Building Confidence, Diminishing Stress: A Clinical Incivility Management Initiative for Nursing Students.

Abstract

The aim of this study was to evaluate the effectiveness of an interactive program designed to reduce nursing students' perceived stress and improve self-efficacy and readiness to professionally address incivility during clinical practice. Incivility in clinical settings adversely impacts learners, educators, institutions, and healthcare systems, undermining safety and the teaching-learning process. Despite its increasing global prevalence, effective interventions remain largely unexplored. Our mixed-methods study, conducted from March to April 2024, involved senior baccalaureate pre-licensure nursing students (N = 35) from a California State University. The three-week, one-hour-per-week, interactive clinical incivility management program was developed through an extensive literature review. Pre- and post-intervention differences were assessed using a 10 min self-administered online survey that included the Uncivil Behavior in Clinical Nursing Education (UBCNE; 12 items), Perceived Stress Scale (PSS; 10 items), General Self-Efficacy Scale (GSE; 10 items), and a sample characteristics questionnaire (11 items). A one-hour face-to-face focus group (n = 11) then provided qualitative data on personal experiences of clinical incivility. Quantitative data were analyzed using SPSS version 27, while qualitative data were analyzed using Colaizzi's method. Clinical incivility prevalence was 71.4% (n = 25 out of 35). No statistically significant differences were found in UBCNE, PSS, and GSE scores between pre- and post-intervention. However, professional responses to clinical incivility significantly improved after the intervention (t = -12.907, p < 0.001). Four themes emerged from the qualitative data: (a) uncivil behaviors or language from nurses, (b) emotional discouragement and low self-confidence, (c) resource and personnel shortages at clinical sites for education, and (d) the necessity for interventions to manage clinical incivility. Nursing schools and clinical agencies should collaborate to establish monitoring systems, enhance communication, and implement evidence-based policies and interactive interventions to prevent and manage clinical incivility experienced by nursing students from clinical sites.