Bullying, and its effects on self-esteem, are perpetuated by practices within nursing. This situation will only be changed if nurses and educators transform their practice and the context in which bullying occurs. Otherwise, each new generation of nurses will continue to be socialized into negative practices which undermine both their own feelings of self-worth and standards of nursing care.

Knowledge of the problems stoma patients can experience can help nurses plan care in an individualized way. Recommendations for nursing practice and future research are made.

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This article is based on a literature review carried out as part of a study of communication skills training in pre-registration nursing education in England in 2000. A systematic literature search was conducted and 200 articles were found that were relevant to the study. Definitional problems were found, with terms such as communication skills and interpersonal skills being used interchangeably. The term communications strategies is suggested to overcome these problems, as it reflects the logical organization of a number of different communication skills within a theoretical or empirical framework. Problems in current communication skills teaching and social barriers to using communication skills in practice are discussed. It is concluded that problems continue to exist in these areas and that an emphasis on both aspects is needed if patient and staff satisfaction is to be improved.