Journal List > J Korean Acad Nurs > v.47(5) > 1003275

Ren and Kim: Effects of Bullying Experience on Psychological Well-Being Mediated by Conflict Management Styles and Psychological Empowerment among Nursing Students in Clinical Placement: A Structural Equation Modeling Approach



This study aimed to test a proposed structural equation model in which bullying experience, conflict management styles and psychological empowerment predict psychological well-being among Chinese nursing students in clinical placement.


Three hundred and sixty-six nursing students recruited from five hospitals in J city and Y city were assessed with self-report questionnaires on bullying experience, conflict management styles, psychological empowerment and psychological well-being including depression, self-esteem, and academic major satisfaction. Data were analyzed using SPSS version 20.0 and AMOS version 22.0.


The evaluation parameters included the comparative fit index at .90, the goodness of fit index at .93, the root mean square error of approximation at .07, and c2/df ratio at 2.66, indicating that the proposed structural equation model provided a good fit to the data. Experience of being bullied during clinical placement, conflict management styles and psychological empowerment explained 93.0% of the variance and had significant effects on psychological well-being, with conflict management styles and psychological empowerment mediating the association between bullying and psychological well-being.


The findings indicated that mediation by conflict management styles and psychological empowerment alleviated the negative influence of bullying on psychological well-being. To limit bullying and its negative effects, development of effective guidelines to deal with bullying will be a critical tool for both Chinese nursing students and their instructors. Further research should incorporate conflict management styles and psychological empowerment into the specific intervention strategies for handling bullying behaviors among nursing students and staff nurses and promoting nursing students’ psychological well-being.


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Figure 1.
Conceptual framework.
Figure 2.
Path diagrams for the hypothetical model.
Table 1.
Sample Characteristics (N=366)
Characteristics Categories n (%)
Gender Female 352 (96.2)
Male 14 (3.8)
Ethnicity The Han nationality 291 (79.5)
The ethnic Korean 51 (13.9)
Other nationality 24 (6.6)
Education program Technical secondary school 68 (18.6)
Junior college 120 (32.8)
Undergraduate 178 (48.6)
Perceived academic performance Bad 72 (19.7)
Middle 175 (47.8)
High 119 (32.5)
Bullying management class No 247 (67.5)
Yes 119 (32.5)
Teacher’s help to deal with bullying No 159 (43.4)
Yes 207 (56.6)
Nurse’s help to deal with bullying No 249 (68.0)
Yes 117 (32.0)
Relationship between nurses and Bad 128 (35.0)
students Neutral 132 (36.0)
Good 106 (29.0)
Table 2.
Descriptive Statistics of Variables (N=366)
Variables Categories Range M±SD Skewness Kurtosis Tolerance VIF
Bullying experience Work-related bullying 0~16 2.98±1.82 1.06 0.47 0.50 1.99
Person-related bullying 0~24 3.95±1.72 1.56 1.86 0.46 2.20
Physically intimidating bullying 0~12 4.27±2.85 0.20 −0.63 0.57 1.76
Conflict management styles Competing 0~12 6.56±2.32 0.15 −0.73 0.39 2.55
Collaborating 0~12 5.95±1.99 0.03 −0.24 0.54 1.84
Compromising 0~12 6.70±2.25 0.07 −0.65 0.79 1.26
Avoiding 0~12 7.36±2.19 −0.18 −0.67 0.80 1.25
Accommodating 0~12 6.15±2.00 −0.20 −0.78 0.35 2.87
Psychological empowerment Meaning 4~12 6.03±2.47 1.10 1.73 0.53 1.88
Competence 4~12 7.99±2.45 0.35 0.17 0.52 1.94
Self-determination 4~12 6.75±2.31 0.79 0.85 0.45 2.25
Impact 4~12 10.25±2.66 −0.12 −0.49 0.76 1.32
Psychological well-being Depression 0~60 22.01±1.75 −0.40 −0.12 0.25 4.06
Self-esteem 10~40 20.60±5.05 0.13 −0.07 0.63 1.59
Academic major satisfaction 6~30 15.90±4.07 0.27 0.16 0.38 2.62
Multivariate 4.08

VIF=Variance inflation factor.

Table 3.
Standardized Direct, Indirect, and Total Effects of the Hypothetical Model
Endogenous variable Exogenous variable β CR (p) SMC Standardized direct effect Standardized indirect effect Standardized total effect
Conflict management styles Bullying experience .66 5.24 (<.001) .43 .66 (.006)
Psychological empowerment Bullying experience −.46 −5.26 (<.001) .21 −.46 (.008)
Psychological well-being Bullying experience −.01 −.05 (.957) .93 −.01 (.983) −.69 (.025) −.68 (.009)
Conflict management styles −.80 −3.49 (<.001) −.80 (.034) −.80 (.034)
Psychological empowerment .36 4.73 (<.001) .36 (.009) .36 (.009)

β=Standardized regression weight; CR=Critical ratio; SMC=Squared multiple correlation (R2).

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