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Freedman B, Li WW, Liang Z, Hartin P, Biedermann N. The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38515008 DOI: 10.1111/jan.16111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/15/2023] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
AIM Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety. METHODS A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies. DATA SOURCES Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023. RESULTS The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety. CONCLUSION Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility. REPORTING METHOD This report adheres to PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.
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Affiliation(s)
- Benjamin Freedman
- James Cook University, Townsville, Queensland, Australia
- Townsville University Hospital, Douglas, Townsville, Australia
| | - Wendy Wen Li
- James Cook University, Townsville, Queensland, Australia
| | - Zhanming Liang
- James Cook University, Townsville, Queensland, Australia
| | - Peter Hartin
- James Cook University, Townsville, Queensland, Australia
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Peng X. Advancing Workplace Civility: a systematic review and meta-analysis of definitions, measurements, and associated factors. Front Psychol 2023; 14:1277188. [PMID: 38023015 PMCID: PMC10666190 DOI: 10.3389/fpsyg.2023.1277188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
This research article focuses on the significance of Workplace Civility, defined as the respectful and courteous behavior exhibited by individuals toward their colleagues in the workplace. The primary objective of this study is to conduct a systematic review and a meta-analysis that synthesizes existing research by: (1) identifying operational definitions of the construct, (2) underlying the strongest correlations with other variables, (3) summarizing the effective strategies for promoting Workplace Civility, and (4) highlighting gaps in the literature, using the theory-characteristics-context-methodology (TCCM) framework. Multiple databases were meticulously searched, yielding 691 results, and ultimately 51 documents were included in the systematic review final sample following the application of predefined exclusion criteria. Then, a meta-analysis has been conducted including those studies with sufficient statistical data (k = 24) which allowed us to calculate 45 Effect Sizes. The review findings expose a notable dearth of research on Workplace Civility when compared to studies on incivility. This dearth highlights the pressing need for additional research endeavors to precisely define Workplace Civility, establish a robust theoretical framework, and develop reliable scales for its measurement. Related to the desirable correlates, organizational commitment, job satisfaction and mental health showed a high ES value, and for undesirable correlates, intention to quit showed a high ES value, while Emotional exhaustion only reached a medium ES value and physical symptoms showed a low ES value. Importantly, this study emphasizes that fostering civility in the workplace can yield significant benefits such as improved physical and mental well-being for workers, reduced burnout, and absenteeism rates. Thus, the promotion of civility in the workplace not only leads to healthier organizations but also enhances cost-efficiency, effectively averting the loss of both human and economic capital.
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Affiliation(s)
- Xue Peng
- School of Marxism, Shandong Normal University, Jinan, China
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McCullough LB, Coverdale J, Chervenak FA. Professional virtue of civility and the responsibilities of medical educators and academic leaders. JOURNAL OF MEDICAL ETHICS 2023; 49:674-678. [PMID: 36889908 PMCID: PMC10579492 DOI: 10.1136/jme-2022-108735] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/25/2023] [Indexed: 05/20/2023]
Abstract
Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical concepts, to meet these goals. The professional virtue of civility and the related concept of professional etiquette was first described by the English physician-ethicist Thomas Percival (1740-1804). Based on a historically informed philosophical account, we propose that the professional virtue of civility has cognitive, affective, behavioural and social components based on a commitment to excellence in scientific and clinical reasoning. Its practice prevents a dysfunctional organisational culture of incivility and sustains a civility-based organisational culture of professionalism. Medical educators and academic leaders are in a pivotal and powerful position to role model, promote and inculcate the professional virtue of civility as essential to an organisational culture of professionalism. Academic leaders should hold medical educators accountable for discharge of this indispensable professional responsibility.
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Affiliation(s)
- Laurence B McCullough
- Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, and Lenox Hill Hospital, New York, New York, USA
| | - John Coverdale
- Menninger Department of Psychiatry and Behavioral Sciences and Center for Ethics, Baylor College of Medicine, Houston, Texas, USA
| | - Frank A Chervenak
- Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, and Lenox Hill Hospital, New York, New York, USA
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Zhang C, Liu L. The Influence of Health-Promoting Leadership on Employees' Positive Workplace Outcomes: The Mediating Role of Employability and the Moderating Role of Workplace Civility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15300. [PMID: 36430021 PMCID: PMC9690448 DOI: 10.3390/ijerph192215300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has severely accelerated the transformation and rapid organisational change in the workplace. The impact of the COVID-19 pandemic on the hotel industry will not fade in a short time, and the long-term coexistence with the COVID-19 pandemic pressure is a real dilemma for the hotel industry. The topic of How to create employee positive workplace outcomes (task performance and innovative work behaviour) during the COVID-19 pandemic has garnered increasing interest in both practical and academic fields. Leaders play a critical role in influencing employee workplace outcomes, yet few studies have explored the predicting role of health-promoting leadership. Drawing upon the conservation of resources (COR) theory, this study aims to examine the employability mediator effect and workplace civility as the moderator effect in the relationship between health-promoting leadership and employee-positive workplace outcomes (task performance and innovative work behaviour). We conducted a two-wave survey of 421 participants from the hotel industry in China and formulated a series of hypotheses that were tested with structural equation modelling. The results showed that health-promoting leadership has a significant positive effect on employees' employability (β = 0.479, p < 0.001), task performance (β = 0.250, p < 0.001), and innovative work behaviour (β = 0.446, p < 0.001). Employability has a significant positive effect on task performance (β = 0.438, p < 0.001) and innovative work behaviour (β = 0.296, p < 0.001). This study makes certain contributions to the extant hotel industry employees' positive workplace outcomes literature by attending to the healthy leadership styles that promote employability during the COVID-19 pandemic, and its novel point is to evaluate the workplace civility moderating effect between the above model. It also provides practical insight that mutual transformation in workplace relationships inspire those positive outcomes.
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Hossny EK, Morsy SM, Ahmed AM, Saleh MSM, Alenezi A, Sorour MS. Management of the COVID-19 pandemic: challenges, practices, and organizational support. BMC Nurs 2022; 21:196. [PMID: 35869492 PMCID: PMC9306231 DOI: 10.1186/s12912-022-00972-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/06/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Health organizations currently face tremendous challenges in the management of the COVID-19 pandemic. To do this, successful and proven scientific practices and support are needed. AIM This study aimed to explore the challenges, practices, and organizational support dealt with by nursing managers in the management of the COVID-19 pandemic. METHOD A qualitative content analysis study evaluated 35 nursing managers in five university hospitals through a semi-structured interview. The Consolidated Criteria for Reporting Qualitative Research were used for this qualitative study. RESULTS Three main themes emerged: Challenges include the development of a COVID-19 crisis management plan, a shortage in nursing staff, and psychological problems. Practices include; changes in work schedules for nursing staff, the exchange process, hospital preparation, and training and education. And organizational support includes both support at an organizational level and support at an individual level. CONCLUSION This study revealed that nursing managers are faced with many challenges in the management of COVID-19, requiring good practices and organizational support. This study offers evidence for nursing managers to expect problems that may arise during the pandemic. RECOMMENDATIONS The COVID-19 pandemic requires the development of an integrated plan, and this plan must be disseminated to the hospital's nursing and medical teams to better equip them for the current and future crises.
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Affiliation(s)
- Eman Kamel Hossny
- grid.252487.e0000 0000 8632 679XNursing Administration, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Sahar Mohamed Morsy
- grid.252487.e0000 0000 8632 679XNursing Administration, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Asmaa Mohamed Ahmed
- grid.412707.70000 0004 0621 7833Nursing Administration, Faculty of Nursing, South Valley University, Qena, Egypt
| | - Manal Saleh Moustafa Saleh
- grid.31451.320000 0001 2158 2757Nursing Administration, Faculty of Nursing, Zagazig University, Sharkia, Egypt ,grid.449644.f0000 0004 0441 5692Nursing Department, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - Atallah Alenezi
- grid.449644.f0000 0004 0441 5692Nursing Department, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - Marwa Samir Sorour
- grid.412258.80000 0000 9477 7793Nursing Administration, Faculty of Nursing, Tanta University, Tanta, Egypt
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Asghari F, Shahvari Z, Ebadi A, Alipour F, Samadi S, Bahreini M, Amini H. Developing and validating an instrument to measure: the medical professionalism climate in clinical settings. J Med Ethics Hist Med 2021; 14:11. [PMID: 35035799 PMCID: PMC8696557 DOI: 10.18502/jmehm.v14i11.7666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022] Open
Abstract
This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach's alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of "personal behavior", "collegiality" and "respect for patient autonomy" in a 25-item questionnaire for service providers and a single factor of "professional behavior" in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers' questionnaire and the single factor explained 63.9% of the variance for patients' questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.
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Affiliation(s)
- Fariba Asghari
- Professor,Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Shahvari
- AssistantProfessor,School of Nursing and Midwifery, Islamic Azad University of Ghachsaran, Ghachsaran, Iran.
| | - Abbas Ebadi
- Professor, Behavioral Sciences Research Center, Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Fateme Alipour
- Associate Professor, Eye Research Center, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shahram Samadi
- Associate Professor, Department of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Bahreini
- Associate Professor, Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Homayoun Amini
- Professor, Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Sawada U, Shimazu A, Kawakami N, Miyamoto Y, Speigel L, Leiter MP. The Effects of the Civility, Respect, and Engagement in the Workplace (CREW) Program on Social Climate and Work Engagement in a Psychiatric Ward in Japan: A Pilot Study. NURSING REPORTS 2021; 11:320-330. [PMID: 34968209 PMCID: PMC8608135 DOI: 10.3390/nursrep11020031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Good social climate and high work engagement are important factors affecting outcomes in healthcare settings. This study observed the effects of a program called Civility, Respect, and Engagement in the Workplace (CREW) on social climate and staff work engagement in a psychiatric ward of a Japanese hospital. Methods: The program comprised 18 sessions installed over six months, with each session lasting 30-min. Participation in the program was recommended to all staff members at the ward, including nurses, medical doctors, and others, but it was not mandatory. A serial cross-sectional study collected data at four time-points. Nurses (n = 17 to 22), medical doctors (n = 9 to 13), and others (n = 6 to 10) participated in each survey. The analysis of variance was used to evaluate the changes in the following dependent variables, the Essen climate evaluation schema (EssenCES), the CREW civility scale, and the Utrecht work engagement scale (UWES) over time. Result: We found no significant effects. The effect size (Cohen’s d) for EssenCES was 0.35 from baseline to post-installation for all staff members. Effect sizes for EssenCES for medical doctors and UWES for nurses were 0.79 and 0.56, respectively, from baseline to post-program. Conclusions: Differences in social climate and work engagement among Japanese healthcare workers between the baseline and post-installation of the CREW program were non-significant.
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Affiliation(s)
- Utako Sawada
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
- Correspondence: ; Tel.: +81-3-5841-3364
| | - Akihito Shimazu
- Faculty of Policy Management, Keio University, 5322 Endo, Fujisawa, Kanagawa 252-0882, Japan;
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Lisa Speigel
- Technology Services, Beveridge Arts Centre, Acadia University, Wolfville, NS B4P 2R6, Canada;
| | - Michael P. Leiter
- School of Psychology, Deakin University, Geelong 3217, Australia;
- Psychology Department, Acadia University, Wolfville, NS B4P 2R6, Canada
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