Definitions and Issue of Incivility in Nursing - Research Paper

Introduction

Incivility may be described as the lower intensity offensive behavior that bears concealed or apparent intent to harm the victim without the regard for the laid down workplace standards that stipulate the principles of mutually respective behavior. In essence, condescending and disrespectful behavior devalues the targeted individual. Incivility has emerged as a significant problem in healthcare settings as it not only adversely affects the clinicians involved but also the care that is accorded within the trappings of incivility. People who are subjected to instances of incivility as either witnesses or targets may succumb to adverse somatic, psychological and behavioral effects. Further, the disruptive and hostile behavior may culminate in the prevalence of medical errors, augment the cost of care and diminish patient satisfaction. Studies estimate that nearly 24.1 percent of nurses have experienced verbal abuse by a nurse leader or colleague (Clark, Farnsworth & Landrum, 2009). Shockingly, national surveys reveal that 68 percent of the participants who were nurses have experienced some form of incivility within different faculties. Bullying and instances of horizontal violence have been categorized as negative workplace behavior which contributes the high turnover rate among workers, especially in acute care settings. In healthcare settings, incivility has been associated with the unsafe working conditions, a surge in medical costs and poor quality in the delivery of patient care.

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Scenario for Incivility in Practice Setting

A meta-analysis of studies focusing on the issue of incivility in nursing reveals the how demeaning behavior may catalyze negative relationships amongst colleagues. In essence, the principle of respect for persons is in accordance with the nursing Code of Ethics which sensitizes on the essence of cultivating caring and the compassionate relationship among team members. Moreover, nursing leaders are expected to institute a culture of fair treatment for all including developing an ideal structure for the conflict resolution process. The principles of the code of conduct categorically prohibit conduct that may be perceived as being intimidating or any form of harassment as workers are expected to uphold the unique contributions of all stakeholders. As a result, most participants in studies claim that incivility creates a sense of uncertainty as a nurse profession may not know how to react in a seemingly unhealthy environment. This phenomenon may be embodied by the sentiments expressed by an individual registered nurse who was yelled at by the nursing manager: "It felt very uncomfortable, I wasn't sure how to respond, it wasn't something that, it wasn't a manner that I was used to hearing from my peers or another faculty so I really wasn't sure how to handle the situation." (Lasiter, Marchiondo & Marchiondo, 2012). The unexpected nature of the interaction left faculty frozen, speechless and unable to confront the uncivil peer. Another professional stated that she was embarrassed to be yelled at even in front of her patients as it was behavior that one is not accustomed to as an adult. Indeed, the victim was subjected to emotional torture, and she felt humiliated and ever since she has often experienced a sense of vulnerability in the workplace.

Strategies for Creating a Healthy Environment

Owing to the complex nature of healthcare delivery systems, elimination of instances of incivility requires a multidisciplinary approach. Some of the fundamental components to be incorporated in this process include recognition, mutual trust, and respect amongst team members including sharing on the decision making on patient care and open dialogue between colleagues. Accordingly, disruptive behaviors may impede the intra-professional collaboration amongst team members. This observation leads to the widely accepted nursing perspective that the primary prevention stratagem for incivility would be creating a culture of acting strenuously. This implies that the nurses are expected to complete their tasks diligently and in a timely fashion to avoid critical situations where nursing leaders feel entitled to act disgracefully towards nurses due to pending tasks.

Effective communication has also been considered as a reliable preventive technique towards incivility. The most significant causative agent of incivility has emerged to be a negative attitude to augment the risks of occurrence of disruptive behaviors. Equally important is the fact that poor communication is regarded as a medium of exacerbating incivility where research indicates that one of the reasons for abusive behaviors from a patient's companion is the development of an inappropriate relationship with the personnel at the health facility (Marchiondo, Marchiondo & Lasiter, 2010). In another study comprising of care staff and patients as the participants, the respondents claimed that if the team took into consideration the opinions, then they would feel that they are treated respectfully thus avoiding instances of aggression and workplace violence. In this regard, communication-related concerns that are raised by patients are often described regarding respect. As a result, a sufficient communication strategy would comprise the use of active interpersonal skill and empathetic approach especially in addressing sensitive issues.

Incivility may also be categorized as a form of workplace violence where nursing managers may begin with a series of focus groups to solicit directly for input from staff who work both during the day and night shifts. To encourage employees to speak freely, the training meetings with the OSHA officer are conducted without the presence of supervisors, and the employees were separated by their various disciplines (mental health workers, physicians, and nurses). This strategy helps the managers comprehend that majority of the health workers perceives violence as part of their job description. Moreover, a health facility may address the workplace issue with the main agenda being management settings; creating a comprehensive "Staying Safe Program"; encouraging collaboration and dialogue between the campus police and clinical staff; implementing daily safety briefings and formulating a steadfast training program (Laschinger et al., 2013). In the long-term, a health facility may to develop a model program that may be utilized by other health facilities that want to implement violence prevention efforts through disseminating information through mainstream media, sharing information and strategies with other facilities and conducting conferences on a regular basis. Moreover, the health facility may adopt an electronic incident reporting program including the implementation and offer training on how to prevent the aggressive behavior from escalating into violent reaction (Hakojarvi, Salminen & Suhonen, 2014). In addition to putting security apparatus such as proper lighting, cameras, and panic buttons, the institution may form a trained Response Team that will be available at all times to assist nurses in situations involving violence.

Conclusion

In sum, incivility is detrimental to the process of delivery of quality health services and guaranteeing patient safety. Moreover, the concept of incivility includes aggressive behavior which may escalate to instances of workplace violence. Due to the complex nature of addressing issues associated with behavior change, the ideal strategy would be to employ a multidisciplinary approach where effective communication and collaboration among team members is critical in curtailing the harmful effects of incivility. In the long run, the prevention of incivility leads to the cultivation of a healthful work environment which makes it seamlessly possible for nurses to function optimally.

References

Clark, C. M., Farnsworth, J., & Landrum, R. E. (2009). Development and description of the incivility in nursing education (INE) survey. Journal of Theory Construction & Testing, 13(1), 7.

Hakojarvi, H. R., Salminen, L., & Suhonen, R. (2014). Health care students' personal experiences and coping with bullying in clinical training. Nurse education today, 34(1), 138-144.Laschinger, H. K., Wong, C., Regan, S., Young-Ritchie, C., & Bushell, P. (2013). Workplace incivility and new graduate nurses' mental health: The protective role of resiliency. Journal of Nursing Administration, 43(7/8), 415-421.

Lasiter, S., Marchiondo, L., & Marchiondo, K. (2012). Student narratives of faculty incivility. Nursing outlook, 60(3), 121-126.Marchiondo, K., Marchiondo, L. A., & Lasiter, S. (2010). Faculty incivility: Effects on program satisfaction of BSN students. Journal of Nursing Education, 49(11), 608-614.