Negative Acts in the Courtroom: Characteristics, Distribution, and Frequency among a National Cohort of Danish Prosecutors

Danish prosecutors report exposure to negative acts from professional counterparts in courtrooms, which is associated with an increased risk of burnout. However, knowledge of the characteristics of these acts is limited. Based on existing theoretical frameworks, this study aims to characterize these negative acts. A nation-wide survey of Danish prosecutors (response rate: 81%) yielded 687 descriptions of experiences with negative acts from professional counterparts from a career perspective. These were analyzed using theory-directed content analysis based on the Stress-as-Offense-to-Self (SOS) theory by Semmer and colleagues and Cortina and colleagues' characterization of incivility in American courtrooms. We identified a total of 15 types of behavior within the three main themes: illegitimate tasks (n = 22), illegitimate stressors (n = 68), and illegitimate behavior (n = 612). Tentative differences in the distribution of experienced negative acts from a career perspective were found for gender and seniority. Women reported negative acts more frequently than men, and assistant prosecutors reported verbal abuse more frequently than senior prosecutors, who, conversely, more often reported a perceived lack of court management. More prospective research is needed on negative acts experienced by prosecutors to assess the scope of these in Danish courtrooms and how they impact the risk of burnout.

Challenges of Incivility in Dental Practice and Education

Professional collaboration is a key component of patient care and a source of fulfilment for oral health care providers. However, reports of incivility in employment as well as education are increasing impacting individuals in all settings including patients. Uncivil behavior implies a disregard for others and creates an atmosphere of disrespect, conflict, and stress. In contrast, civility towards others implies polite, respectful behavior towards others. This short report presents case studies in dental hygiene clinical practice and in dental hygiene education with strategies for approaching uncivil behavior.

Clinician responses to disruptive intraoperative behaviour: patterns and norms identified from a multinational survey

PURPOSE

Disruptive intraoperative behaviour can have detrimental consequences for clinicians, institutions, and patients. The way victims and witnesses respond to disruptive behaviour can ameliorate or exacerbate consequences. Nevertheless, previous research has neither described the responses of a multinational sample of clinicians nor developed tools to recognize and evaluate responses.

METHODS

After obtaining ethics committee approval, 23 perioperative organizations distributed a survey evaluating clinician responses to disruptive behaviour. We grouped responses into four response strategies: passive, assertive, manipulative, and malicious. Thereafter, we derived norms (i.e., percentile distributions) for each response strategy using empirical distribution functions. Latent profile analysis identified groups of clinicians balancing their use of the four response strategies differently (i.e., response pattern groups). We used Chi square tests to examine associations between response pattern groups and respondent demographics.

RESULTS

We analyzed 4,789 complete responses. In response to disruptive behaviour, 33.7% of clinicians altered medical care in ways that were unindicated, 54.6% avoided communication with team members, and 12.1% misled the offender. Profile analysis identified five response pattern groups: extreme passive-predominant (30.5% of clinicians), extreme assertive-predominant (20.5%), moderate passive-predominant (18.9%), moderate assertive-predominant (26.5%), and a disparate pattern (greater use of manipulative and malicious responses) (3.5%). Profession, sex, management responsibilities, and sexual orientation predicted the response pattern group (all, P < 0.001).

DISCUSSION

The responses of thousands of clinicians involved passivity, manipulativeness, or maliciousness. We present norms and a response pattern classification to help organizations evaluate responses, recognize response patterns, and provide tailored support to victims and witnesses.

The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis

AIM

Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety.

METHODS

A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies.

DATA SOURCES

Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023.

RESULTS

The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety.

CONCLUSION

Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT

This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility.

REPORTING METHOD

This report adheres to PRISMA reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.

Interventions for Preventing and Resolving Bullying in Nursing: A Scoping Review

Bullying in the workplace is a serious problem in nursing and has an impact on the well-being of teams, patients, and organisations. This study's aim is to map possible interventions designed to prevent or resolve bullying in nursing. A scoping review of primary research published in English and Italian between 2011 and 2021 was undertaken from four databases (Cochrane Collaboration, PubMed, CINAHL Complete, and PsycInfo). The data were analysed using Arksey and O'Malley's framework, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Checklist was followed to report the study. Fourteen papers met the review eligibility criteria. The analysis revealed four main themes: educational interventions, cognitive rehearsal, team building, and nursing leaders' experiences. Interventions enabled nurses to recognise bullying and address it with assertive communication. Further research is needed to demonstrate these interventions' effectiveness and if they lead to a significant decrease in the short-/long-term frequency of these issues. This review increases the available knowledge and guides nurse leaders in choosing effective interventions. Eradicating this phenomenon from healthcare settings involves active engagement of nurses, regardless of their role, in addition to support from the nurse leaders, the organisations, and professional and health policies.

Coping with disruptive patients: Perspectives of primary care employees

BACKGROUND

The impact of patient aggression on primary health care employees is underexplored, yet imperative to address, given high rates of burnout.

OBJECTIVE

We qualitatively explore perceptions of patient aggression among staff in women's health primary care at the Veterans Health Administration (VA). Our objective is to identify coping strategies that staf devised in response to aggressive behavior.

METHODS

We conducted semi-structured interviews with 60 VA women's health primary care employees in 2021 and 2022. Informed by the Job Demands-Resources theoretical model, we used rapid qualitative analysis to identify themes related to patient aggression and employee coping strategies.

RESULTS

Disruptive behaviors reported by participants included verbal and physical aggression. Staff cited disruptive patient behavior as emotionally draining and perceived a lack of consequences for low-level aggression. Respondents used coping strategies in response to patient aggression at three time points: before, during, and after a negative interaction. At each point, support from team members emerged as a dominant coping mechanism, as well as rapport-building with patients.

CONCLUSION

Patient aggression can negatively impact the work experiences of primary care employees. At VA, women's health primary care staff have devised multiple strategies to cope with these interactions. However, the ability to effectively prevent and manage patient aggression is limited by the lack of meaningful repercussions for aggression at the organizational level, which has important implications for employee well-being and retention. Retention of women's health employees in VA is critical given the need for a highly specialized workforce to address the complex health needs of women veterans.

Perceptions of Incivility Among Dental Hygiene Students and Faculty/Administrators

Purpose While incivility has been part of higher education for many years, there has been a documented increase as both students and educators have begun to recognize this behavior and its effects on student learning, faculty satisfaction and stress. The purpose of this descriptive study was to investigate the perceptions of incivility among dental hygiene students and faculty/administrators.Methods This study utilized a convenience sample of five dental hygiene programs in California. The Incivility in Higher Education-Revised survey (IHE-R) was adapted to obtain data regarding perceptions of incivility among dental hygiene students and faculty/administrators. The survey required participants to describe incivil encounters and the perceived reasons for and consequences of the incivil behavior. An online survey was used for faculty and a paper survey was administered for dental hygiene students. Data from the open-ended questions were reviewed, summarized, edited for redundancy, and analyzed using categories.Results Of the 196 participants, 81.63% were dental hygiene students (n = 160) and 18.37% were dental hygiene faculty and administrators (n = 36). Data analysis of participant responses related to the primary reason for incivil behavior in dental hygiene education revealed five categories including lack of consequences, personality traits, miscommunication, stress, and lack of professionalism. Upon data analysis of participant responses related to the most significant consequence of incivil behavior in dental hygiene education, five categories emerged including hostile environment, decreased student success, emotional distress, relationship damage, and professional damage.Conclusion Both faculty and students felt there was a lack of consequences for incivil behavior and did not feel adequately equipped to manage these situations when they arose. Dental hygiene institutions and professional organizations need to consider offering advanced training in creating a culture of civility to prevent and address incivil behaviors.

Incivility in COVID-19 Vaccine Mandate Discourse and Moral Foundations: Natural Language Processing Approach

BACKGROUND

Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines.

OBJECTIVE

This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits.

METHODS

Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, "vaccinate" and "Pfizer") and mandates (eg, "forced" and "mandating"). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10% sample of the filtered key terms was used for the final analysis.

RESULTS

Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001).

CONCLUSIONS

This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19.

Improving Formal Incivility Reporting in Ambulatory Oncology: Implementing the CIVIC Duty Program

The aim of this quality improvement project was to increase formal reporting of incivility events committed by patients and their visitors on an ambulatory oncology infusion unit. Evidence-based interventions of providing edu.

Prevalence and Impact of Workplace Bullying among Pharmacy Practice Faculty in the United States

Objective: To identify the prevalence and impact of workplace bullying among pharmacy practice faculty in the United States. Methods: Members of the Pharmacy Practice section of the American Association of Colleges of Pharmacy were invited to complete an online survey about the frequency with which they experienced negative workplace behaviors in the communication, humiliation, manipulation, discrimination, and violence domains as well as workplace bullying in the previous 12 months. Independent t-tests and chi-squared tests were used to investigate associations between workplace bullying and pharmacy practice faculty demographic and employment characteristics. Results: Participants (n=256) reported a median of 6 negative behaviors in the workplace, most often in the communication and humiliation domains. A total of 50 (19.5%) reported experiencing workplace bullying. The most common impacts of workplace bullying included increasing their stress level (n=44/49, 89.8%), negative effects on their emotional health (n=42/49, 85.7%), and job dissatisfaction (n=40/49, 81.6%). Female participants more frequently reported workplace bullying (n=43/196, 21.9%) compared to male participants (n=4/56, 7.1%; p=0.012). Individuals who identified as white were less likely to report workplace bullying (n=40/233, 17.2%) compared to individuals of all other races (n=8/19, 42.1%; p=0.008). Conclusion: Most pharmacy practice faculty reported experiencing some degree of negative workplace behaviors during the past 12 months. Additional strategies are needed to create inclusive work environments with transparent, actionable policies when workplace bullying occurs.

Advancing Workplace Civility: a systematic review and meta-analysis of definitions, measurements, and associated factors

This research article focuses on the significance of Workplace Civility, defined as the respectful and courteous behavior exhibited by individuals toward their colleagues in the workplace. The primary objective of this study is to conduct a systematic review and a meta-analysis that synthesizes existing research by: (1) identifying operational definitions of the construct, (2) underlying the strongest correlations with other variables, (3) summarizing the effective strategies for promoting Workplace Civility, and (4) highlighting gaps in the literature, using the theory-characteristics-context-methodology (TCCM) framework. Multiple databases were meticulously searched, yielding 691 results, and ultimately 51 documents were included in the systematic review final sample following the application of predefined exclusion criteria. Then, a meta-analysis has been conducted including those studies with sufficient statistical data (k = 24) which allowed us to calculate 45 Effect Sizes. The review findings expose a notable dearth of research on Workplace Civility when compared to studies on incivility. This dearth highlights the pressing need for additional research endeavors to precisely define Workplace Civility, establish a robust theoretical framework, and develop reliable scales for its measurement. Related to the desirable correlates, organizational commitment, job satisfaction and mental health showed a high ES value, and for undesirable correlates, intention to quit showed a high ES value, while Emotional exhaustion only reached a medium ES value and physical symptoms showed a low ES value. Importantly, this study emphasizes that fostering civility in the workplace can yield significant benefits such as improved physical and mental well-being for workers, reduced burnout, and absenteeism rates. Thus, the promotion of civility in the workplace not only leads to healthier organizations but also enhances cost-efficiency, effectively averting the loss of both human and economic capital.

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.

The social media discourse of engaged partisans is toxic even when politics are irrelevant

Prevailing theories of partisan incivility on social media suggest that it derives from disagreement about political issues or from status competition between groups. This study-which analyzes the commenting behavior of Reddit users across diverse cultural contexts (subreddits)-tests the alternative hypothesis that such incivility derives in large part from a selection effect: Toxic people are especially likely to opt into discourse in partisan contexts. First, we examined commenting behavior across over 9,000 unique cultural contexts (subreddits) and confirmed that discourse is indeed more toxic in partisan (e.g. r/progressive, r/conservatives) than in nonpartisan contexts (e.g. r/movies, r/programming). Next, we analyzed hundreds of millions of comments from over 6.3 million users and found robust evidence that: (i) the discourse of people whose behavior is especially toxic in partisan contexts is also especially toxic in nonpartisan contexts (i.e. people are not politics-only toxicity specialists); and (ii) when considering only nonpartisan contexts, the discourse of people who also comment in partisan contexts is more toxic than the discourse of people who do not. These effects were not driven by socialization processes whereby people overgeneralized toxic behavioral norms they had learned in partisan contexts. In contrast to speculation about the need for partisans to engage beyond their echo chambers, toxicity in nonpartisan contexts was higher among people who also comment in both left-wing and right-wing contexts (bilaterally engaged users) than among people who also comment in only left-wing or right-wing contexts (unilaterally engaged users). The discussion considers implications for democratic functioning and theories of polarization.

Workplace incivility and the professional quality of life in nurses

BACKGROUND

Workplace Incivility is a common issue in the nursing profession. Nurses who are affected by such behaviors may experience distress.

OBJECTIVES

This study aimed to assess the relationship between workplace incivility and nurses' professional quality of life.

RESEARCH DESIGN

This cross-sectional correlational study was conducted in 2021 in "Tehran". Data were collected using a demographic questionnaire, the Nursing Incivility Scale (NIS), and the Professional Quality Of Life scale (ProQOL). Data analysis was performed through the Pearson correlation and multiple linear regression, using the SPSS v.16.

PARTICIPANTS AND RESEARCH CONTEXT

Participants were 200 nurses randomly recruited from selected hospitals of "TUMS".

ETHICAL CONSIDERATIONS

The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation.

FINDINGS

The mean age of participants was 32.30 ± 7.22, and 76.5% were female. There was a significant correlation between the professional quality of life and workplace incivility (r = -0.23, p = .001). Multiple regression analysis between the subscales of workplace incivility and professional quality of life demonstrated that the incivility from the supervisor (β = -0.29, p = .001) and incivility from patients (β = -0.27, p < .001) can predict the compassion satisfaction dimension. The incivility from the supervisor (β = 0.24, p = .001) and incivility from patients (β = 0.26, p < .001) can explain burnout. The incivility of the patients can explain secondary traumatic stress (β = 0.14, p = .02).

CONCLUSION

This study showed that workplace incivility is significantly related to professional quality of life. Therefore, the reduction of behaviors of incivility can lead to the improvement of the professional quality of life.

Incivility and interpersonal harm in organizational context: A qualitative exploration of values in STEM training programs

This study investigates science, technology, engineering, and math (STEM) PhD students' perceptions of organizational values and incivility. Interviews with 26 STEM PhD students elicited examples of and perceptions surrounding incivility and related harms. Productivity, prestige, expertise, objectivity, self-sufficiency, and collaboration values were identified. Each included aspects deemed useful (e.g., productivity fueling discovery; expertise facilitating learning) as well as potentially contributing to harm when weaponized (e.g., productivity appeared in incivility stories when one "looked down" on those who did not work long days; expertise appeared when people gossiped about intelligence). Some aspects of collaboration (e.g., long-lasting working relationships fueling scientific discovery) may be protective. Organizational values such as productivity appeared to supersede considerations such as well-being. Current framing of these values may bolster refusal to engage in or support social justice and mental health efforts, which some participants identified as needed. Implications across settings are discussed.

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.

The impact of vulnerability and exposure to pervasive interprofessional incivility among medical staff on wellbeing

Introduction

Traditional methods for modelling human interactions within organisational contexts are often hindered by the complexity inherent within these systems. Building on new approaches to information modelling in the social sciences and drawing on the work of scholars in transdisciplinary fields, we proposed that a reliable model of human interaction as well as its emergent properties can be demonstrated using theories related to emergent information.

Methods

We demonstrated these dynamics through a test case related to data from a prevalence survey of incivility among medical staff. For each survey respondent we defined their vulnerability profile based upon a combination of their biographical characteristics, such as age, gender, and length of employment within a hospital and the hospital type (private or public). We modelled the interactions between the composite vulnerability profile of staff against their reports of their exposure to incivility and the consequent negative impact on their wellbeing.

Results

We found that vulnerability profile appeared to be proportionally related to the extent to which they were exposed to rudeness in the workplace and to a negative impact on subjective wellbeing.

Discussion

This model can potentially be used to tailor resources to improve the wellbeing of hospital medical staff at increased risk of facing incivility, bullying and harassment at their workplaces.

Kindness Isn't Just about Being Nice: The Value Proposition of Kindness as Viewed through the Lens of Incivility in the Healthcare Workplace

The healthcare workplace is a high-stress environment. All stakeholders, including patients and providers, display evidence of that stress. High stress has several effects. Even acutely, stress can negatively affect cognitive function, worsening diagnostic acumen, decision-making, and problem-solving. It decreases helpfulness. As stress increases, it can progress to burnout and more severe mental health consequences, including depression and suicide. One of the consequences (and causes) of stress is incivility. Both patients and staff can manifest these unkind behaviors, which in turn have been shown to cause medical errors. The human cost of errors is enormous, reflected in thousands of lives impacted every year. The economic cost is also enormous, costing at least several billion dollars annually. The warrant for promoting kindness, therefore, is enormous. Kindness creates positive interpersonal connections, which, in turn, buffers stress and fosters resilience. Kindness, therefore, is not just a nice thing to do: it is critically important in the workplace. Ways to promote kindness, including leadership modeling positive behaviors as well as the deterrence of negative behaviors, are essential. A new approach using kindness media is described. It uplifts patients and staff, decreases irritation and stress, and increases happiness, calmness, and feeling connected to others.

When Patient Rudeness Impacts Care: A Review of Incivility in Healthcare

Healthcare workers increasingly face incivility and rude behaviors from patients, families, and visitors. Although these are less severe than other types of mistreatment, studies have documented that they may still impact healthcare worker well-being and patient care. Defining and measuring incivility can be challenging because current research relies on the perceptions of the targets. Furthermore, there is often overlap among different types of mistreatment, and much of it goes unreported by those who experience it. Nevertheless, multiple studies have documented that incivility is common in healthcare and has been associated with burnout and intent to leave. In clinical settings, multiple consequences for patient care have been documented, including adverse consequences in the diagnostic and intervention performance of teams, as well as team processes. One theory is that incivility incidents divert cognitive resources away from the intervention and that these experiences may interfere with higher-order reasoning. Although limited research has been performed in the areas of prevention, response to incidents of incivility, and best practices for ameliorating the effects of incivility, some promising interventions have been reported in the literature.

Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

Nursing students and faculty perception of academic incivility: A descriptive qualitative study

BACKGROUND

Incivility is one of the significant challenges that affect nursing education. Uncivil behaviors have a significant upward trend compared to the past in nursing education. This study was conducted to explore academic incivility from the perspective of nursing students and faculty.

MATERIALS AND METHODS

This study was conducted in 2021 using a descriptive qualitative method. Fifteen baccalaureate nursing students and six faculty were selected using purposeful sampling method. Data was collected through in-depth semi-structured interviews, and a qualitative content analysis was applied for data analysis.

RESULTS

Data analysis revealed four categories, namely, ineffective teaching-learning, inapposite/unreasonable requests, behaviors disrupting mutually respectful environment, and academic dishonesty, and 14 subcategories.

CONCLUSION

To reduce incivility, closer attention needs to be paid to the admission of faculty as well as training them to use effective communication techniques and interactive teaching methods. In addition, nursing students must be provided with the training about uncivil behaviors. Furthermore, clear and precise rules and regulations concerning incivility incidence should be developed and implemented in the universities.

Does Bystander Intervention Training Work? When Employee Intentions and Organisational Barriers Collide

Scholars have recently begun to consider the role of bystander intervention training in countering workplace incivility and bullying. Given the scarce empirical evidence of bystander training outcomes in occupational settings, this study set out to evaluate the effectiveness of a bystander intervention training in a large healthcare organisation, by assessing changes to levels of psychological safety, bystander efficacy, intent and behaviours over time. One hundred and forty employees in a large healthcare organisation in New Zealand attended the training and were asked to complete three surveys, one conducted at baseline, one carried out 2 weeks following the training and the last survey conducted 2 months later. The qualitative and qualitative findings of this study show that the bystander intervention training resulted in significant improvements to bystander attitudes and beliefs, which were ascribed to the quality of training materials, the facilitator and opportunities to role-play bystander intervention strategies. However, the positive bystander beliefs, attitudes and intent to intervene declined in the months following the training. The qualitative findings shed a light on these results and suggest that the participants required support for training transfer in the form of updated and accessible information about negative acts and bystander intervention strategies, leadership support and role modelling of bystander behaviours and civility, and the implementation of accountability systems that ensure the ongoing development of a civility culture.

Patient and Family Perpetrated Cyber-Incivility and Cyber-Aggression Within Healthcare: A Cross-Sectional Descriptive Study

Introduction

Verbal violence may manifest in written form as cyber incivility within patient portal communications. As a form of digital technology, patient portal messages create a physical and emotional distance leading the sender to be disinhibited and disassociated from the recipient nurse. Written patient portal messages may contain uncivil language deemed verbally violent when the content escalates beyond professional standards. When these messages are encountered as part of patient care, they may lead to nurses' psychological distress. Although cyber-incivility has been studied within social media and business, little is known about cyber-incivility within healthcare.

Objectives

The purpose of the study was to define cyber-incivility as it manifests within healthcare compared to business, determine sender demographics, and quantify the impact on nurses.

Methods

A cross-sectional descriptive study was conducted to analyze portal communications. Nurses forwarded aggressive messages to leadership and quantified their level of distress after receiving the message. Sender demographics were tracked, and content was analyzed using Braun and Clarke's Thematic Analysis.

Results

Of the 31 included messages, senders were of varying ages, genders, and marital statuses. Messages rarely related to medications and rarely contained expletives. The most distressing messages were ad hominem, demanding, accusatory, or contained threats. These messages illustrated how healthcare cyber-incivility manifested and deviated from appropriate professional standards to become a form of verbal workplace violence. Message content also identified antecedents; related to unmet expectations, patient accountability, or difficulty navigating healthcare.

Conclusions

Written incivil/uncivil/aggressive patient portal messages contained personal attacks and professionally degrading content, which were distressing to nurses. A healthcare-specific framework was created and provided context to understand the difficult and aggressive messages nurses received while providing digital patient care. Awareness of cyber-incivility within healthcare allows for better support of nurses who are exposed to this form of workplace violence and is foundational to future intervention development.

Perspectives of student incivility in the online learning environment and social media platforms

OBJECTIVES

The purpose of this study was to examine student and faculty perspectives of student incivility in the online learning environment and social media platforms and to describe the participants' recommendations for promoting civility.

METHODS

Mixed-method design was used to collect data from a convenience sample of students and faculty in a nursing program in the Southeast United States.

RESULTS

53 faculty members and 203 nursing students participated, and the majority agreed that incivility is a problem to some degree. Several themes emerged for effectively promoting civility.

CONCLUSIONS

Incivility is a problem, but students and faculty believe the use of proactive strategies may be effective in promoting civility. Implications for International Audience: As more nursing programs move to the OLE, even if temporarily as occurred during the pandemic, coupled with the increase in social media use, there is need to recognize and implement strategies to thwart the incidence of incivility.

Workplace Incivility and Employee Performance: Does Trust in Supervisors Matter? (A Dual Theory Perspective)

Employee performance is the backbone of achieving competitiveness and sustainability. This study aims to examine the impact of workplace incivility on employee performance. In addition, trust in supervisors is examined as a mediator. The conservation of resources (COR) theory and Maslow's hierarchy of needs theory provided the grounds for developing the framework. The data were collected through closed-ended questionnaires and were analyzed using structural equation modeling with SmartPLS. The results affirmed that incivility is harmful to the performance of employees, and that trust in supervisors helps employees to perform well. The trust in the supervisor significantly mediates the incivility-performance relationship. The examination of the proposed model through the lens of two theories as well as the study of low-intensity deviant workplace behavior in a collectivist and developing economy are the contributions of this study to the growing body of literature. However, the use of a single sector was one of the limitations of this study.

Associations among workplace incivility, stress coping, and nursing performance in hospital nurses: A path analysis

PURPOSE

This study aimed to identify the associations among workplace incivility, stress-coping strategy, and nursing performance and confirm how workplace incivility influences nursing performance through the stress-coping strategy.

DESIGN

This is a descriptive, cross-sectional study. Data were collected using a self-reported questionnaire from 245 nurses working at seven hospitals in Korea between December 2019 and January 2020.

METHODS

The associations among the study variables (workplace incivility, stress coping, and nursing performance) were analyzed using path analysis with bootstrapping.

RESULTS

Supervisors' incivility affected directly and negatively nursing performance although problem-focused coping was mediating between them. By contrast, coworkers' and doctors' incivility was not directly associated with nursing performance through stress-coping strategies.

CONCLUSION

Problem-focused coping enhanced nursing performance and was a more effective stress-coping strategy than emotion-focused coping for nurses affected by coworkers' and doctors' incivilities. Supervisors' incivility may be considered a threatening factor to nursing performance even though problem-focused coping partially mediates between supervisors' incivility and nursing performance.

CLINICAL RELEVANCE

Organizations must prevent all kinds of workplace incivilities from occurring. Nursing managers should periodically monitor the relationship between the supervisors and nurses and be aware of nurses' stress-coping strategies under stressful situations.

Coping with Workplace Incivility in Hospital Teams: How Does Team Mindfulness Influence Prevention- and Promotion-Focused Emotional Coping?

Incivility is a growing concern for researchers and practitioners alike, yet we know little about how the team context is related to the way that employees respond to it. In this study, we examined the role of team mindfulness and its direct and buffering effects on individual-level promotion- and prevention-focused emotional coping. We also examined how these forms of coping were related to individual work engagement. In a temporally lagged study of 73 hospital teams (involving 440 team members), multi-level analyses showed that team mindfulness was directly negatively associated with individual-level prevention-focused emotional coping (behavioral disengagement, denial, and venting); however, it was not positively related to individual-level promotion-focused forms of coping (positive reframing and acceptance). In addition, a cross-level interaction effect was identified whereby team mindfulness reduced the positive relationship between incivility and venting, meaning there was less individual-level venting following incivility in the context of higher team mindfulness. These findings may have implications for work engagement, which was shown to be negatively related to venting and behavioral disengagement. Our findings are useful for managers of teams that regularly experience customer incivility as it uncovers how they can develop a team context that discourages ineffective coping responses.

Frequency and Outcomes of Workplace Incivility in Healthcare: A Scoping Review of the Literature

AIMS

To evaluate the frequency and outcomes of workplace incivility in healthcare for nursing management.

BACKGROUND

Incivility in the workplace is a significant problem that is important to nurse managers, as it goes directly against the fundamental values and ethics of providing high-quality care to patients. The Joint Commission (2021) and the American Nurses Credentialing Center have called on healthcare organizations to identify and intervene in the problem of workplace incivility.

EVALUATION

Studies included in this scoping review were those that measured and analyzed the frequency and outcomes of workplace incivility in healthcare. Four databases were searched, and 28 articles were reviewed. Evaluation was based on general quality, including study characteristics, instruments, and statistical analyses.

KEY ISSUES

Studies used a quasi-experimental design, and most focused on the Registered Nurse population. The Workplace Incivility Scale was the most commonly used instrument to measure workplace incivility frequency. The most frequently studied work-related outcomes were burnout, satisfaction, and turnover.

CONCLUSIONS

Although the frequency of workplace incivility in healthcare is not clear, its consequences are substantial. Multiple studies have revealed significant relationships between workplace incivility and work-related outcomes that are important to nurse managers. Research is needed on non-nursing healthcare professionals, and validation studies are needed on instruments used to measure workplace incivility frequency.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this review can help nurse managers better understand the phenomenon, frequency, and impact of workplace incivility in the healthcare setting and move toward addressing the problem of workplace incivility among nurses and other healthcare professionals.

The Relationship between Workplace Incivility and Well-Being in Administrative Court Judges

Judicial stress is an important area of study, as judges' decisions have life-altering consequences for the immediate parties and, sometimes, society in general. Although there are numerous studies of judicial stress, few have specifically investigated the relationship between judicial stress and workplace incivility (i.e., rude or condescending behavior with ambiguous intent). This survey investigated relationships between workplace incivility and judicial stress, health, and job outcomes in a group of administrative judges. Overall, judges reported moderate levels of stress and low exposure to incivility. They indicated that incivility is a moderate problem, with attorneys as the most common source of incivility. Supporting the Model of Judicial Stress, workplace incivility was positively associated with levels of stress and compassion fatigue and negatively associated with job satisfaction. The relationships between incivility and measures of mental health, physical health, and compassion fatigue were all mediated by stress. Implications for judicial stress interventions include the need for judicial training and interventions to curb incivility.

Consequences and coping: Investigating client, co-worker and senior colleague incivility within veterinary practice

BACKGROUND

Workplace incivility is a workplace stressor with varying effects according to the status of the target and instigator. This study sought to examine veterinary staff's experiences of incivility from clients, co-workers and senior colleagues.

METHOD

An online mixed-measures survey gathered data from UK veterinary staff (n = 252, primarily veterinarians and nurses). Quantitative scales were used to collect data on incivility frequency, burnout, mental health, job satisfaction, turnover intention and key coping responses. Qualitative data expanded on preferred coping strategies.

RESULTS

The impact of uncivil behaviour varied according to the source of the incivility and the status of the target. Senior colleague incivility predicted veterinarian turnover intention, whereas client incivility predicted burnout. Similarly, senior colleague incivility predicted job satisfaction for veterinary nurses. Seeking support was the most frequently reported coping strategy. The qualitative data illustrated strategies focused on calming the situation and management of self.

LIMITATIONS

The data are based on self-reports and are subject to social desirability bias. The sample is limited to UK veterinary staff.

CONCLUSION

Veterinary staff are at risk of experiencing incivility, with varying impacts across job roles and incivility sources. A proactive system approach to incivility is recommended, encompassing support and procedural changes.

Intervention types and their effects on workplace bullying among nurses: A systematic review

AIM

To integrate the literature on workplace bullying among nurses and identify characteristics of anti-bullying interventions.

BACKGROUND

Workplace bullying in nursing is a major concern, potentially affecting nursing practice, patient outcomes, and nurses' health.

EVALUATION

PubMed, Cochrane Library, CINAHL, EMBASE, and PsychINFO were searched for English articles published between December 2020 and January 2021 on workplace bullying among nurses. Eight articles were selected, and a quality assessment and data extraction followed.

KEY ISSUES

While the studies employed various intervention approaches, their workplace bullying conceptualizations and instruments varied, as did the outcome variables selected to assess the effects of the intervention.

CONCLUSION

Anti-bullying interventions were effective, and the methods of their delivery have diversified. However, issues such as the lack of conceptual clarity, intervention specificity, and elaboration remain unaddressed. Further studies are needed to develop updated and standardized instruments to tailor anti-bullying interventions.

IMPLICATIONS FOR NURSING MANAGEMENT

Upgraded intervention strategies that reflect the contemporary nursing context and participant characteristics are warranted to ensure workplace bullying prevention. Active intervention by upper management is essential to develop and implement effective workplace bullying interventions.

The Embodiment of Insult: A Theory of Biobehavioral Response to Workplace Incivility

This article builds a broad theory to explain how people respond, both biologically and behaviorally, when targeted with incivility in organizations. Central to our theorizing is a multifaceted framework that yields four quadrants of target response: reciprocation, retreat, relationship repair, and recruitment of support. We advance the novel argument that these behaviors not only stem from biological change within the body but also stimulate such change. Behavioral responses that revolve around affiliation and produce positive social connections are most likely to bring biological benefits. However, social and cultural features of an organization can stand in the way of affiliation, especially for employees holding marginalized identities. When incivility persists over time and employees lack access to the resources needed to recover, we theorize, downstream consequences can include harms to their physical health. Like other aspects of organizational life, this biobehavioral theory of incivility response is anything but simple. But it may help explain how seemingly "small" insults can sometimes have large effects, ultimately undermining workforce well-being. It may also suggest novel sites for incivility intervention, focusing on the relational and inclusive side of work. The overarching goal of this article is to motivate new science on workplace incivility, new knowledge, and ultimately, new solutions.

Psychometric evaluation of the perceived nursing student's Incivility questionnaire

AIM

Student's uncivil behaviour is one of the most common problems in the educational setting, including nursing schools. It is essential to develop tools for measuring the uncivil behaviour of nursing students to solve this problem. Therefore, this study aimed to evaluate psychometric properties of perceived nursing student's incivility questionnaire among the Iranian community.

DESIGN

In this methodological study, perceived nursing student's incivility questionnaire was completed by 360 nursing students and 121 nursing faculty members.

METHODS

Sampling was done from October 2019-November 2019. Content and construct validity of the questionnaire were evaluated. Reliability was estimated using Cronbach's alpha and McDonald's omega coefficients and composite reliability. The construct validity of nursing student's perceived incivility was investigated by exploratory and confirmatory factor analyses.

RESULTS

Content validity index 0.88 for the whole instrument. The three factors of violent behaviours, irresponsible behaviours and unsound behaviours explained more than 51.485% of the variance. Factor structure extracted using model fit indices (PCFI = 0.763, PNFI = 0.732, CMIN/DF = 2.501, RMSEA = 0.056, GFI = 0.941, AGFI = 0.918, CFI = 0.935) and convergent validity were also confirmed. Internal consistency and composite reliability were estimated to be more than 0.7. The results showed that Iranian perceived nursing student's incivility questionnaire is a three-dimensional construct with good validity and reliability.

Association of stress, resilience, and nursing student incivility during COVID-19

Although incivility in nursing education is linked with negative physical and psychological effects on students, it is unclear how resilience and stress interact and relate to student incivility. The purpose was to understand the role of resilience and stress with peer incivility in a sample of prelicensure nursing students during coronavirus disease 2019. The study design was cross-sectional and correlational. Data were from an online survey administered to undergraduate nursing students of one college of nursing in a southwestern US state during September-October 2020. In a sample of 490 students, ordinal regression model results supported that including a stress and resilience interaction term resulted in a nonsignificant effect of stress and resilience, as the main effect correlates on low-level uncivil student behavior. More research is needed to understand the prevalence of stress and resilience at different points in prelicensure nursing education so that targeted interventions can be developed and deployed to assist students.

Your Care Mitigates My Ego Depletion: Why and When Perfectionists Show Incivility Toward Coworkers

Drawing on ego depletion theory and trait activation theory, this study examines why and when employee perfectionism personality is linked with incivility toward coworkers. The study indulges ego depletion as a mediator between perfectionism personality and incivility toward coworkers, with coworker empathic concern moderating the relationship between perfectionism personality and ego depletion. A three-waved questionnaire was incorporated with sample of 253 employee-coworker dyads. Our findings demonstrate that dimensions of perfectionism personality are positively associated with incivility toward coworkers. In addition, our study confirms that ego depletion mediates the relationship between self-oriented perfectionism, other-oriented perfectionism, and incivility toward coworkers. Furthermore, our study shows that high levels of coworker empathic concern weakens the direct effect of self-oriented perfectionism on ego depletion along with the indirect effect of self-oriented perfectionism on incivility toward coworkers. Theoretical and practical implications of the study are discussed in the organizational context.

Incivility Is Associated with Burnout and Reduced Compassion Satisfaction: A Mixed-Method Study to Identify Causes of Burnout among Oncology Clinical Research Coordinators

While oncology clinical research coordinators (CRCs) experience a combination of factors that are thought to put them at increased risk for burnout, very little research has been conducted to understand the risk factors associated with burnout among CRCs. We used a mixed-method approach, including self-report questionnaires to assess burnout and compassion satisfaction, as well as individual and interpersonal variables hypothesized to impact CRC well-being. We also conducted a focus group to gain a more nuanced understanding of coordinators’ experiences around burnout, teamwork, resilience, and incivility. Coordinators reported relatively moderate levels of burnout and compassion satisfaction. Resilience, sleep dysfunction, stress, and incivility experienced from patients/family were significant predictors of burnout. Resilience and incivility from patients/family were significant predictors of compassion satisfaction. Themes that emerged from the focus group included that burnout is triggered by feeling overwhelmed from the workload, which is buffered by what was described as a supportive work culture based in teamwork. This study identified variables at the individual and interpersonal level that are associated with burnout and compassion satisfaction among oncology CRCs. Addressing these variables is of critical importance given that oncology CRCs and team-based coordinator care are vital to the success of clinical trials.

Ruminating on rudeness: Exploring veterinarians' experiences of client incivility

BACKGROUND

Interactions with clients have been identified as a key potential stressor within veterinary practice. However, there is a lack of research investigating the experience, and impact, of specific behaviours, such as incivility. The current study aimed to address this literature gap by investigating veterinarian perceptions of client rudeness.

METHOD

Telephone interviews (n = 18) were used to gather qualitative data regarding veterinarian perceptions of client rudeness. This encompassed description of an uncivil interaction, potential causes of incivility, the impact on the veterinarian and coping strategies.

RESULTS

The results indicate that veterinarians are exposed to a range of rude behaviours from clients, with suggested causal attributions spanning financial concerns, stress and worry. Adverse consequences associated with uncivil interactions included increased stress, mental health impacts and withdrawal from clients. Responses to incivility encompassed proactive pre-planning, empathy and clear communication. Support from colleagues was important to enable reflection and coping, alongside individual strategies, such as self-care.

CONCLUSION

Client incivility has the potential to adversely impact veterinarians. Appraisal of potential external causes for rudeness could facilitate constructive responses to client incivility and support coping. This should be combined with emotional support from colleagues to mitigate any negative consequences following uncivil client interactions.

Effects of Anger and Moral Identity on the Relationship between Supervisors' Incivility and Deviant Behavior: A Study of Public Service Officers in Republic of Korea

This study investigated the effects of supervisors' incivility regarding employees' deviant behavior, the mediating effect of anger, and the moderating role of moral identity in the relationship between incivility and deviant behavior. To test our hypotheses, we collected data from supervisor-employee dyads in South Korean military units, applying a time-lagged design, hierarchical regression, and SPSS macro. The results elicited three relevant findings. First, supervisors' incivility was found to positively influence employees' deviant behavior. Second, employees' anger was confirmed to have a mediating effect between supervisors' incivility and employees' deviant behavior. Third, the analysis demonstrated that moral identity moderates the relationship between anger and deviant behavior, and incivility through anger has an indirect effect on deviant behavior. These findings imply that supervisors' incivility, which is readily observed within the organization, is a harmful behavior that increases anger and deviant behavior. These findings suggest that negative leadership should be minimized and employees with high moral identity should be selected to reduce deviant behavior that harms the organization.

Incivility in the Environment of Care: A Positive Approach

Decades from its first reporting, incivility remains a pervasive professional issue in health-care environments. Nursing is recognized as a profession based on the art of caring, but the nursing field is also an environment in which harsh treatment of coworkers has become normative in some workplaces. The realities of high-stress environments, high levels of acuity, and heavy workloads abound on most nursing units. Negative behaviors associated with these realities are issues needing resolution. This article presents a positive approach to incivility, with principles illustrated in a fictitious vignette. This positive approach may help reduce the prevalence of negative behaviors.

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.

Registered Nurses' Experiences With Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-State Survey

Background:

Incivility among workers in the health sector is recognized as an occupational hazard. The COVID-19 outbreak brought sudden and profound changes to many health care settings, many of which have been identified as antecedents to workplace incivility. The purpose of this retrospective study was to explore the experiences of registered nurses with workplace incivility, cyber-incivility, and incivility outside of work during the early phase of the COVID-19 pandemic.

Methods:

This mixed-methods study used convenience sampling. Data were collected from June to September 2020 via an online survey, which consisted of both closed- and open-ended questions. Participants were recruited from national nursing organizations and unions. Data were analyzed using descriptive statistics and thematic analysis for open-ended responses.

Findings:

A total of 526 nurses’ responses were included in the analysis. More than one third experienced greater incivility at work during the COVID-19 outbreak than before the pandemic (37.4%), and almost half (45.7%) said they witnessed more incivility than before the pandemic. Cyber-incivility and incivility outside of work were also issues. Qualitative results indicated that respondents felt they were on edge during this period. Other themes included leadership failure, fractured co-worker relationships, heightened incivility from patients and families, and hostility and ostracism from the general public

Conclusion/Application to practice:

Occupational health nurses, nursing leaders, and staff nurses need to work to restore relations that were fractured by incivility during the pandemic. In the future, improved preparedness, including establishing clear channels of communication, may lessen incivility by decreasing role stress and organizational chaos.

Capturing women's voices: lived experiences of incivility during childbirth in the United States

Increasing research has improved global awareness of mistreatment during childbirth. However, research primarily focuses on "higher-intensity" mistreatment during childbirth, and largely focuses on women outside the United States (U.S.). We address these gaps by exploring the phenomenology of incivility, a "lower-intensity" mistreatment, experienced by women during childbirth in the U.S. We used a combination of interpretative phenomenological analysis (IPA) and thematic analysis to analyze the qualitative responses (N = 200) of experiences of incivility during childbirth. We identified nine primary themes of incivility: lack of empathy, denial/minimization, ignoring, pressure, privacy issues, breastfeeding/formula issues, identity-based, uncomfortable physical interactions, and silencing. Results demonstrate incivility is critical to consider as a form of mistreatment in childbirth because it violates respect. The results help nuance the understanding of how mistreatment is experienced in childbirth. Results also demonstrate unique manifestations of incivility were shaped by the sociopolitical context of the U.S. Implications for policy development and health outcomes are discussed.

Constructing and Validating Students' Psychological Contract Violation Scale

For two and a half decades, psychological contracts are researched mainly in work organisations as drivers of the attitudes and behaviours of employees, overlooking the importance of understanding the nature of the psychological contracts of students in higher education. This study constructs and validates a new scale for measuring the perceived psychological contract violations of students in the context of faculty incivility. A mixed-method approach was applied to study the issue in three phases. First, a qualitative method was used to capture and analyse the perceived entitlements of students, as described by 78 college students, resulting in 37 items or elements identified by students as reflecting their psychological contracts. Second, a sample of 244 students was studied to identify the perceptions of violated expectations of students. In the final phase, items were rephrased as expectations and were given to the third sample of 154 undergraduate college students to determine the level of fulfilment of these expectations. Additionally, to ascertain discriminate and convergent validity measures, students were asked about the extent to which they experienced faculty incivility (discriminant validity) and frustration with the quality of interaction with their faculty (convergent validity). From these results, students’ psychological contract violation scale was constructed and validated.

Witnessed Incivility and Perceptions of Patients and Visitors in Hospitals

Research has examined instances of incivility witnessed by physicians, nurses, or employees in hospitals. Although patients and visitors are members in hospitals, witnessed incivility from their perspective has rarely been empirically investigated. The aims of the current study are 2-fold: (1) to investigate the forms of incivility patients/visitors witness in hospitals and (2) to examine whether these patients/visitors believe these incivilities impact the target’s sense of perceived control. An integration of interpretative phenomenological analysis and thematic analysis was used to code qualitative data (N = 77). Eight themes of witnessed incivility and 3 themes for impact on perceived control were identified. The results illuminate patterns of incivility targeted at marginalized groups, historically underrepresented in hospital-focused incivility research (eg, homeless individuals, incarcerated individuals, the elderly individuals). The majority of witnesses believed the incident of incivility would negatively impact the target’s perception of control, possibly affecting their experience and health. The current study demonstrates that empirically investigating witnessed incivility from the patient/visitor perspective provides critical information about the unique patterns of mistreatment occurring within hospital contexts.

A qualitative systematic review on nurses' experiences of workplace bullying and implications for nursing practice

AIMS

To explore nurses' experiences of workplace bullying and ways to prevent such occurrences.

DESIGN

A qualitative systematic review was conducted.

DATA SOURCES

Five electronic databases were searched from each database's inception to December 2020.

REVIEW METHODS

Meta-summary and meta-synthesis were conducted using Sandelowski and Barroso's approach.

RESULTS

Twenty-seven studies were included in this review. The overarching theme, 'The Vicious Cycle of Bullying in Nursing', and four themes were synthesized: (a) different 'faces' of bullying, (b) the hidden drivers of bullying, (c) impact of being bullied and (d) responses to bullying.

CONCLUSION

The nursing code of ethics and anti-bullying policies should be consistently enforced by each organization's upper management. Nurses should be provided a safe space to voice their concerns on bullying within the organization.

Exploring faculty-to-faculty incivility among nursing faculty: Related factors, reasons and solutions

AIM

This study aimed to explore faculty-to-faculty incivility in university nursing programmes and to identify the perceptions of faculty regarding the reasons and solutions for incivility.

BACKGROUND

Incivility is a fundamental problem in nursing educational settings.

METHODS

This cross-sectional and analytic study comprised 330 faculty members from different schools of nursing in Turkey. A personal information form and the 12-item Incivility Scale were used to collect data. The data were analysed by using descriptive analysis, Mann-Whitney U and Kruskal-Wallis tests, Spearman's correlation test, linear regression tests and thematic analysis.

RESULTS

Faculty and research assistants who were single and holding master's degrees perceived high incivility (p < .05). There was also a significant, mildly negative relationship between age and incivility scores (r = -0.236). A strict hierarchical structure was revealed to also be a reason for incivility (p < .05).

CONCLUSION

Further research is needed to determine the effectiveness of the solutions for faculty-to-faculty incivility.

IMPLICATIONS FOR NURSING MANAGEMENT

This study can guide administrators regarding the causes and solutions of incivility within academic environments. By implementing strategies to increase awareness, administrators can become positive role models for faculty, providing a respectful and fair work environment to prevent incivility.

Technology-enacted abusive supervision and its effect on work and family

This study examines the effects of technology-enacted abusive supervision, defined as subordinate perceptions of supervisor's use of information and communication technologies (ICTs) to engage in hostile communications. This research was designed to examine if technology-enacted abusive supervision has an impact on both the work and family domains. Based on conservation of resources theory, we theorize that technology-enacted abusive supervision enhances subordinate engagement in emotional labor surface acting, which contributes to emotional exhaustion, which in turn impacts both the work and family domains. Results demonstrate significant paths in both domains. Subordinate perceptions of technology-enacted abusive supervision are positively related to the engagement in technology-enacted incivility through the serial mediation of emotional labor surface acting and emotional exhaustion. Additionally, subordinate perceptions of technology-enacted abusive supervision are positively related to family undermining at home for the subordinate through the serial mediation of emotional labor surface acting, emotional exhaustion, and stress transmission.

A survey of the prevalence and predictors of workplace bullying towards the dental hygienist

OBJECTIVE/PURPOSE

Given the lack of research within dentistry as it relates to workplace bullying (WPB), the purpose of this study was to explore the prevalence of WPB and predictors of WPB for dental hygienists in clinical practice.

METHODS

Cross-sectional survey research was used with a convenience sample of dental hygienists (n = 943) providing patient care to explore WPB. Ninety-three per cent of participants resided in the United States, and 6.9% lived internationally. The survey was shared via social media on Facebook and Instagram group pages, specifically dental focussed. The validated Negative Acts Questionnaire-Revised (NAQ-R) was used to measure the exposure WPB using descriptive, correlation, chi-square and Mann-Whitney U.

RESULTS

The completion rate was 81% (n = 765). Results showed 21% of participants had experienced WPB now and then, 9.4% several times a week and 2.9% almost daily. Predictors for WPB included highest degree earned (p = -0.03), US (United States) region of residence (p = 0.001), clinical setting (private practice vs. dental service organization) (p < 0.001), clinical years of experience (p = 0.002) and work status (full- or part-time) (p = 0.02).

CONCLUSIONS

The findings confirmed WPB has been experienced by 1 in 5 clinical dental hygienists. Dental hygienists in their early years are more likely to have reported workplace bullying than those with more years of practice. WPB is not a new phenomenon, but given the prevalence observed in dental hygiene participants, employers need to be active in preventing and managing bullying to create and maintain an effective dental team and positive work environment.

The hollow: A theory on workplace bullying in nursing practice

BACKGROUND

Incivility and bullying within the profession of nursing remains a problem within the workplace. As a result, healthcare workplaces can become unhealthy and difficult for nurses to function within. Work productivity is impacted and patients' healthcare is placed at risk when nurses are emotionally and physically affected by workplace incivility and bullying. Clinical nurse leaders (CNLs) applying theoretical reasoning and nursing competencies' in addressing bullying and incivility within the workplace, can provide an organized and effective organizational approach to addressing bullying and incivility in work environments.

METHODS

Theoretical reasoning and nursing competencies in addressing bullying and incivility within the workplace, will be examined as a means to identify nurses exhibiting signs and symptoms of bullying and incivility in work environments. The theory of The Hollow will identify the origins of affected nurses' behaviors and the physiological and psychological impact of bullying and incivility. The CNL role will be used as a facilitator of change at the microsystem level. And competencies for addressing behaviors associated with bullying and incivility will be addressed.

APPROACH

Innovation adapted from prior research and literature developed by the author, extrapolated from the literature on workplace bullying and incivility in nursing practice.

OUTCOMES

Bullying and incivility can be resolved in the workplace when competencies are set forth by nursing leaders to educate and empower nursing staff on expectations of healthy work environments.

CONCLUSION

Healthy workplaces are achievable when nurse leaders, such as CNLs, educate and empower nurses to have the expectation of healthy work environments not only for themselves, but for all nurses.