Incivility experiences in clinical practicum education among nursing students

Experiences of bullying among nursing students during clinical practice: a scoping review of qualitative studies

Bullying in the clinical setting has become a significant issue for nursing students. The experience of bullying during clinical practice can negatively affect students' mental and physical health, as well as their professional development. Nursing students are often targets of verbal abuse, intimidation, and discrimination from various individuals in the clinical environment. This behavior not only harms individual students but also affects the quality of patient care. The aim of this study is to provide a deeper understanding of the phenomenon of bullying toward nursing students, identify research gaps, and offer recommendations for future research. This study employed a scoping review method, with articles sourced from four major databases: CINAHL, PubMed, Scopus, and Web of Science. The main keywords used included "bullying," "nursing students," "clinical practice," and "verbal violence." Inclusion criteria were studies with nurse participants, original research articles, and published within the last 10 years (2015-2024). Data were manually extracted using tables and analyzed through a qualitative descriptive approach. Eleven articles met the inclusion criteria. This scoping review focuses on the findings of an exploration of the experiences of bullying experienced by nursing students, identifies research gaps, and provides suggestions for future research. Findings showed that nursing students experience various forms of bullying, including verbal violence and intimidation, often triggered by power imbalances in interactions with clinical staff and mentors. The impact of bullying is not only detrimental to students' mental health, but also affects their academic performance and quality of learning. Research gaps found include a lack of studies on the direct relationship between bullying and clinical assessment outcomes, as well as a lack of understanding of effective strategies to address bullying. This study recommends the need for clearer anti-bullying policies and transparent reporting systems, as well as further research to explore the impact of bullying in the context of nursing culture and education system.

The effects of incivility on student nurses in the clinical setting: A grounded theory approach

AIM

To use a grounded theory approach to explore and understand the encounters of undergraduate nursing students with incivility in the clinical setting so that data-informed strategies for addressing this counterproductive behavior could be developed.

BACKGROUND

Nurses are being called upon to fill ever-increasing responsibilities associated with expanding roles in different specialties within healthcare. One issue that has developed in this high-pressure environment is an increase in incivility in the workplace that spills over into the clinical training environment. As a pervasive problem in the healthcare system, its effects on nursing students could compound the nursing shortage by undermining the integrity of nursing education and discouraging individuals from entering the profession. Therefore, it is vital to construct new theories regarding incivility so that this unprofessional practice can be eradicated or reduced. When this is done, there may be a renewed hope for new nursing students to practice their clinical rotations without feeling disrespected, undermined and intimidated. Students should be able to complete clinical rotations without these unnecessary barriers.

DESIGN

Qualitative grounded theory using philosophical underpinnings of symbolic interactionism and pragmatism.

METHODS

A classical grounded theory approach focusing on the Glaserian Model was used to develop an inductively derived theory from the data. Participants were interviewed about their encounters with incivility and then open coding was used to identify recurring concerns on which a model of the effect of these occurrences could be established. The study sample consisted of 32 participants of which 25 were undergraduate nursing students and seven were graduate students who participated in a focus group. Data were collected through face-to-face (in-person and virtual) structured interviews that were audiotaped. These individuals were recruited by flyers posted at varying strategic points on university campuses.

RESULTS

Open coding of student responses revealed three significant areas of concern: feelings of being disrespected, intimidated and undermined, from which the Inhibiting Actions Theory emerged.

CONCLUSION

Nursing students' perceptions of incivility and their attitudes and behaviors toward this occurrence culminated in the Inhibiting Actions Theory, which provides a framework for implementing effective policies and personnel training in clinical settings. The hope is that these research findings will be a call to action for introducing systemic changes in the clinical training environment, thereby improving the clinical experiences of nursing students and patients.

Building Confidence, Diminishing Stress: A Clinical Incivility Management Initiative for Nursing Students

OBJECTIVE

The aim of this study was to evaluate the effectiveness of an interactive program designed to reduce nursing students' perceived stress and improve self-efficacy and readiness to professionally address incivility during clinical practice.

BACKGROUND

Incivility in clinical settings adversely impacts learners, educators, institutions, and healthcare systems, undermining safety and the teaching-learning process. Despite its increasing global prevalence, effective interventions remain largely unexplored.

METHODS

Our mixed-methods study, conducted from March to April 2024, involved senior baccalaureate pre-licensure nursing students (N = 35) from a California State University. The three-week, one-hour-per-week, interactive clinical incivility management program was developed through an extensive literature review. Pre- and post-intervention differences were assessed using a 10 min self-administered online survey that included the Uncivil Behavior in Clinical Nursing Education (UBCNE; 12 items), Perceived Stress Scale (PSS; 10 items), General Self-Efficacy Scale (GSE; 10 items), and a sample characteristics questionnaire (11 items). A one-hour face-to-face focus group (n = 11) then provided qualitative data on personal experiences of clinical incivility. Quantitative data were analyzed using SPSS version 27, while qualitative data were analyzed using Colaizzi's method.

RESULTS

Clinical incivility prevalence was 71.4% (n = 25 out of 35). No statistically significant differences were found in UBCNE, PSS, and GSE scores between pre- and post-intervention. However, professional responses to clinical incivility significantly improved after the intervention (t = -12.907, p < 0.001). Four themes emerged from the qualitative data: (a) uncivil behaviors or language from nurses, (b) emotional discouragement and low self-confidence, (c) resource and personnel shortages at clinical sites for education, and (d) the necessity for interventions to manage clinical incivility.

CONCLUSIONS

Nursing schools and clinical agencies should collaborate to establish monitoring systems, enhance communication, and implement evidence-based policies and interactive interventions to prevent and manage clinical incivility experienced by nursing students from clinical sites.

Incivility in Nursing Education: A Concept Analysis

Background

Incivility in nursing education is a complex concept that is not exactly defined in nursing. The purpose of this study was to clarify the concept of incivility in nursing education in the Iranian cultural context.

Materials and Methods

Concept analysis was performed based on hybrid model in three steps. In the theoretical phase, a review of studies was conducted from 2000 to 2020. During the fieldwork, 7 nursing faculty members and 9 nursing students were interviewed. The third phase included the comparison of the themes that were extracted from the two previous phases.

Results

From the 1250 titles, 45 articles were analyzed. Review of literature showed that incivility has several attributes: unconventional communication, irresponsible and disrespectful behavior. The fieldwork phase added unmanaged behavior and being contrary to academic goal.

Conclusions

Defining the concept of incivility in nursing education refers to an unconventional, disrespectful, unmanaged behavior that is contrary to the academic goal of nursing education and results from individual differences, stress, improper application of technology, and inappropriate role models which, by creating an unsafe learning condition leads to harming the individual, organization and profession. Here, this study provides a comprehensive understanding of the incivility in nursing education that can be used in instrumentation, model building, and development of theory.

Preparedness for a first clinical placement in nursing: a descriptive qualitative study

BACKGROUND

A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students' perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students' emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience.

METHODS

The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically.

RESULTS

Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants' feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students' expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers.

CONCLUSIONS

This unique study of first-year postgraduate entry-to-practice nursing students' perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students' narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Global prevalence of bullying and associated factors among nursing students during clinical practice: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis aims to estimate the global prevalence of bullying among nursing students during clinical practice and identify associated factors.

DESIGN

Systematic review and meta-analysis.

REVIEW METHODS AND DATA SOURCES

We conducted a comprehensive literature search across ten databases (PubMed, Cochrane, Web of Science, Embase, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG) from their inception to January 3, 2023. Two researchers independently screened potentially eligible studies, extracted data, and assessed study quality. Data were analyzed using random-effects or fixed-effects models. Subgroup analyses and meta-regression explored the influence of participant and study characteristics on bullying prevalence. Publication bias and sensitivity analyses were also performed.

RESULTS

We included 28 studies (N = 9511) from 13 countries on five continents. The pooled estimate of bullying prevalence among nursing students during clinical practice was 65.60 % (95 % CI 55. 75 to 74.27), with no evidence of publication bias (t = 1.51, p-value = 0.14). Subgroup and moderator analyses highlighted the impact of country, continent, publication year, and assessment tool on bullying prevalence.

CONCLUSION

Nursing students face a high prevalence of bullying during clinical practice. Addressing this issue in nursing education requires prioritizing associated factors, fostering a culture of safety, providing effective training, and promoting individual resilience. These actions can prevent and mitigate bullying, creating a supportive and empowering learning environment for future nurses.

A Clinical Incivility Management Module for Nursing Students: A Quasi-Experimental Study

BACKGROUND

Incivility experienced by pre-licensure nursing students in clinical settings continues to grow. Interventions for clinical incivility to nursing students are needed. Our study aimed to examine the effects of a piloted two-hour interactive incivility management module on nursing students' perceived stress and general self-efficacy levels and preparedness for responding professionally to clinical incivility.

METHODS

A quasi-experimental post-test-only non-equivalent comparison design with control and experimental groups was used. Senior nursing students enrolled in a Bachelor of Science in Nursing program from a nursing college located in Seoul, South Korea, were recruited. The control group (n = 94) completed a self-administered online survey without the clinical incivility management module. The experimental group (n = 93) completed the same survey after receiving the clinical incivility management module. The two groups' survey data were compared; qualitative data from the experimental group's post-module debriefing session were also analyzed.

RESULTS

The prevalence of reported clinical incivility was 72.73% (n = 137 out of 187 participants). Clinical incivility experienced by the experimental group was significantly lower than that of the control group (z = -4.865, p < 0.001). However, there was no significant difference in stress levels and self-efficacy between the two groups. The mean score of the experimental group on preparedness for responding professionally to clinical incivility was statistically higher than the control group's mean score (z = -2.850, p = 0.004).

CONCLUSIONS

Interventions to prepare students for the experience of clinical incivility are useful; they can positively affect the students' ability to respond professionally.

Nursing students' rights in clinical practice in South Korea: a hybrid concept-analysis study

PURPOSE

This study aimed to derive a conceptual definition and attributes for nursing students' rights in clinical practice in South Korea.

METHODS

This concept-analysis study was conducted at a nursing school in South Korea. The participants were recruited using purposive sampling. The inclusion criteria were being a fourth-year nursing student and having two or more semesters of practical experience. The hybrid model used in this study had three stages. First, 12 studies were reviewed during the theoretical stage. Second, 10 in-depth interviews were conducted during the fieldwork stage. Third, in the analytical stage, the concept of nursing students' rights related to clinical practice was defined and the attributes were derived.

RESULTS

The analysis established five attributes of nursing students' rights: the right to learn, the right to be protected from infections and accidents, the right to be cared for and supported, the right to be respected, and the right to be recognized as a member of a nursing team. A key theme that emerged from this study was having the right to learn in a safe and supportive environment.

CONCLUSION

It is necessary to develop a measurement tool based on the above five attributes and to verify its effectiveness.

Online prelicensure nursing students' experiences of academic incivility during COVID-19: A qualitative inquiry

AIM

The aim of this study was to describe online prelicensure nursing students' experiences of incivility during COVID-19.

DESIGN

Qualitative descriptive. Five optional open-ended questions were presented to nursing students to share their experiences with incivility during the pandemic.

METHODS

Data were collected from September to October 2020 as a part of a larger multimethod study on stress, resilience and incivility with nursing students and faculty (n = 710) from a large public undergraduate nursing programme in the southwestern United States. Out of the initial 675 students who completed the survey, 260 individuals responded to three or more of the open-ended questions which were reviewed and coded using reflexive thematic analysis.

RESULTS

Thirteen themes were organized into four analytical categories: (1) experiencing incivility, (2) causes and consequences of incivility, (3) the pandemic and academic incivility and (4) promoting civility in the academic setting.

CONCLUSIONS

Prelicensure nursing students perceived unrealistic expectations, a lack of awareness and miscommunication hindered academic performance, as well as, created feelings of stress, discouragement and inadequacy.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Fostering academic civility during virtual educational experiences may require training in proper coping strategies when challenged with incivility.

IMPACT

As the body of research emerges concerning the effects of COVID-19 and undergraduate nursing education, understanding prelicensure students' experiences of academic incivility could prove to be beneficial to designing strategies co-created with students to promote positive educational outcomes. Understanding students' viewpoints of uncivil experiences revealed prioritizing civility awareness is essential in creating healthy academic environments, improving clinical performance and providing safe patient care.

REPORTING METHOD

The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was used.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review

AIMS

To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS.

BACKGROUND

WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser.

METHODS

A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings.

RESULTS

A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: 'Types of workplace violence', 'Perpetrators', 'Causes', 'Consequences' and 'Management of workplace violence'.

CONCLUSIONS

This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement.

RELATIVE TO CLINICAL PRACTICE

This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.

Nursing students' experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey

AIMS

To assess the reported prevalence of unprofessional behaviours, including incivility and bullying, experienced by nursing students during their clinical practice. To assess the prevalence of students' abilities to speak up about unprofessional behaviours encountered and infection control concerns; their compliance with standard precautions and COVID-19 guidelines; and their perceived responsibility for infection prevention. Lastly, to describe the potential impact of unprofessional behaviour on compliance with these guidelines.

BACKGROUND

Unprofessional behaviours in healthcare settings are associated with a wide range of individual and organisational negative outcomes for nurses and nursing students, which may affect patient safety. The COVID-19 pandemic created new challenges for clinical education and for infection control.

DESIGN

A descriptive cross-sectional design.

METHODS

A multi-centre survey was carried out in six academic universities and colleges in Israel. The research study involved 369 undergraduate nursing students during 2022. Their clinical experiences were assessed using an online questionnaire. The STROBE guideline was used for accurate reporting.

RESULTS

301 (81.6%) students reported experience of unprofessional behaviour while undertaking clinical practice. Students with reported skills to speak up about unprofessional behaviour were less likely to report having experienced these behaviours (p = 0.003). Students who did not experience unprofessional behaviours were more likely to report higher compliance with standard and COVID-19 precaution guidelines (OR 3.624, 95% CI 1.790-7.335, p < 0.001). These students also had a higher perception of personal responsibility toward patient safety (OR 1.757, 95% CI 1.215-2.541, p = 0.003).

CONCLUSIONS

Nursing students experiencing unprofessional behaviours in the clinical setting reported lower compliance with standard and COVID-19 precautions. In addition, cultivating personal responsibility towards patients' safety may have a positive impact on guidelines compliance. Nursing educators and leaders should develop strategies to enable students to better cope with unprofessional behaviours. Closer cooperation between all stakeholders may promote civility among nurses and nursing students in the clinical setting.

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

Positive and negative aspects of psychological stress in clinical education in nursing: A scoping review

BACKGROUND

Even though clinical practice is crucial for nursing students' personal and professional development, it is recurrently associated with stress. However, stressful situations may not only elicit negative responses, but positive responses as well, and such aspects should be further investigated.

AIM

To explore the literature addressing the positive and negative aspects of stress experienced by nursing students during clinical practicum.

DESIGN

This scoping review followed the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines.

DATA SOURCES

CINAHL, MEDLINE/PubMed, PsycINFO, Web of Science, IBECS, LILACS, BDENF and two theses and dissertations repositories.

REVIEW METHODS

Searches were conducted from June to August 2022. Studies addressing the positive and negative aspects of stress experienced by nursing students during clinical practice were included regardless of the method adopted.

RESULTS

This review included 32 studies published between 1999 and 2022 in 25 countries across four continents: Africa, America, Asia, and Europe. Stress can positively influence academic performance, especially in mobilizing a search for learning and professional development and in integrating theoretical knowledge and improving clinical skills and competencies. Negatively, stress can cause biopsychosocial symptoms that compromise a student's academic performance and can cause doubts and uncertainties about the construction of their professional identity.

CONCLUSIONS

Although the negative aspects stand out over the positive ones, it is evident that both are present in the clinical practice environment. When considering stress of nursing students, educators should conduct the teaching-learning process in order to reduce the negative impact and promote the positive side of stressful situations.

DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE SENSE OF BELONGING IN NURSING SCHOOL SCALE

Background and Purpose: While sense of belonging is essential for human motivation, impaired belonging among nurses can impact the care and safety of patients. This article reports the development and psychometric testing of the Sense of Belonging in Nursing School (SBNS) scale to assess nursing students' sense of belonging in three different environments: Clinical, classroom, and among the student cohort. Method: Principal component exploratory factor analysis with varimax rotation was used to determine the construct validity on the 36-item SBNS scale with a sample of 110 undergraduate nursing students. Cronbach's alpha was used to determine the scale's internal consistency. Results: The scale was reduced to 19-items with high internal consistency (α = 0.914). Principal component analysis then identified four factors (sub-scales) with high internal consistency: Clinical staff (α = 0.904), clinical instructor (α = 0.926), classroom (α = 0.902), and classmates/cohort (α = 0.952). Conclusion: The SBNS scale is a reliable and valid tool to measure sense of belonging across three environments among nursing students. Further research is needed to determine the scale's predictive validity.

Nursing students' experience of incivility behaviours and its correlation with their nursing professional values: A cross-sectional descriptive study

AIMS

The purpose of this study was to determine the relationship between experienced incivility behaviours and professional values in the clinical setting and also the factors influencing incivility and professional values.

DESIGN

Cross-sectional descriptive study.

METHODS

Data gathering tools used in the study includes demographic characteristics, incivility behaviour and nursing professional values. Data were analysed using IBM SPSS version 21.

RESULTS

The findings showed that incivility behaviours had a statistically significant negative correlation with professional values (r = -.150, p = .003), so that the level of incivility behaviours experienced by students was low (1.76 out of 5). This was while the level of professional values was moderate to high among students (3.72 out of 5). Due to the negative and statistically significant correlation between incivility behaviours experienced by students and nursing professional values, it is necessary that the officials of teaching hospitals inform nurses about incivility behaviours. Considering the negative and statistically significant correlation, it can be concluded that the reduction in nurses' incivility behaviours as patterns of the nursing profession causes nursing students to better acquire and internalize nursing professional values in the clinical setting. Nurse educators should also try to communicate with nursing administrators to exchange information about nurses' civil and incivility behaviours perceived by students.

The Influence of Reducing Clinical Practicum Anxiety on Nursing Professional Employment in Nursing Students with Low Emotional Stability

Nursing students experience anxiety during clinical practicum, which may interfere with their learning in clinical practice and nursing employment after graduation. This study explored: (1) the factors of the difference in anxiety levels between pre- and post-practicum in nursing students; (2) identified their anxiety events in a clinical environment; and (3) the correlation between emotional stability and 5-year nursing professional employment. The study was designed as a mixed method. A longitudinal secondary analysis method and a qualitative approach with open questionnaire were conducted. The emotional stability subscale of Lai’s Personality Inventory and the Beck Anxiety Inventory, as well as open questionnaires were administered. Research data were collected through the purposive sampling of 237 nursing students (mean age was 20.96, SD = 1.29) of 4.2% male and 95.8% female in a central Taiwan hospital in 2013, and the participants were followed up in 2021 to show 70% in clinical service. Most of the nursing students exhibited significantly decreased anxiety levels in the post-practicum period. Compared to nursing students with high emotional stability, those with low emotional stability exhibited higher differences in their anxiety levels between the pre- and post-practicum periods. Low emotional stability is critical in a pre-practicum BAI score. However, the high pre-practicum BAI score would decrease to normal range after enrolling to practicum setting. So, as to their 5-year nursing professional employment after graduation. Teachers foster a positive learning atmosphere that emphasizes the importance of “we are family” to students. Teachers and advisors need to make efforts in leading the low emotional stability nursing students to learn effective coping and adapting strategies in clinical practicum.

Incivility in practice - incidence and experiences of nursing students in eastern Canada: A descriptive quantitative study

BACKGROUND

Incivility within nursing is professionally unacceptable. Little research exists regarding student nurses' experiences with incivility from healthcare professionals and others within the clinical environment and particularly within a Canadian context.

AIM

To describe the incidence and perceptions of incivility experienced by undergraduate nursing students from healthcare professionals and others within clinical practice.

METHOD

This descriptive study used an electronic survey and was conducted at an eastern Canadian university. Descriptive statistics were applied.

RESULTS

Of 650 nursing students invited to participate in the study, 260 surveys were fully completed. Of these, 70% of respondents indicated experiencing incivility, mostly in acute care settings. Registered nurses and licensed practical nurses were the major offenders. Discourteous gestures and condescending remarks were the most frequently experienced uncivil acts, resulting in feelings of high anxiety and inadequacy. Participants coped by avoiding communication with the perpetrator. Incivility was rarely reported because of a belief it would be fruitless to do so, lack of awareness of policies and fear of retaliation.

CONCLUSIONS

Nursing students experience incivility frequently in clinical practice with serious consequences. Recommendations arising from this study encourage educators and healthcare leaders to collaborate to review, implement and evaluate curricula, policies and processes to address incivility.

Cross-sectional Study of the Relationship between Experiences of Incivility from Staff Nurses and Undergraduate Nursing Students’ Sense of Belonging to the Nursing Profession

AIM

This study examined the frequency of incivility for undergraduate nursing students and the relationship between staff nurse incivility and nursing students' sense of belonging. Factors between program semester and students' body mass index (BMI) to staff nurse incivility and students' sense of belonging were assessed.

BACKGROUND

Sense of belonging enhances belonging development to the profession. However, no studies address the relationship between incivility and nursing students' sense of belonging.

METHODS

A cross-sectional design assessed the relationship between staff nurse incivility and undergraduate nursing students' sense of belonging to the nursing profession. An online survey was administered to 123 pre-licensure junior and senior undergraduate nursing students from February 1, 2021, to May 5, 2021. Correlation coefficient, descriptive statistics, Fisher r-to-z transformation, 95% confidence intervals were calculated.

RESULTS

Staff nurse incivility inversely correlated with undergraduate nursing students' sense of belonging (rs=-.358; p <.001). American Indian or Alaskan Native students reported the highest mean frequency of incivility (1.25 ± .421). There were no significant differences in correlations based on semester or BMI.

CONCLUSION

Staff nurse incivility is inversely associated with sense of belonging in students. Further research is needed to test interventions mitigating the effects of incivility on belonging.

Bullying in the clinical setting: Lived experiences of nursing students in the Central Region of Ghana

INTRODUCTION

Nursing students are confronted with bullies in the classroom and during clinical placement. Acquisition of the necessary psychomotor skills intended during clinical placements may be impeded when workplace bullies intimidate students. This study aimed to describe the various bullying behaviours experienced by nursing students and their effects during clinical placement in the Central Region of Ghana.

METHODS

A qualitative phenomenological descriptive approach using a semi-structured interview guide was employed to collect data from nursing students in focus groups. Overall, six (6) focus groups were used, with five (5) students in each group comprising males and females. The sample size was based on data saturation and was saturated on the six focus group discussions giving a sample size of 30. Purposive sampling was used to select students who had been on the ward at least three clinical placements and had experienced bullying in the clinical setting. In-depth interviews were conducted, recorded, transcribed verbatim and analysed using content analysis.

RESULTS

The study revealed that nursing students had experienced bullying practices such as shouting, isolation, humiliation and being assigned tasks below their competency level. In addition, findings showed that bullying led to a loss of confidence and caused stress and anxiety in nursing students.

CONCLUSION

Therefore, it is recommended that nursing students are mentored holistically in a caring and accepting environment where they will be supported to achieve their learning goals, build their confidence, and develop their personal and professional identity.

Promoting a Culture of Civility in Nursing Learning Environments

BACKGROUND

Incivility in nursing education imperils the well-being of both faculty and students, is damaging to professional relationships, and hinders the exchange of knowledge in nursing learning environments. Because supportive, respectful learning environments foster students' ability to flourish and reach their highest potential, it is essential that open dialogue and relationship building in nursing education are as valued as content taught.

PURPOSE

This study explored strategies for promoting a culture of civility in nursing learning environments.

METHOD

A 9-item survey was used to gather insights from nurses (n = 441) about how incivility could be managed or prevented in order to promote a culture of civility.

RESULTS

The data revealed 2 major themes: personal action, and organization action.

CONCLUSION

Nursing faculty, students, and schools/programs can promote civility in nursing learning environments through establishing a power balance, effective communication, self-reflection, setting clear expectations early, and instituting consequences for violating a culture of civility.

Challenges faced by student nurses and midwives in clinical learning environment - A systematic review and meta-synthesis

OBJECTIVES

This systematic review aimed to offer insight and understanding, through synthesis of findings from studies that report on perspectives of student nurses/midwives, clinical instructors, clinical nurses/midwives on the challenges faced by student nurses/midwives in the clinical learning environment (CLE).

DESIGN

All primary qualitative research studies published in the English language that reported on the views of student nurses/midwives, clinical instructors and clinical nurses/midwives on the challenges faced by student nurses/midwives in the CLE were included.

DATA SOURCES

The electronic databases of Medline EBSCO (1946-), CINAHL (1970), Embase Ovid (1974-), ScielO, WHOLIS (2002-), ASSIA (1985-), Web of Science (1956-), PsycINFO (1800s-) and Maternal and Infant Care (1970-) were searched in November 2019.

REVIEW METHODS

Retrieved papers were reviewed independently by two authors for selection by title, abstract and full text, and two authors agreed for inclusion of the papers. The COREQ criteria checklist was used for assessment of methodological quality of the included studies.

RESULTS

The review included 32 studies published over 22 years between 1997 and 2019 involving 853 nursing/midwifery students, clinical instructors, and clinical nurses/midwives from 14 countries. Three key themes emerged: 'The support structure', 'Personal factors', and 'Planning and organisation - influence of extrinsic factors'.

CONCLUSION

Attitude of clinical staff, instructors, and significant others had a major influence on students' clinical learning. Lack of a sense of belongingness and self-motivation to learn, and perceived fear of doing errors were some of the demotivating factors. Lack of resources to facilitate need-based training, staff shortages, workload and inconsistencies between theory and practice were other key challenges in the CLE. Understanding the challenges faced by students in clinical practice can help overcome the barriers leading to development of competent and confident nurses and midwives.

Clinical stress among undergraduate nursing students: perceptions of clinical nursing faculty

Clinical faculty have a critical role in recognizing the stress students experience in the clinical environment. Despite an increasing body of research on stress and student perceptions of stress, faculty perceptions of student stress have been relatively unexplored. A qualitative descriptive design provided a rich description of clinical nursing faculty perceptions of undergraduate baccalaureate nursing student stress in the clinical environment. Colaizzi's method guided data analysis. Four themes that emerged from the interview data were: feeling overwhelmed when encountering the unknown, which included the sub-themes of facing self-doubt and experiencing insecurity in nursing actions; struggling with personal life factors; enduring uncivil clinical interactions; and contending with nursing faculty interactions. This study assists in filling the gap for nursing education by providing a rich description of student stress as described by faculty. Implications include providing faculty a clearer understanding of the stress phenomenon so they may better educate and evaluate students.

Revisión de la literatura sobre la violencia y sus implicaciones en la formación en enfermería

Introducción: La violencia es un fenómeno social complejo, que se manifiesta en varios sectores de la sociedad contemporánea. Los actos violentos están presentes en los procesos de formación en diferentes áreas del conocimiento, como el pregrado en enfermería. Objetivo: Identificar la forma en que se presenta la violencia en el pregrado de enfermería y las posibles implicaciones para la formación de los estudiantes. Materiales y métodos: Se realizó una revisión integradora en la biblioteca virtual SciELO® , las bases de datos ERIC®, LILACS®, Web of Science®, MEDLINE®, CINAHL®, Scopus®  y Google Académico®, con la que se recuperaron 21 documentos para el período entre 2014 y 2018. Resultados: El análisis permitió organizar los resultados en cuatro categorías: caracterización de estudios y autores; comprensión y naturaleza de la violencia; espacios en los que ocurre la violencia y los principales perpetradores; y las consecuencias generadas por la violencia y las acciones para enfrentar el fenómeno. Discusión: Los actos violentos afectan las condiciones de vida de los involucrados, impactan negativamente el desarrollo de habilidades relacionadas con la interacción interpersonal y generan debilidades en la formación de futuros enfermeros. Conclusiones: La violencia es un fenómeno constante en el contexto del pregrado en enfermería, para lo que es necesario promover el fortalecimiento de una cultura de paz en este entorno. Como citar este artículo: Maffissoni, André Lucas; Sanes, Marina da Silva; Oliveira, Saionara Nunes; Martini, Jussara Gue; Lino, Monica Motta. Violência e suas implicações na formação em enfermagem: revisão da literatura. Revista Cuidarte. 2020; 11(2): e1064. http://dx.doi.org/10.15649/cuidarte.1064

Incivility through the continuum of nursing: A concept analysis

AIM

The aim of this study is to explore the gap between incivility in the workplace and academia and develop a connection to the psychosocial distress effects on the victims.

BACKGROUND

While incivility in nursing has reached epidemic proportions in the past decade, the current definitions of incivility are limited to the workplace or academia and lack consideration of the consequences related to the social well-being of the victim.

DESIGN

Rodgers' evolutionary method was used in this study.

DATA SOURCE

Following the PRISMA guidelines, articles were reviewed from PubMed and CINAHL between 2008 to 2019. Twenty articles describing incivility faced by staff nurses, student nurses, academic faculty, and nursing administrators were included in the final analysis.

REVIEW METHODS

Inductive thematic analysis was used to determine the antecedents, attributes, and consequences of incivility in nursing.

RESULTS

Findings included a culture of incivility and power gradients as antecedents. The attributes of incivility were verbal or non-verbal behaviors that demean, dismiss, or exclude the individual. Consequences of incivility are psychosocial and physiological distress.

CONCLUSION

A broader definition of incivility may be appropriate. Further research is needed to determine interventions to mitigate the effects of incivility.

Incivility in nursing practice education in the operating room

BACKGROUND

Incivility toward nursing students has been identified as a contributor to negative experiences in clinical education and may cause a weakened learning environment, anxiety, depression and workplace violence. However, few data with regard to uncivilized behavior toward nursing students in the operating room are available. The operation room is a special place where the tempo is fast and the risk is high. Nursing students may have to face pressure from different people, such as anesthesiologists, surgeons, clinical instructors, and staff nurses.

OBJECTIVES

To explore uncivilized behavior toward nursing students in the operating room and to discuss the source of uncivilized behavior and the attitude of clinical instructors when it occurs.

METHOD

A total of 215 nursing students in the operating room of the Second XiangYa Hospital from January to December 2018 were investigated. The uncivilized behavior in clinical nursing education tool and self-designed questionnaire were used.

RESULTS

The incivility mean score was (4.6 ± 6.7). In all, 122 (56.7%) participants had experienced various degrees of uncivilized behavior in the operating room. There were significant differences in incivility toward students according to degree of education and age. The most frequent uncivilized behavior toward students was raising of the voice when speaking to students (41.9%), followed by inappropriate tone (36.7%), being embarrassed in front of others (36.3%), and snide remarks (34.4%). Surgeons (59%) were considered as the most important source of uncivil behaviors, followed by staff nurses (46.7%). When students experienced uncivilized behavior, 61.5% clinical instructors defended and comforted them, 23% comforted them privately, 13.1% ignored them, and 2.5% even criticized them together with the uncivil behavior actor.

CONCLUSION

Nursing managers and instructors should pay more attention to the incivility toward students and take actions to foster a healthy, civilized and respectful work environment in the operating room for students.

Proceso de Atención de Enfermería como instrumento del cuidado, significado para estudiantes de último curso

Introducción: El Proceso de Atención de Enfermería (PAE) como guía para el cuidado, se aplica desde que inicia la formación académica. Comprender el significado que tiene para estudiantes del último curso permite visualizar la importancia y dificultades que se presentan en su aplicación, para proponer estrategias que fortalezcan la calidad educativa. Objetivo: Comprender el significado del PAE que tienen los estudiantes del último curso de Enfermería. Método: Estudio con enfoque cualitativo. Referencial teórico y metodológico fue el Interaccionismo Simbólico y la Teoría Fundamentada en los Datos. Muestra por saturación teórica. Colecta de datos con entrevistas semiestructuradas en 17 estudiantes del 10° ciclo de una universidad privada de Lima Este. Análisis de datos basado en la codificación de Strauss y Corbin posibilitó la identificación de categorías y subcategorías, y el fenómeno central. Resultados: Emergieron cinco categorías: 1) Cuidado enfermero utilizando el PAE desde el inicio de su formación (Condición causal); 2) Satisfacción o insatisfacción al dar cuidado con el PAE (Contexto); 3) PAE como herramienta de investigación en formación profesional (Condiciones Intervinientes); 4) Dificultades en la aplicación del PAE en el cotidiano de los profesionales (Estrategias de Acción/ Interacción) y 5) Mejora de la práctica al dar cuidado con PAE (Consecuencias). Conclusiones: El fenómeno central es el PAE, instrumento que guía el cuidado de enfermería para brindar a las personas atención integral y con fundamento en evidencia científica; a partir de la experiencia profesional con una proyección positiva al campo laboral, no exenta de limitaciones en su aplicación en el campo hospitalario.