Nurse Leaders Research Articles

Unethical conduct as a multifaceted phenomenon in psychiatric care: Nurse leaders' perspectives.

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization.

Nurse Leader Perspectives and Experiences on Caregiver Support Following a Serious Medical Error

OBJECTIVE This study explored nurse leaders' perspectives and experiences in supporting nurses following a serious medical error. BACKGROUND Appropriate support is crucial for nurses following an error. Authentic leadership provides an environment of psychological safety and establishes a patient safety culture. METHODS A cross-sectional survey research design was conducted to determine nurse leader's (NLs') perspectives on supporting nurses following a medical error. RESULTS NL training on handling serious medical errors varied. NLs indicated experiencing a variety of formal support programs: peer support, education, error examination, employee assistance, and just culture. Following an error, NLs reported these interventions were helpful, including education/retraining, psychological safety, time off the unit, identifying system failures, nurse involvement in disclosure, and peer support. CONCLUSION This study illuminates how NLs support nurses following an error. It provides insight into the education of NLs on assisting nurses and the need to implement formal caregiver support programs.

Nurses' and midwives' perception of the leadership skills and attributes required of future leaders.

Identify the skills and knowledge future nurse and midwife leaders might require in the next 6 years. Design/methodology/approach: An online questionnaire elicited health professionals' perspectives on the future requirements for nurse and midwife leaders. Qualitative data were generated in response on health care and the likely leadership skills for the future. Data were extracted and analysed using qualitative content analysis. Four generic categories were abstracted from the core category 'Nursing and Midwifery Leadership'. These were values/traits; creating positive healthcare cultures; digital capability/competence; and systems thinking. Limitations/implications. This first stage evaluation has gained a wide variety of perspectives regarding the perceived skills and knowledge future nurse and midwife leaders might need. This is important to enable those who deliver leadership development programmes to plan appropriately, ensuring their programmes are designed and adjusted in response to the needs of a shifting health and care landscape. However, over 50% of respondents were White, so the data may not be representative of the diversity of registered nurses and midwives. The findings may not have direct relevance to the global context due to geographical limitations.

When Leaders Don’t Walk the Walk: A National Survey of Academic Nurse Leader Perceptions of Staff Burnout

When Leaders Don’t Walk the Walk: A National Survey of Academic Nurse Leader Perceptions of Staff Burnout

Characteristics of Successful Leadership: Perspectives From Asian Nursing Leaders.

The development of nursing leaders is an important topic in changing healthcare environments. Successful nursing leadership is critical to the reconstruction, implementation, and evaluation of healthcare systems worldwide. However, the characteristics of successful nursing leadership remain unclear, especially in a global context. Furthermore, despite the growing importance of cultural intelligence, cross-cultural concepts of successful nursing leadership have been inadequately addressed in the literature. This study was designed to identify the characteristics of successful leadership in nursing from the perspective of Asian leaders in four countries (United States, Taiwan, Korea, and Japan) and to make recommendations for successful leadership in nursing in the future. A qualitative approach employing five strategies, including in-depth discussions through face-to-face and email discussions, an integrated literature review using multiple databases, responses to 10 topics related to nursing leadership, and written note summaries of the characteristics of successful leadership, was used in this study. A total of 10 nursing leaders from four countries were recruited as participants using snowball sampling. The collected qualitative data were analyzed using line-by-line coding and simple content analysis to extract the characteristics of successful leadership in nursing. The final sample included seven nursing leaders aged between 55 and 70 years. All of the participants were in nursing leadership positions at schools/colleges of nursing or professional organizations for at least two decades and had extensive leadership experience through their schools/colleges, professional organizations, and/or governments. Five key themes related to the characteristics of successful leadership were identified from the participants: (a) culturally and historically prescribed, (b) overcoming gendered experience, (c) equipped with good character, (d) guiding with a vision, and (e) with contextualized leadership. Five characteristics of successful leadership were identified from the perspective of Asian nursing leaders. All of the participants recommended that successful nursing leadership be based on contextual leadership and that successful nursing leadership help meet rapidly changing needs, enable mutual trust, and actively commit and complete necessary risks. Moreover, future successful leadership should have a clear vision and strongly guide the implementation of changes as well as be equipped with cultural intelligence. Finally, successful nursing leadership should be based on ethical, trustable, and humane behaviors while promptly and adequately responding to the changing needs of their institutions/organizations. Cross-regional research on successful nursing leadership is essential to enrich the global evidence and knowledge on developing the next generation of nursing leaders.

Mediating effect of Felt obligation between Inclusive leadership and Caring behavior of Chinese nurses

PurposeIt aims to validate the mediating role of felt obligation between inclusive leadership and the caring behavior of clinical nurses using a structural equation model. MethodsAll of the nurses were investigated with the general Information Questionnaire, Caring Behavior Scale, Felt Obligation Scale and Inclusive Leadership Questionnaire. AMOS 21.0 was used to construct the structural equation model and analyze the mediating effect of felt obligation, and Bootstrap method was used to test the mediating effect model. ResultsThe total scores of caring behavior, felt obligation and inclusive leadership were 125.25±18.31,21.38±3.36 and 38.04±6.56 respectively. Felt obligation played a partial mediating role in the relationship between inclusive leadership and caring behavior of nurses, and the mediating effect accounted for 43.5%. ConclusionsFelt obligation plays a partial mediating effect between inclusive leadership and caring behavior of nurses. Nursing managers can adopt the leadership concept of inclusive leadership to enhance the level of felt obligation of nurses, so as to better improve the caring behavior of nurses.

Promoting Nursing Diversity, Equity, and Inclusion Through Virtual Reality Learning.

Nurse leaders are foundational to the success of creating an inclusive culture and climate and responding to situations of discrimination, racism, microaggressions, and bias in healthcare settings. This article describes a leadership education initiative using virtual reality to provide diversity, equity, and inclusion training for nurse leaders. Immersion in a lived experience provides a safe and effective learning environment to promote, improve, and exemplify diversity, equity, and inclusion principles and should be explored for other educational applications.

Nursing student reflections on a research internship: A reflective discussion following the Gibbs' reflective cycle

BackgroundEvidence-based practice underscores the importance of utilising research-based skills in the delivery of care. However, entry-to-practice nursing curriculums in Australia currently do not provide students with practical research opportunities. Acknowledging this gap, an Australian university initiated a two-month summer research internship that aim to expose undergraduate nursing students to clinical research under the mentorship of a nursing academic. AimTo understand the opportunities and challenges of a research internship and its contribution to developing research knowledge and skills for future nursing practice and leadership. DesignA reflective discussion following the six stages of the Gibbs' Reflective Cycle. SettingsA two-month research internship at an Australian University was held over the summer. ParticipantsTwo successful nursing students (FO and BM) who were both students in the Master of Nursing (Graduate Entry) program. MethodsFollowing the Gibbs' Reflective Cycle, a description of the internship experience was outlined, alongside feelings encountered. The opportunities and challenges of the internship are explored, evaluated, and analysed with related literature to inform an overall conclusion. To support other nursing students pursuing similar research endeavours during their professional transition, an action plan was developed. ResultsThe optional summer research internship proved to be a valuable experience for participating nursing students. FO and BM were granted co-authorship on their respective research projects, providing opportunities at international nursing and midwifery conferences and several avenues for career advancement. ConclusionsNursing research internships contribute to students' personal and professional development. This paper highlights the need for universities to provide innovative educational opportunities to students that enrich evidence-based nursing practice and inspire further opportunities.

Commentary on “Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis” by Travers and colleagues (2024)

The purpose of this commentary is to highlight key points made by Travers and colleagues (2024) in their study entitled, “Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis” and provide additional recommendations for future research and policy related to diversity in academic nursing leadership. While there is a significant underrepresentation of racial and ethnic minoritized populations in academic leadership in nursing, the level of underrepresentation and contributors to underrepresentation are not the same across racial and ethnic minoritized populations. As we design strategies to promote diversity in academic nursing it is important to benchmark efforts to ensure representation from groups who experience the most significant health inequities, create tailored strategies that consider the unique historical and contemporary barriers to leadership in academic nursing across and within minoritized groups, and build upon evidence-based strategies, especially the important role that minority serving institutions have played.

Nurse leaders’ recommendations for implementing LGBTQ+ inclusive practices in health systems: A qualitative descriptive study

BackgroundDiscrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders’ perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems. MethodsTwenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders’ definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation. ResultsNurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices. ConclusionImplementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable.

Nurse Leadership in Disaster Preparedness in 5 Community Health Centers in the Ende Regency City

Nurses have a very strategic role in reducing risk. This research aims to determine the relationship between nurse leadership and disaster preparedness. The research design used in this research is descriptive analytic with a cross sectional approach. This research was carried out at the Community Health Center from January to October 2023. The population in this study were all nurses at the Ende Regency. Sampling was taken using a non-probability sampling technique, namely purposive sampling. Data were processed using SPSS software in two stages, namely descriptive analysis and bivariate analysis. The research results show that leadership is in the good category with a p value (0.90). Nurses in general are not prepared to be leaders, especially in disaster preparedness

Setting national nursing research priorities in Qatar: A Delphi survey.

To establish consensus on the priorities of nursing research in Qatar regarding nursing administration, nursing practice and nursing education for the years 2023-2033. Classic Delphi format over three phases. The first phase involved a qualitative round where participants identified 10 research priorities. In phase two, the collected sentences were analysed and grouped into themes. Participants were then requested to rate these sentences based on their perceived importance. During phase three, participants received their individual responses, the consolidated group response from the second round, and were given the opportunity to agree or disagree with the group ranking. The panel of experts consisted of 32 participants who agreed to participate in all three rounds. They included a mixture of nursing academics, clinical managers and nursing directors from public sectors and nursing schools in Qatar. The experts reached a consensus on the research priorities for Qatar. These prioritized topics focused on improving patient care outcomes, enhancing workforce development, strengthening nursing leadership, integrating technology to improve nursing and nursing education and promoting evidence-based practice. This research emphasizes the importance of progress in nursing to meet healthcare demands. Findings showed the need of future research to focus on improving nursing workforce and well-being, leadership styles and technology, and evidence-based practice and technology in nursing education. The impact of identifying nursing research priorities in Qatar will improve healthcare practices, fostering a culture of evidence-based care. These advancements will motivate nurses to engage more actively in research, thereby enhancing overall healthcare outcomes. Not applicable.

Knowing, Being and Becoming a Person-Centred Nurse Leader: Findings from a Transformative Professional Development Programme.

Background/Objectives Leadership is central to the development of effective workplace cultures and as such should be viewed as a practice that is relational, exercised through a process of mutual and reciprocal influence. Person-centred leadership is an approach to leadership that supports a way of being that is authentic, prioritising values lived out in action. However, there is an increasing recognition that leadership development has not been impactful in relation to workplace culture. This paper reports on the ongoing evaluation of an innovative development programme (Queen's Nurse Development Programme), the overall aim of which was to illuminate the participants' experiences of engaging in transformative learning and development and identify the technical and transformative outcomes arising. The programme focused on developing leadership capacity for societal change and maximising the health impact of community nursing leaders. Methods The methodological framework for evaluation was underpinned by a Collaborative Critical Creative Inquiry. Twenty community nurses were selected to undertake the programme during 2020. The collection and analysis of data was consistent with the Collaborative Critical Creative Inquiry and was conducted as a one-day workshop, with participants engaged in a cycle of creative hermeneutic analysis. Results A total of seven themes were identified, including: sense of belonging; personal growth; developing new skills; finding voice; importance of self-care; and creating a safe place. This illuminated how the transformative learning and development processes within this programme were experienced and how these enabled participants to explore how they influence their practice and workplace. It is the journey with self that generates a sense of belonging and enables personal growth and the ability to care for self and others. Conclusions The key learning from this innovative development programme is the importance of focusing on the attributes of practitioners and the key building blocks for knowing, being, and becoming a person-centred practitioner.

Exploring Organisational Agility's Impact on Nurses' Green Work Behaviour: The Mediating Role of Climate Activism.

To examine the relationship between organisational agility and nurses' green work behaviour and to assess how climate activism mediates this relationship. Understanding this relationship is crucial for promoting sustainable practices in healthcare. A cross-sectional research design was employed. This approach was chosen to examine how organisational agility and climate activism simultaneously influence green work behaviour in the present context, providing a snapshot of their synergistic interactions. This study was conducted in 2024 at eight hospitals in Egypt, with a total of 781 nurses conveniently selected for participation. Data were collected using validated instruments: the Agility Survey, Employee Green Behaviour Scale and Environmental Action Scale. Correlation and path analyses were utilised to test the study hypotheses. Nurses reported moderate levels of organisational agility, climate activism and green work behaviour. Statistically significant positive correlations were found between organisational agility, climate activism and green work behaviour. Organisational agility and climate activism emerged as significant predictors of green work behaviour, with climate activism acting as a partial mediator between organisational agility and green work behaviour. This study contributes to the growing body of knowledge on fostering sustainable nursing practices as results indicate that agile organisations, which embrace flexibility and nurse-led climate initiatives, are better positioned to promote sustainable behaviour. Practical strategies include selecting nurses with high climate literacy, designing agile working strategies and promoting eco-conscious behaviours. Nurse leaders should develop policies that integrate climate initiatives into everyday practice to enhance green work behaviour. The healthcare sector faces increasing environmental challenges, making it crucial to foster green work behaviour. Our study addresses a gap in the literature by revealing that organisational agility and climate activism are essential drivers of green behaviour among nurses, offering actionable insights for greening healthcare practices. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). No patient or public contribution.

The Personal Faculty Mentor (PFM) Role: Advanced Support for Individualized Student Care

Background - Given the complexity of student responsibilities and backgrounds, the need for additional support during graduate education is evident for overall success. An innovative role that addresses these complexities and mitigates issues facing today’s nursing student was developed. Purpose - The Personal Faculty Mentor (PFM) role was developed to provide one, specific point of contact in an effort to support students throughout their MSN journey by completing new student orientation, individualized student outreach, frequent personal communication, and development of success plans. The PFM role also supports the faculty or instructor role by providing additional support and outreach with student concerns (low participation or scores). The overall purpose of the PFM is to improve student outcomes including pass rates, persistence rates, and satisfaction. Methods - Within the University’s Master of Science in Nursing Accelerated Track (MSN AT) Advanced Generalist and Clinical Nurse Leader (CNL), the PFM role was implemented to support student success. The MSN AT has flexible due dates for assignments which lends for more intensive student support. Results – Since the PFM role has been in place since program inception (July 2019), persistence and program completion are on average 12% higher, as high as 29%, with those students who actively participate with their PFM. Through survey, students report high satisfaction with the PFM role and attribute part of their success to this supportive role. Each session, students who actively participate with their PFM have better persistence than those who do not. Limitations – While the anecdotal feedback and positive outcomes are noteworthy, this strategy did not involve an empirical research investigation. As a result, a causative relationship may not be concrete. There is clearly an improvement in the retention and persistence of students who engage regularly with the PFM; however, there are additional variables that may be impacting the outcomes that would be helpful to identify. Conclusions / Implications for Practice - Student support promotes success. The role of the PFM provides individualized, student-centered support. Students who participate and interact with their PFM are more likely to be successful in the MSN AT.

Nurses as UN champions: Increasing nursing presence and influence at the United Nations.

Representing half of the global health workforce, nurses are critical to health promotion, disease prevention, and the economic and social needs of populations. However, nursing expertise is underutilized in the UN System, and nurses are underprepared for roles in policy to influence global health and sustainable development. Innovative education strategies are necessary to address the sidelining of nursing expertise in these spaces and build nursing literacy in shaping global policy. This quality improvement project aimed to develop and evaluate a model to build a USA-based school of nursing's literacy and engagement with the United Nations (UN) System. A Doctor of Nursing Practice (DNP) student developed an innovative educational model, the United Nations Essentials for Global Nursing Leadership, in partnership with a school of nursing (SON), to build faculty knowledge and skills on initiating and sustaining bidirectional engagement with the UN. In 2023, SON faculty piloted the model, and pre-/post-intervention survey data were utilized for improvement. Participants reported increased knowledge, awareness, and confidence related to the UN System and their ability to engage as policy influencers, health diplomats, and global citizens. In total, 100% of participants volunteered to hold the role of UN champion for the SON. This innovative model advances nursing knowledge and coherence in the UN System and key areas of policy, diplomacy, and global governance for meaningful UN engagement. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY: Models that invest in closing the global nursing leadership preparation gap can raise the profession's visible UN presence and strategic policy influence at a critical time for people and theplanet.

Unit Leadership and Climates for Evidence-Based Practice Implementation in Maternal-Infant Health Units: A Cross-Sectional Descriptive Study.

To describe unit leadership and climates for evidence-based practice implementation and test for differences in unit leader and staff nurses' perceptions within maternal-infant units. A cross-sectional descriptive study. A convenience sample of maternal-infant unit leaders and nurses (labour, postpartum, neonatal intensive care, paediatrics) from four Midwestern United States hospitals completed a survey including the Implementation Leadership Scale (ILS) and Implementation Climate Scale (ICS). Descriptive statistics described items, subscales and total scores. Independent t-tests with Bonferroni correction tested for differences in perceptions. A total of 470 nurses and 21 unit leaders responded, representing 17 units. Ratings of unit leadership and climates for implementation were modest at best [ICS: M = 2.17 (nurses), 2.41 (leaders); ILS: M = 2.4 (nurses), 2.98 (leaders)]. Unit leader ratings were statistically significant and higher than nurse ratings. This study is one of the first to describe unit leadership and climates for implementation in maternal-infant health. To improve outcomes and equity in maternal-infant health, attention on leadership behaviours and unit climates for evidence-based practice implementation is needed. Nurse leaders are encouraged to evaluate their leadership behaviours and the unit climates they facilitate, and work to improve areas of concern or where staff perceptions differ. Staff nurses should work with their leaders to identify resources and rewards/recognition which support and facilitate EBP implementation. This study addressed a gap in research examining the social dynamic factors of unit leadership and climate for evidence-based practice implementation in maternal-infant units. Leadership behaviours for implementation and unit climate were rated moderately by both staff and leaders. Unit leaders rated their implementation leadership and climates higher in almost all items. This study is relevant to unit leaders and nurses in maternal-infant units in the United States. This study adhered to STROBE guidelines. No patient or public contribution.

Resilience, compassion fatigue, moral distress and moral injury of nurses.

Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study.

Investigation of Resonant Leadership, Work Engagement and Employee Performance in Nurses

The aim of this study is to examine the relationships between resonant leadership, work engagement and employee performance and to reveal whether work engagement has a mediating effect on the effect of resonant leadership perception on employee performance. Another aim of the study is to determine whether nurses’ perceptions of resonant leadership, work engagement and employee performance differ according to various socio-demographic characteristics (such as age, gender and educational status). The study was carried out on 310 nurses working in a university hospital in Edirne, Turkey. According to the analyses made in the study, resonant leadership explained 8.7 per cent of the total variance on work engagement and 2 per cent of the total variance on employee performance; it was determined that work engagement explained 22.2 per cent of the total variance on employee performance. As a result of the analyses, it was determined that the effect of resonant leadership perception on employee performance was mediated by work engagement.

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

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. Four databases were searched from January 2018 to April 2023. Thematic analysis was used to analyze 22 studies. 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. 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. 202x;5x(x):xx-xx.].