An Innovative Civility Intervention Created by a Faculty and Student Action Research Team

Effectiveness of Cognitive Rehearsal in Addressing Nursing Incivility: An Integrative Review

BACKGROUND

Incivility is detrimental to nurses, patients, and health care organizations. Cognitive rehearsal has shown promise in addressing incivility, yet the most recent review of cognitive rehearsal training contained articles published in 2014 and earlier. This review integrates current knowledge of the effectiveness of cognitive rehearsal training in addressing nursing incivility.

METHOD

Four databases were searched from January 2018 to April 2023. Thematic analysis was used to analyze 22 studies.

RESULTS

Three main themes emerged: (a) theoretical frameworks, (b) participant responses to cognitive rehearsal training, and (c) work culture influences. Nine theoretical frameworks uncover the mechanism behind nursing incivility and provide guidance on how to remedy it.

CONCLUSION

Cognitive rehearsal training that includes four core components can foster skills and confidence to address nursing incivility and, in turn, decrease its occurrence, but training alone is not sufficient. Nurse managers and leaders need to model civil behavior, support zero tolerance, create a safe environment for reporting incivility, and intervene effectively. [J Contin Educ Nurs. 2024;55(11):523-529.].

The impact of interprofessional incivility on medical performance, service and patient care: a systematic review

The stressful nature of the medical profession is a known trigger for aggression or abuse among healthcare staff. Interprofessional incivility, defined as low-intensity negative interactions with ambiguous or unclear intent to harm, has recently become an occupational concern in healthcare. While incivility in nursing has been widely investigated, its prevalence among physicians and its impact on patient care are poorly understood. This review summarises current understanding of the effects of interprofessional incivility on medical performance, service and patient care. A structured search and screening of literature returned 13 studies of diverse origin, methodology, quality, size and population type. The consensus is that interprofessional incivility is common among physicians and nurses and has both psychological and clinical outcomes, resulting in stress, compromised patient safety and poor quality of care. Junior staff are affected more often than consultants, with higher rates in radiology, general surgery, neurosurgery and cardiology. Incivility also undermines medical team performance, particularly in perioperative settings. In patient care, incivility is associated with complications, medical errors, mortality, and compromised patient safety and quality of care. Patients whose surgeons have a record of incivility can be at higher risk of complications. The impact of incivility on medical performance, service and patient care appears systemic and must be addressed accordingly. This analysis was limited by the methodological weaknesses of the included studies, which highlights the need for more high-quality empirical research. This would benefit the NHS and other stakeholders when designing targeted interventions. In particular, establishing quantitative methods for identifying and measuring incivility will be crucial for improving our understanding of the phenomenon.

A review: Developing an ecological model approach to co-worker incivility experiences of new graduate nurses

AIM

To explore how an ecological approach be used to explore relationships among workplace empowerment, authentic leadership, trust in management, areas of work life and co-worker incivility experiences of new graduate nurses.

DESIGN

Key concepts related to new graduate nurses' incivility experience informed the research question building on the findings of our first author's integrative review. Second, relevant theories and concepts were identified by conducting a literature review. Third, the themes build on prior theories and factors to propose a hypothetical model.

DATA SOURCES

(2016-2019) CINAHL, OVID, PSYCINFO, PUBMED, EBSCO, ERIC, SCOPUS, Cochrane Library; PROQUEST and Google Scholar.

REVIEW METHODS

(a) Constructs identified in an IR (Blackstock et al., 2018) guided a literature review on predictive variables linked to new graduate nurse's co-worker incivility experiences; (b) an ecological approach was explored; and (c) we demonstrate how multidimensional organizational factors related to incivility experiences of new graduate nurses can be situated in an ecological model.

RESULTS

Structural and organizational factors, and nurse leaders influencing new graduate nurses' experiences are situated in an ecological model. Placing new graduate nurses' co-worker incivility experiences in the microsystem and close to the mesosystem (nurse supervisor) and exosystem (workplace empowerment) of our ecological model provides new insights into their incivility experiences and informs future research.

CONCLUSION

The ecological approach and operational definition of incivility help to clarify incivility behaviours as not merely individual behaviours observed by others needing corrective cognitive behaviours, nor support in a graduate transition program, but rather a symptom of work environment factors contributing to multidimensional work environments of new graduate nurses' and influence incivility behaviours.

IMPACT

New graduate nurse co-worker incivility research could measure change across time and across system domains informed by this ecological approach and can shape new ways of thinking about how to prevent and mitigate incivility.

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

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.