullying is included in the 10 health problems that worry teenagers.³

Bullying is aggressive and violent behavior who causes hostility between the two parties (the perpetrator and the victim), and repeat a negative behavior resulting in an imbalance of power between perpetrator and victim.⁴ Victims also perceive themselves as weak, powerless and always feel threatened by bullying. Negative behavior that causes a person to be uncomfortable/injured and usually occurs repeatedly which is characterized by an imbalance of power between the perpetrator and the victim.⁵ This bullying behavior cannot be separated from the desire for power and also being someone who is feared in the school environment.⁶ The perpetrators of bullying which are commonly called bullies can be a person, it can also be a group of people, and he or they perceive themselves to have the power to do anything to their victims. Victims also perceive themselves as weak, powerless and always feel threatened by bullying.^6,7 Examples of bullying behavior are fighting, giving nicknames, isolating, spreading gossip, speaking harshly, or sexually harassing, while bullying behavior can also be done via the internet such as the use of text messages, pictures, videos, or social media.⁸ Data from UNICEF shows that the causes of bullying are 25% because of their physical appearance, 25% because of their gender, 25% because of their ethnicity or country of origin, and 25% for other reasons.⁹ The physical and verbal bullying they receive is often a trauma factor for the short and long term. The problem for victims of bullying is the emergence of various mental health problems such as depression, anxiety and sleep problems that may carry over into adulthood, physical health complaints, such as headaches, stomach aches and muscle tension, feeling insecure in the school environment, and decreased enthusiasm for learning and academic achievement.¹⁰ The impact of bullying behavior that is carried out can result in victims becoming desperate, embarrassed, aloof, unwilling to socialize, not enthusiastic, and even hallucinating.¹¹ These disorders include poor social adjustment as well as psychological disorders.^12,13 This is in line with previous research which states that violence against children will affect the psychology of children’s growth and development, where children will become tough personalities in the future.¹⁴ Children who are bullied have the potential to become perpetrators of juvenile delinquency, perpetrators of violence and criminal acts.¹⁵ Bullying causes psychological problems such as 60.17% experiencing emotional mental disorders (44.54% feel lonely, 40.75% feel anxious, and 7.33% have ever wanted to commit suicide).¹⁴

To lessen the effects of bullying, efforts must be made to help the victims. Previous studies have demonstrated that counseling is an effort to lessen the damaging effects of bullying on adolescents.^10,16 Bullying intervention programs have been shown to be successful when using peer-based psychoeducation.¹⁷ Access to and availability of time for participation in the intervention’s execution are obstacles to efforts to lessen the detrimental effects of bullying on its victims.¹⁸ Online nursing interventions are possible following the pandemic. Previous studies have demonstrated the effectiveness of online nursing treatments to lessen the effects of bullying on nurses.¹⁹ This demonstrates that there is a problem gap since nurses’ online solutions to lessen the effects of bullying are still mostly unknown to nurses.²⁰

Nursing intervention is needed for victims, families, schools, and perpetrators of bullying. This aims to reduce the incidence of bullying in students. Nurses and psychologists collaborate to conduct counseling and rehabilitation efforts to prevent perpetrators from bullying again.²¹ Intervention for families is also an effort to increase family awareness of bullying and involve families in preventing bullying by students. Other studies also show that interventions need to be given to schools to carry out programs to prevent and overcome bullying by students at school.^22,23 Interventions to reduce the negative impact of bullying need to be given to victims who have physical and psychological problems. Intervention with victims is an effort that must be done first to prevent more serious problems from occurring to victims. Previous studies have shown that victims who are not treated immediately suffer from post-traumatic stress disorder and are at risk of suicide.^11,24 So this study focuses on interventions to reduce the negative impact on victims of bullying on students.

Providing comprehensive nursing care covering physical, psychological, spiritual, and cultural aspects to victims of bullying are the most important role of nurses. The role of the nurse as an educator serves to increase parental and community knowledge about bullying and its effects.²⁵ Nurses also act as advocates and collaborators to increase public awareness and empathy in responding to bullying issues. Then the nurse also acts as a counselor to help victims in solving psychological problems due to bullying.²⁶ The importance of nurses must also be carried out in collaboration with other health workers and the role of the family to get maximum purposes.²⁷

Previous scoping review about school-based program (collaborated with health workers and teachers) are effective for reducing negative impact of bullying.²⁸ However, the obstacle in implementing the intervention was that it took a long time and some participants did not fully participate in the activity. So further studies are needed to review nursing intervention by online for reducing impact of bullying to make it more effective and efficient. Another studies showed that online interventions are effective in improving students’ mental health during the Covid-19 pandemic.^29,30 This study shows that there is potential for nursing interventions conducted online to address the impact of mental health problems. So this scoping review is the first study to discuss online-based interventions to reduce negative impacts on students.

Bullying has a detrimental effect and can result in long-term psychological issues. To provide victims of bullying with comprehensive nursing care, nurses have a crucial role to play. However, because they require so much time, offline nursing interventions are viewed as being less effective and efficient. There is a need for a scoping review so that nurses may learn what kinds of nursing interventions can be carried out online to lessen the effects of bullying on pupils. As a result, the authors plans to carry out a scoping review to explore the method of online-based nursing treatments might be used to lessen the negative effects of bullying on students.

Materials and Methods

Design

This study used a design scoping review framework. Scoping review is a design to explore various types of interesting and developing topics in the world according to research objectives.³¹ This method used data to discuss research results with a wide conceptual range in accordance with research objectives.³² The authors used five stages for this study were define research questions and research objectives, define inclusion and exclusion criteria, identify and select articles, collecting data, and reporting study results.³³ This study used the PRISMA Extension for Scoping Reviews (PRISMA-ScR) to identify the articles who discussed about the method of nursing interventions by online on students for reducing negative effect/traumatic effect of bullying.

Search Methods

The authors used three databases in this study: CINAHL, PubMed, and Scopus. The keywords for search of the articles are: “nursing care OR nursing intervention” AND “bullying OR victimization” AND “online OR digital” AND “students”. The research questions for this study is what the methods of nursing interventions by online on students for reducing negative impacts of bullying?

Inclusion and Exclusion Criteria

Search strategy for articles in this study made use of the PRISM-ScR diagram (Figure 1). For the purpose of choosing articles, the authors employed inclusion and exclusion criteria. The study’s inclusion criteria included original research, sample is students, nursing interventions delivered online, RCT or quasi-experimental design, English language, and publication within the last ten years (2013–2022). The study’s exclusion criteria were that the intervention was offline and the sample was not made up of students.

Figure 1 PRISMA Flow Diagram. Note: PRISMA figure adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71. Creative Commons.70

Data Extraction

The authors created manually table for extraction data. This table helped the authors to classified similar interventions from the results of this scoping review. Data included in the extraction table are purpose, design of the study, samples in the study, interventions, and results.

Quality Appraisal

The authors used the Joanna Briggs Institute (JBI) critical evaluation method to determine the quality of the journals selected for the scoping review. JBI is a method of describing the content of each paper and evaluating the quality of the paper according to the research design as a reference for judging whether the paper can be reviewed. The article scoring method used a score for each statement (yes, no, unknown, not applicable). A score of yes is given a value of 1, any other score is given a value of 0. The authors determined the criteria for the articles used and analyzed in this study by her JBI rating score of 75% or higher for criteria and topical relevance.

Data Analysis

Articles chosen in accordance with inclusion and exclusion criteria. The authors then evaluated the articles’ quality after having all of them read and fully examined. Data analysis was conducted using a descriptive methodology. The reviews are created by the authors and added to the extract table Following summaries, each authors discussed and described how nursing interventions are conducted.

Results

The authors found articles from search results based on keywords of 686 articles. After we made a selection based on article duplication, we obtained 636 articles. Then the authors selected articles according to the inclusion criteria and screened abstracts and article titles, found 30 articles. After that, the authors read the full-text and eliminated based on the exclusion criteria, resulting in 10 articles. The authors double-checked to get relevant articles with high quality. The authors analyzed the quality of the articles using the JBI Critical Appraisal Tool assessment. The standard value of the articles in this study is above 75% according to the relevance of the topics in this study (Table 1).

Table 1 JBI Critical Appraisal Tool

The extraction data in this study were presented used manual tabular from all authors presented in Table 2:

Table 2 Extraction Data

The authors found 10 articles that discussed topics according to the research objectives. Of the 10 articles, 1 article were found from Brazil, 1 article from Austria, 1 article from Australia, 1 article from Finland, 1 article from Israel, 2 articles from the US, 1 article from Spain, 1 article from Germany, and 1 article from Italy. Based on the design of the articles, 8 articles used an RCT design and 3 articles used a quasi-experimental design. We found that there were three methods of nursing intervention, there were improved students’ skills, social-based programs, and counseling. Each intervention is described based on the study results of each type of intervention.

Improving Skill Students

Online-based nursing interventions that can be delivered through skill development. Skills-based interventions consist of several activities, including role-playing, dramatization, positive reinforcement, modeling, feedback, videos, and homework.³⁶ This activity was conducted for 4 weeks with start, middle and end activities. Other activities, such as the Cyber Friendly School Program, which reviews relevant school policies, educates staff about the technology students are using, raises student awareness, and provides bullying prevention training to students and parents.³⁷ The program will be conducted in 6 sessions over 8 weeks. Interventions are effective in reducing bullying and victimization.

There are 19 one-hour sessions total in the Cyber-program 2.0 intervention.³⁸ The exercises included identifying bullying, examining its effects, creating coping mechanisms, and creating constructive variables (empathy, active listening, social skills, constructive conflict resolution and tolerance). The NoTrap Intervention Program! It is divided into three stages: education, virtual empathy training, and effort to strengthen the system of supports.³⁹ Special training is provided to students and schools on how to stop and handle bullying. According to the intervention’s findings, bullying in schools has decreased.

Social-Based Program

Another intervention that can be implemented online to reduce the impact of bullying on students is the one-year ViSC social-based program.⁴⁰ Training consisted of several sessions. Meetings to implement preventive measures at school and class level (class projects). Other program, such as KiVa’s anti-bullying program, run for 90 minutes a day for 10 weeks.⁴¹ Prevention and intervention programs are implemented through social and school support systems. The activities to be implemented are education and training to improve the support system. Interventions can reduce the incidence of bullying. Another program is the Whole-School Change Intervention which is carried out online in collaboration with the school.⁴² This intervention focuses on Peer Education activities to improve resilience and coping skills in dealing with stress. Students are also given education related to bullying so that bullying does not happen again to students.

The Internet-based intervention (CORE: Cultivating our Resilience) teaches stress management techniques and promotes personal growth while enhancing wellbeing.⁴³ The intervention was divided into six interactive modules: life objectives, connecting with others, overcoming obstacles, self-care and compassion. Along with instruction in brief distance power-points (15–20 minutes) and fundamental cognitive-behavioral therapy (CBT) approaches, other programs are provided, such as media-based preventive interventions.⁴⁴ Applications-based remote interventions for bullying victims are practical and acceptable, and the results of such interventions can enhance wellbeing. Interventions can help lessen depression and anxiety.

Counseling

Online counseling also attempts to reduce the incidence of bullying among students. An anti-bullying intervention program was conducted in three sessions over four weeks.⁴⁵ The actions taken are in the form of education, problem-solving advice, and bullying prevention. The intervention lasted for 12 sessions, 60–90 minutes per session. The activities carried out are aimed at solving problems and implementing solutions to overcome bullying. Activities will be held online in each group. Each group is asked to present a problem. Each student then takes turns consulting to demonstrate the problems and solutions being implemented. The intervention was shown to significantly reduce the incidence of bullying in schools.

Discussion

This scoping review shows that online nursing interventions can reduce the impact of bullying on students at school. There are 3 types of interventions that can be carried out based on this study, namely by increasing students’ skills, increasing social skills, and counseling. The nursing interventions carried out are independent interventions and collaborative interventions, both with the school or psychologist.

The results of the study show that the sample is adolescents aged 10–19 years. Teenagers are someone who is in a transition period from children to adults. At this stage of adolescent development, curiosity arises and does not want to be controlled, as well as the search for identity. Sometimes, Adolescents finds it difficult to accept the differences that occur between him and others.⁴⁶ So that these differences lead to bullying. Previous study have shown that the cause of bullying is the differences in race, religion, culture, and physical characteristics of students.⁴⁷ Other studies also show that students experience bullying due to physical differences experienced by students.^11,48 In adolescence, guidance needs to be given to parents and community nurses in preventing and reducing the negative effects of bullying on students.

Online nursing interventions last anywhere between two and sixteen weeks. The length of the intervention was customized for the victim’s characteristics and the actual intervention sessions. Interventions conducted online are more effective than those conducted offline.⁴⁹ This is because the intervention can be done at any time.⁵⁰ This is in line with previous studies which showed that the intervention to increase students’ self-esteem could be done online for 6 weeks.^51,52 Programs to reduce the impact of stress on victims of violence are also more efficient online, which took 8 weeks compared to offline, which took 12 weeks.⁵³ The efficiency of implementing nursing interventions can be considered in making programs to reduce the impact of bullying on students.

Improving student skills is an important thing to do in reducing the negative impact of bullying. Students need to have high resilience skills in order to be able to face the bullying they get. Resilience is an individual’s resistance used when dealing with stressors.⁵¹ Previous studies have shown that resilience is an effective ability to deal with unpleasant events experienced by students.⁵⁴ Another study shows that the impact of bullying will decrease when the victim has adaptive coping and high resilience.⁵⁵ Resilience and coping skills also help improve students’ ability to reduce the traumatic effects of bullying. Students with adaptive coping deal with stressors by focusing on solving problems, so that trauma problems can be handled properly.⁵⁶ In solving their problems, students need to be facilitated by nurses to make the right decisions in solving problems due to their trauma.

Nurses provide online nursing care to make it more effective and efficient, and to reach a wider range of victims of bullying. Nurses provide education about bullying online. Providing online education can increase student awareness of bullying. Online education is also effective in reducing the incidence of bullying among students.¹⁹ Nurses also perform their role as counselors to improve students’ adaptive coping in dealing with bullying. Counseling is carried out in collaboration with psychologists to explore the feelings of victims of bullying, then discuss solutions to the problems experienced by victims. Previous studies have shown that 60 minutes of counseling is an effective method of reducing the effects of trauma on adolescents.^57,58 In addition, counseling can also increase the sense of security and comfort in victims of bullying. Then the role of the nurse as a facilitator is to facilitate activities carried out by adolescents. Activities in the form of peer education and skills improvement such as improving coping and resilience in reducing the impact of bullying. Nurses facilitate youth to do positive things according to the victim’s hobbies, and nurses facilitate students to share with other students. Activities carried out by nurses can be collaborated with the school and parents to monitor the progress of victims of bullying. Previous studies have shown that school-based nursing interventions are effective for preventing and reducing the impact of bullying on students.^28,49 Social support is also an important aspect to reduce the impact of bullying on victims. Social support will increase the confidence of victims of bullying and reduce the impact of social isolation that appears on victims.⁵⁹ This is in line with previous studies which showed a decrease in anxiety and social isolation that occurred in victims after receiving social support for victims of bullying.^60–62 Social support can be provided by friends, teachers or the school, parents, and health workers including nurses.⁶³ Social support training can be done to increase environmental awareness of victims of bullying. Another study shows that victims who get social support from the environment can reduce anxiety and depression that appear in victims of bullying.⁶⁴ The nurse becomes a facilitator to guide students in conducting peer-support groups. Students are given the opportunity to express their feelings, then given the motivation to solve the problem.⁶⁵ Students are also invited to discuss solutions to trauma problems experienced by students.⁶⁶ So that social-support is needed as a means to support each other in the process of healing trauma due to bullying.

Efforts to reduce the negative impact of bullying can be done in collaboration with psychologists, namely counseling. Counseling is an effort to express the feelings experienced by the victim and discuss to resolve the problem together with the victim.⁶⁷ Counseling is done online between the psychologist and the victim. Previous studies have shown that counseling is an effective effort to reduce the impact of bullying on students.^58,68 Counseling is carried out by teachers and nurses to students and parents to find out the problems faced by students. Students attend counseling with the aim of determining methods of solving problems due to trauma.⁵⁷ Then counseling also involves parents so that supervision of students at home runs optimally to reduce the negative effects of bullying.⁶⁹ In addition, counseling can also solve mental health problems experienced by victims of violence. Victims can also adapt to the environment at school.

Nurses, other health professionals, or the school can work together to implement programs to lessen the effects of bullying on students. However, collaborative interventions can be conducted more thoroughly in order to have a more positive effect.⁷⁰ Efforts to reduce bullying need to be carried out by various parties including students, teachers, health workers, parents, and the community.³⁴ Collaboration can also increase awareness of the school environment to reduce the incidence of bullying. Collaboration is carried out online between health workers to coordinate and monitor students’ progress on the behavior and impact of bullying. So that the monitoring process runs optimally.

Limitations

This study has research limitations, namely the articles used only with RCT and quasi-experiment designs. This causes the authors to be unable to compare the results of the study with other research designs. In addition, the limitation of this study is the period of article publication which is limited to the last 10 years (2013–2022). The authors tried to get articles with the latest nursing interventions but cannot compare the results of data outside the last 10 years.

Conclusion

Nursing interventions carried out online have the potential to reduce the negative effects of bullying on students. This is shown from the results of a scoping review of 10 articles which show the effectiveness of implementing online nursing interventions to reduce psychological problems in students. The results of this study indicate that there are three methods of online-based nursing interventions, namely improving students’ skills, increasing social skills, and counseling. This shows the use of technology as a relevant medium to support the success of nursing interventions. Implementation of nursing interventions must pay attention to various aspects such as physical, psychological, cultural, and spiritual. Nurses provide comprehensive nursing care to victims of bullying. The role of the nurse as a facilitator in carrying out nursing interventions, the nurse also acts as a counselor to improve adaptive coping for victims of bullying, and nurses collaborate with schools, parents and other health workers to increase awareness and reduce the negative impact of bullying.

The implication of this study is that the study results become the basis for nurses in providing online nursing care to students. This study is also a reference for educators in the field of psychiatric nursing and community nursing regarding bullying in adolescents. The suggestion in this study is the need for a systematic review and meta-analysis to determine the effectiveness of online nursing interventions to reduce the negative effects of bullying on adolescents.