Stifled Learning: Nursing Students' Experience of Incivility in Clinical Education

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.

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.

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.

Relationships among stress, resilience, and incivility in undergraduate nursing students and faculty during the COVID-19 pandemic: Policy implications for nurse leaders

BACKGROUND

Developing successful targeted interventions to reduce incivility for undergraduate nursing students and educators will require understanding the differences in their unique experiences. Although resilience may act as protective buffer against stressors, little is known about the relationships between stress, resilience, and perceptions of the frequency of incivility in the academic environment.

PURPOSE

The purpose of this study was to compare relationships among and differences between perceptions of incivility frequency and self-reported stress and resilience levels in undergraduate nursing students and faculty during the COVID-19 pandemic.

METHOD

A comparative descriptive and correlational research design was utilized. An online survey was used to collect data from undergraduate nursing students and faculty (n = 710) at one public university.

RESULTS

Students were significantly more stressed and less resilient than faculty. Faculty reported significantly greater low and high-level student and low-level faculty incivility behaviors than students.

CONCLUSION

Understanding student and faculty perceptions of uncivil behavior frequency occurring at the intersection of high stress and moderate resilience levels is key to the creation of targeted interventions and policy development.

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.