Responding to disruptive behaviors in nursing: A longitudinal, quasi-experimental investigation of training for nursing students

Effectiveness of interventions for the prevention or management of workplace violence in student nurses during clinical placement: A systematic review

AIM

To systematically investigate the effectiveness of interventions for managing workplace violence experienced by registered nursing students during clinical placement.

DESIGN

A systematic review of experimental studies.

METHODS

The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The key search concepts such as "Nursing students", "Education", "workplace violence", "clinical placement" and "clinical study" were inspected to identify relevant articles (Appendix A). Two independent reviewers completed screening, critical appraisal and data extraction. Due to heterogeneity among the included studies, results were synthesized narratively.

DATA SOURCES

MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate Analytics), Scopus (Elsevier), Embase (Ovid), Cochrane CENTRAL, ERIC (ProQuest), ProQuest Central and ProQuest Social Science Premium Collection were searched from inception to 27th February 2023.

RESULTS

A total of 13 studies were included in this review. The predominant intervention for managing workplace violence experienced by registered nursing students during clinical placements was education. Approaches varied among studies and included didactic teaching, e-learning, role-playing and simulation practice. The included studies showed uncertain improvements in registered nursing students' confidence, coping skills, knowledge, competence and self-efficacy in dealing with workplace violence during clinical placements. Only one study assessed the incidence rate of workplace violence and found that a multi-faceted intervention involving both staff and students decreased the incidence.

CONCLUSION

Given the heterogeneity of educational interventions, the effect of interventions for managing workplace violence during students' clinical placement is uncertain. To address this gap, high-quality, proactive and combined interventions at both institutional and organizational levels are needed.

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.].

Promoting Civility in the Workplace: Addressing Bullying in New Graduate Nurses Using Simulation and Cognitive Rehearsal

This evidence-based practice project implementation aimed to enhance new graduate nurses' abilities to address workplace bullying. A mixed educational methodology was used. Participants indicated applying learned behaviors to improve communication, peer relationships, teamwork, and patient safety and to address bullying. Civility ratings did not significantly increase from before to after the intervention, presumably because of high baseline ratings. Future research should identify sensitive and specific measures to detect bullying behavior changes.

Interventions for workplace violence against health-care professionals: A systematic review

BACKGROUND

Workplace violence (WPV) against health-care professionals has been a concern worldwide as it strains the relationship between the patient and healthcare professionals. Implementing mitigation interventions to help the healthcare professionals to prevent and manage these violent episodes might make the workplaces more secure.

OBJECTIVE

This study aimed to synthesize the recent evidence on intervention strategies for workplace violence.

METHOD

Four electronic databases (PubMed, Wiley, Cochrane and Google Scholar) were searched for peer-reviewed intervention studies published in the last 11 years to mitigate workplace violence. A qualitative synthesis of the findings from included studies was done.

RESULT

A total of 17 studies were identified based on prevention and management of workplace violence. The interventions were mainly educational in nature based on a workshop format. These interventions were found to be effective in improving the perceived ability to deal with situations that lead to violence.

CONCLUSION

Strategies to mitigate violent episodes could be helpful to health-care professionals and administrators in their attempts to make safer workplaces in the health-care settings.

De-escalation Training as Part of a Workplace Violence Prevention Program

Workplace violence, including verbal and physical abuse, is escalating nationwide. As healthcare workers try to enforce COVID-19 prevention policies and practices, this phenomenon is exacerbated. De-escalation training is a method to prepare nurses through increased situational awareness, leading to early recognition and improved coping and confidence in dealing with aggression. Outcomes are presented, suggesting education of nurses may have a positive influence on the number of security calls and incident reports.

Nursing Students and Cognitive Rehearsal Training as an Antibullying Strategy: A Canadian National Study

BACKGROUND

Bullying in nursing is a well-documented phenomenon and is a factor in job satisfaction, nurse retention, and client safety. Both nursing students and nursing staff experience these negative interactions in clinical settings.

METHOD

This study was conducted to refine and improve the cognitive rehearsal training (CRT) intervention. Experiential workshops were conducted with third-year or equivalent baccalaureate nursing students at five different schools of nursing across Canada (N = 329).

RESULTS

Students supported the CRT approach as a first response toward dealing with bullying behavior in the health care workplace and offered advice for its improvement.

CONCLUSION

Currently, schools of nursing and health authorities typically use theoretical and online approaches to address bullying. The CRT intervention described in this study is novel as it involves role-play, which promotes learning at a deeper level than didactic approaches. [J Nurs Educ. 2022;61(2):80-87.].

Role of sociodemographic factors and self-efficacy in the perception of social support of nursing students

OBJECTIVE

To analyze the role of sociodemographic factors and self-efficacy in the perception of social support by nursing students of the first years of nursing school.

METHOD

This is a quantitative cross-sectional research, developed with 121 undergraduate students from the early years of the course. A sociodemographic questionnaire, the Higher Education Self-Efficacy Scale and the abbreviated version of the Social Support Questionnaire were used. Spearman and Mann-Whitney correlation tests were performed using software for statistical analysis.

RESULTS

It was identified that students with better self-efficacy and who are self-declared black or brown reported, respectively, greater satisfaction with the support and a smaller number of supporters.

CONCLUSION

Considering that the race/color factor had a negative influence and self-efficacy a positive influence in the perception of social support, it is recommended that mental health promotion strategies be conducted that permeate both affirmative action policies and improvements in the teaching-learning process, especially in the first years of the nursing course.

Bullying in nursing students: A integrative literature review

The purpose of this integrative review was to analyse the current situation of bullying in nursing students through an exhaustive review of the last 10 years. As the sources of information, we used electronic databases, such as Medline, CINAHL, PubMed, Cochrane, and SciELO, using bullying, nursing students, and clinical environment as search terms. We based the methodology of the study in PRISMA checklist. Articles were selected for their relevance and suitability for the purpose, and they were constructed into a table. A critical appraisal was done using MMAT TOOL and AACOODS checklist. Papers were analysed using a constant comparison and a concept mapping. Finally, 30 articles were included. We analysed: prevalence, profile of the victim and perpetrator, type of violence, and bullying consequences. Bullying prevalence varied from 9-96% according to the author. Differences about the influence of sociodemographic variables were detected, there is no consensus about age, gender, or educational level. Bullying in nursing students is an important problem that affects all spheres of their life. Harassment also has consequences for the patient and for the health organization, so it is really important to take action regarding bullying and to act to victims, perpetrators, and health organizations. Regarding to implications for nursing practice, we found that some interventions were useful to reduce bullying, so it is important to participate in intervention programmes to eventually stop this problem. This study has revealed that more research on the efficacy of psychological intervention programmes to help students cope with bullying situations is essential.

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

BACKGROUND

Incivility is a significant issue in nursing education and practice, contributing to ineffective learning, unprofessional nursing practice, and negative patient outcomes.

METHOD

A team of nursing faculty and students used Action Research to develop a quality improvement project targeting civility. A two-part, evidence-based training was offered to prelicensure nursing students, faculty, and staff. Part one was designed to increase incivility awareness, and part two was intended to enhance communication skills.

RESULTS

Program evaluation data were collected through an anonymous survey and analyzed descriptively for themes. Results indicated students, faculty, and staff perceived the educational innovation as valuable and useful.

CONCLUSION

By using free resources, a college of nursing was able to implement a cost-effective program to begin a conversation and offer a communication strategy to address incivility for students, faculty, and staff. This program design can be adopted by others for use in their organization. [J Nurs Educ. 2020;59(4):214-217.].

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.

Addressing Workplace Incivility: Facilitating Nursing Students' Transition to the Health-Care Setting

Workplace incivility is a known cause of anxiety in the workplace, leading to the loss of many new members of the nursing field. This perpetual cycle of hiring and losing nurses, especially new graduates, contributes to the increasing nursing shortage. This study investigated whether the inclusion of prelicensure nursing education on workplace incivility is achievable and capable of improving the outcome for nurses when it occurs. Review of the literature revealed that inclusion of prelicensure education on this topic is possible through utilization of a zero-tolerance policy, Cognitive Rehearsal Technique (CRT), and simulation. Education on workplace incivility and the aforementioned formats for prelicensure education were presented to faculty of a Southeastern U.S. college. Respondents demonstrated interest in detailed instruction on incorporating it into their teaching.