Uncivil Behavior Research Articles

Impact of the presence of a mediator on patient violent or uncivil behaviours in emergency departments: a cluster randomised crossover trial.

Several studies reported that violent behaviours were committed by patients against healthcare professionals in emergency departments (EDs). The presence of mediators could prevent or resolve situations of tension. To evaluate whether the presence of mediators in EDs would have an impact on violent behaviours committed by patients or their relatives against healthcare professionals. Design, settings and participants A 6-period cluster randomised crossover trial was performed in 4 EDs during 12 months. Patients aged ≥18 and their relatives were included. In order to prevent or resolve situations of tension and conflict, four mediators were recruited.Outcome measure and analysis Using a logistic regression mixed model, the rate of ED visits in which at least one act of violence was committed by a patient or their relatives, reported by healthcare professionals, was compared between the intervention group and the control group. A total of 50 429 ED visits were performed in the mediator intervention group and 50 851 in the control group. The mediators reported 1365 interventions; >50% of the interventions were to answer questions about clinical management or waiting time. In the intervention group, 173 acts of violence were committed during 129 ED visits, and there were 145 acts of violence committed during 106 ED visits in the control group. The rate of ED visits in which at least one act of violence was committed, was 0.26% in the intervention group and 0.21% in the control group (OR = 1.23; 95% CI [0.73-2.09]); on a 4-level seriousness scale, 41.6% of the acts of violence were rated level-1 (acts of incivility or rudeness) in the intervention group and 40.0% in the control group. The presence of mediators in the ED was not associated with a reduction in violent or uncivil behaviours committed by patients or their relatives. However, the study highlighted that patients had a major need for information regarding their care; improving communication between patients and healthcare professionals might reduce the violence in EDs. Clinicaltrials.gov (NCT03139110).

Detrimental impact of employees' job demand on their workplace incivility behaviour: Restorative role of self-efficacy

This study aimed to measure the impact of employees' job demands as a stressor on exhibiting their uncivil behavior at the workplace and the remedial role of self-efficacy for the detrimental effect of job demand on workplace incivility behavior. Research on employees' uncivil behavior in the workplace is crucial to understanding its causes, impacts, and potential interventions, enabling organizations to foster a respectful and productive work environment, enhance employee well-being, and optimize organizational performance. Employees of the Nepalese cooperative industry participated in a survey to gather empirical data. The perceptual cross-sectional data were analyzed using a positivist research methodology and deductive reasoning. Altogether, 495 responses were analyzed quantitatively using "Analysis of Moment Structure" (AMOS) software and graphically presented. The result revealed that employees' perceived job demand positively affected (B = 0.43, p < 0.001) their workplace incivility behavior. At the same time, self-efficacy had a negative impact (B = -0.32, p <0.001) on uncivil behavior at the workplace. In addition, self-efficacy moderated (B = -0.47, p <0.001) the connection between job demand and workplace incivility behavior. Job demands positively impacted incivility for employees with low self-efficacy, but the effect was insignificant for those with high self-efficacy. Moreover, employees with low perceived job demand exhibit higher workplace incivility behavior (WIB) when they have high self-efficacy compared to low self-efficacy. These findings have implications for addressing job demands and fostering self-efficacy to mitigate workplace incivility. Further avenues for research are discussed.

Perception and Contributing Factors of Academic Incivility Among Undergraduate Nursing Students in India

Introduction Academic incivility in students has the potential to undermine the learning process because it affects both the perpetrator and the educator. This results from the reduced trust between students and faculty resulting in a reduction in productivity, thereby impeding the learning process. Objectives The study was conducted to understand the perception and factors contributing to academic incivility among undergraduate nursing students. Methods A descriptive cross-sectional survey was conducted. A total of 250 undergraduate nursing students studying in three nursing colleges in India participated in the study. A convenience sampling approach was used to recruit the participants. A 13-item Uncivil Behavior in Clinical Nursing Education (UBCNE) tool was used to collect the data. Results The study found that 7.56% of the sampled nursing students always indulged in uncivil behavior, 9.51% of them often indulged in uncivilized activities, while 20.06% of them reported sometimes indulging in uncivil behavior. This means that 37.45% of the nursing students sampled engaged in some forms of uncivil behavior. In contrast, the study found that 62.55% of the nursing students never indulge in uncivilized activities. The contributing factors of academic incivility were the academic setting, the student's academic preparation, the teacher's attitude, emotional disturbance, substance abuse, cultural issues, and social issues. There was no significant association between the demographic variables and the level of perception on academic incivility among nursing students at p < .05. Conclusion It is important to understand the perceptions and factors that predispose students to engage in uncivil behavior given the prevalence of this educational challenge. Corrective strategies are needed to educate the perpetrators about the ill effects of their actions.

Unmasking Incivility in Nursing: The Hidden Cost to Patient Care

Nursing is a respected and noble profession. Nurses are considered compassionate, skillful, and highly ethical. Once again for the 21st consecutive year, nurses are ranked the most trusted profession. Despite the positive accolades that the nursing profession has received over the years, there is pervasive plague which diminishes the reputation of the profession; incivility. Incivility in the nursing profession is associated with decreased job satisfaction, staff shortages, and alterations in physical well-being and mental anguish. Nursing incivility has a negative impact on healthcare organizations. The results can be seen in decreased productivity, increased absenteeism, increased turnover, and overall job dissatisfaction. These can cause strains on other staff and healthcare administration. Besides issues with morale and employee satisfaction, there are real financial costs associated with lost productivity and employee turnover. Uncivil actions and behaviors among nurses are delivered in many different forms from subtle to very aggressive and overt. While the literature is abundant with evidence to substantiate the existence of incivility in the nursing profession, it is imperative to raise awareness to the current culture and climate in nursing as it poses great risk to patient safety. A hostile work environment fractures interpersonal relationships thus contributing to the breakdown of essential communication methods needed to maintain safe delivery of care. Attempting to deliver nursing care in an environment where there is intimidation, violence, and bullying increases the risk of nurses making errors such as with medication administration. Over 100,000 reports of medication errors a year are reported and the estimated cost of these errors is $42 billion annually. The repercussions associated with incivility are massive as the effects are felt on an individual, the profession, health care agencies, nursing academia, and consumer (the patient.

Perceptions of incivility in a nursing school at a university in South Africa – Cross-sectional study. “Incivility in nursing education – Is it a problem?”

BackgroundRespectful civil behaviour of nurses is key to nursing practice and can directly affect quality of patient care. Reports of international studies on incivility in nursing schools is well documented, however little is known about incivility in nursing schools in South Africa. This study aimed to describe the nursing students’ perception of the level and occurrence of incivility in nursing students and faculty at a nursing school at a university in South Africa. MethodsA quantitative descriptive cross-sectional survey was conducted. A self-administered questionnaire was used to determine the student nurses’ perceptions of levels and occurrence of incivility among nursing students and faculty. The questionnaire included the Incivility in Nursing Education-Revised (INE-R) scale. A sample of 277 was calculated, and an all-inclusive sampling method was used to target all undergraduate nursing students. Data was analysed using IBM Statistical Package for Social Sciences (SPSS) version 27 and descriptive statistics, 95% confidence intervals were used to describe the data and Independent Samples Mann-Whitney U tests were used to compare gender differences. ResultsThe questionnaire was completed by 540 (77 %) undergraduate nursing student respondents, between 12 March 2021 and 20 April 2021. Respondents reported low levels of perceived student incivility behaviours (2.07 ± 0.7 [95 %CI 2.0–2.1]), with using a computer, phone, or other media device during class, meetings, activities for unrelated purposes being the highest rated perceived low-level student incivility behaviour (2.52 [95 %CI 2.43–2.62]. Low levels of perceived levels and occurrence of low faculty incivility were reported with respondents rating arriving late for class or other scheduled activities as the highest rated perceived level of low incivility behaviour (1.91 [95 %CI 1.82–1.99]). The highest perceived occurrence for low faculty incivility was being unavailable outside of class (not returning calls or emails, not maintaining office hours) (1.82 [95 %CI 1.74–1.9]). ConclusionThough some perceived incivility amongst students and faculty in the selected nursing school exist, the occurrence is perceived to be low. Further investigations should explore the impact of uncivil behaviours in academic theory environments, and the impact on individuals in practice.

An Online Cross-Sectional Study of Nursing Students' Perceptions of Workplace Incivility in Nursing Schools During the COVID-19 Pandemic.

Despite a growing body of evidence on academic incivility, limited information exists on workplace incivility perceived by nursing students in nursing schools. This study, conducted amid the COVID-19 pandemic, explores nursing students' perceptions of workplace incivility in Jordanian nursing schools and investigates demographic-based differences. This study employed a descriptive cross-sectional design, using an online survey for data collection. A convenience sample of 104 nursing students from diverse backgrounds and various Jordanian universities participated, allowing for a comprehensive examination of workplace incivility perceptions at a specific point in time. The online survey ensured efficient data collection, enhancing accessibility and ease of participation. This approach aimed to capture a snapshot of nursing students' perspectives on workplace incivility within a given time frame and across multiple educational institutions, efficiently gathering data from a geographically dispersed and demographically varied sample. Students perceived workplace incivility in nursing schools as "mild," with moderate confidence in schools' ability to address it. Workplace civility was rated between 60.00% and 70.00% on a 0-100 scale. The overall mean for uncivil behaviors was "sometimes," with criticism of expertise as the most common. Incivility in the past year was seen as "rare," with misusing authority being the most frequent. Male and low-GPA students reported higher perceptions of incivility. Stress was the most perceived contributing factor, and a lack of administrative support was the main barrier. Establishing codes of conduct was considered the key strategy for fostering workplace civility. Workplace civility is prevalent in Jordanian nursing schools, even amid the COVID-19 pandemic. However, the occasional occurrence of incivility behaviors should be approached with caution. To enhance perceptions of workplace civility, nursing schools should prioritize effective teaching, a friendly environment, and respectful relationships. Encouraging faculty members to reassess their performance, starting with identifying academic workplace incivility, is crucial.

Does family incivility trigger suicidal ideation? The role of emotional exhaustion at work and regulation of emotion

PurposeDespite the prevalence of uncivil behaviors across families and past studies attributing work stressors to suicidal ideation (SI), there is no conclusive evidence of the interactive effect of family incivility (FI) aggravating SI. Hence, the purpose of this study is to explore the association between FI and SI through emotional exhaustion (EE) in the workplace and regulation of emotion.Design/methodology/approachA time lag (T1 and T2) study is applied for primary data collection using a survey questionnaire. The partial least squares–structural equational modeling algorithm tests reliability, validity and hypotheses.FindingsExperiencing FI exacerbates SI, while the regulation of emotion and EE mediate the association between FI and SI.Practical implicationsProfessionals are advised to adopt regulation of emotion that fosters desirable behavior and shields targets from FI and EE, minimizing the intensity of SI.Originality/valueThis study significantly adds to how FI and EE aggravate SI and contribute to the body of knowledge on the regulation of emotion in stress and coping mechanisms.

Perpetrator-Targeted Reciprocated Incivility: The Investigation of the Incivility Spiral and the Effects of Agreeableness as a Moderator

Workplace incivility can result in detrimental effects for the members of the organization. One characteristic of the workplace incivility theory is that this low-intensity behavior can escalate into more severe forms of aggression through incivility exchange. Using the experimental vignette method and content analysis technique, the present study examined perpetrator-targeted reciprocated incivility and the moderating effects of agreeableness in order to clarify the effects of the incivility spiral. 296 employees in the United States were recruited from Amazon’s Mechanical Turk. The results of the multilevel regression analyses suggest that the more an individual perceived their coworker’s behavior as uncivil, the more likely they were to reciprocate incivility. Individuals high on agreeableness were less likely to reciprocate uncivil behavior.

When workplace incivility begets ineffectual employee silence-the role of rationalized knowledge hiding and regulation of emotion

PurposeThe purpose of the study is to investigate the relationship between workplace incivility (WIN) and ineffectual employee silence (IES) through rationalized knowledge-hiding (RKH) and regulation of emotion, drawing on the conservation of resources (COR) and social exchange theory (SET).Design/methodology/approachThe study employed a cross-sectional design and used the partial least squares (PLS)-structural equational modeling (SEM) algorithm to test the reliability, validity of the measurement and hypotheses using a sample of 252 information technology (IT) professionals.FindingsThe results demonstrate that experienced WIN and RKH behavior significantly exacerbate IES. On the other side, the regulation of emotion decreases the negative influence of WIN and aids in the reduction of IES.Practical implicationsThe study suggests that organizations should take appropriate measures to alleviate WIN, which might prevent concealing information/knowledge, IES and encourage employees to practice regulation of emotion.Originality/valueThe study significantly contributes to the relationship between uncivil behavior and ES and expands the knowledge on the mediating roles of RKH and regulation of emotion.

Recognizing and Addressing Ghosting of Nursing Candidates.

Ghosting of applicants in nursing recruitment can be considered uncivil behavior. Ghosting, or cutting off communication with another person without explanation, is a problem that can be addressed by setting organizational and industry standards for the handling of nursing applicants. This column reviews the phenomenon of ghosting in the recruitment process and offers suggestions to ensure this experience does not occur.

The Impact of Customer Incivility and Its Consequences on Hotel Employees: Mediating Role of Employees’ Emotional Exhaustion

Employees’ negative outcomes have continued to be the logical position emphasized by service-oriented organizations that ‘the customer is always right’ and organizational policies that require employees to make customers happy, even in situations involving a customer’s uncivil behavior. The current study builds and evaluates a research model that analyzes the associations among customer incivility, employees’ emotional exhaustion, employees’ intentions to quit the workplace, and employees’ satisfaction at the workplace using the conservation of resources theory. Employees from four- and five-star hotels in Pakistan. The data shows that customers’ incivility boosts employees’ emotional exhaustion and employees’ intentions to quit the workplace, but intentions have no effect on employees’ satisfaction at the workplace when using structural equation modeling. The results show that employees’ emotional exhaustion slightly mediates customers’ incivility influence on employees’ intentions to quit the workplace while totally mediating customers’ incivility effect on employees’ satisfaction at the workplace. The findings’ implications, limitations, and future directions are examined.

The effects of descriptive and injunctive social norms on workplace incivility

AbstractThis research examines workplace incivility through the lens of the focus theory of normative conduct, demonstrating effects of descriptive and injunctive norms on incivility perpetration. Using an experimental vignette methodology, Study 1 demonstrated that incivility intentions toward an insulting colleague were higher when organizational incivility (vs. civility) was described as both common (descriptive norm) and approved (injunctive norm). Study 2 disentangled the influences of descriptive from injunctive norms, demonstrating that each exerts an independent effect on incivility intentions. In Study 3, workers' perceptions of the descriptive and injunctive norms for incivility at their organizations predicted their uncivil intentions toward an insulting colleague—beyond the effects of other established workplace mistreatment predictors. Study 4 replicated these findings in predicting uncivil behavior frequency; additionally, job satisfaction accentuated the effects of both norm types and organizational identification amplified the effects of injunctive norms. Overall, results support key tenets of the focus theory of normative conduct, provide novel evidence for individual difference moderators of the norms' effects, and suggest that norm‐based persuasive messaging interventions may hold promise for discouraging workplace incivility.

Promoting civility and safety with cognitive rehearsal.

Uncivil behaviors have detrimental consequences that can impact healthcare team cohesion, resulting in conflicts and poor teamwork. This article details civil and uncivil behaviors and how the latter affects healthcare, and provides a tool to prepare nurses for uncivil encounters.

Confrontation and Avoidance of Uncivil Behaviors in the Workplace: Empirical Evidence From the Tourism Industry

This study examines factors hindering employee engagement, focusing on perceived workplace incivility and its relationship with work engagement. It also presents the mediating and moderating roles of emotional responses and coping mechanisms in the workplace to determine “why” and “when” employee engagement is destabilized. The cross-sectional study used 391 samples from the hotel industry; data were collected from the crew staff via self-administered questionnaires and analyzed using Smart PLS. The study’s outcome draws attention to perceived workplace incivility and its significant negative impact on work engagement. The results also reveal that employees’ emotional responses and coping mechanisms play significant mediator and moderator roles in the relationship between workplace incivility and work engagement. In terms of theoretical background, the study makes a novel theoretical contribution by applying Affective Events Theory (AET) when employees confront incivility that triggers emotional reactions and then shows how those reactions lead to adverse work outcomes and behaviors. The study outcomes have significant implications for strategic hotel industry staff and policymakers and provide insights for future researchers. Hotel management might consider this study helpful for generating a crew-supportive work environment and stabilizing employee engagement.

Cyberincivility among Filipino Nursing Students in a public university: knowledge, experience, and acceptability

Introduction: The pandemic rapidly shifted nursing education to the online platform, and cybercommunication may expose students to the risk of online uncivil behaviors. Understanding cyberincivility in the primary mode of education during the pandemic is necessary. This study determined the cyberincivility knowledge, experience, and perception of acceptability among nursing students in the Philippines. Methods: A cross-sectional research design was employed with 300 Filipino nursing students of a public university who participated in the survey conducted last June 2021 using the Academic Cyberincivility Assessment Questionnaire. Data were described, and statistical differences and relationships were tested using ANOVA, t-Test, and Pearson correlation. Results: Findings indicated that nursing students generally had high knowledge (M=11.53), low experience (M=1.67), and low acceptability (M=1.41) of online uncivil behaviors. Academic cyberincivility knowledge, experiences, and acceptability did not significantly vary (p>0.05) based on sex, year level, and duration of daily internet usage. There was a significant positive moderate correlation (r=.402, p=.000) between cyberincivility experience and acceptability. Conclusions: Nursing schools should continuously strive to avoid the risk of uncivil cyberspace behaviors and promote an online culture of civility in online learning spaces.

Does adolescent incivility longitudinally predict future bullying?

Adolescent bullying is a complicated behavior that is difficult to prevent. Understanding factors that predict bullying during adolescence can help us minimize such behavior. Classroom incivility is a low-level antisocial behavior that has been discussed in the literature as being a potential predictor of bullying in adolescence. Therefore, the goal of the present study was to examine the longitudinal link between classroom incivility and bullying. Data for the current study was collected using quantitative surveys at two-time points, three years apart (November 2019 and November 2022) in southern Ontario, Canada. Our sample comprised 349 adolescents (51.3% boys, 46.4% girls, 0.6% other, and 1.7% preferred not to say) between the ages of 9 and 14 years old (M = 11.92 years; SD = 1.42). We utilized cross-lagged analyses to examine the stability of classroom incivility in adolescence, and the longitudinal association between classroom incivility and bullying. Classroom incivility at Time 1 predicted bullying behavior at Time 2, while bullying at Time 1 did not predict classroom incivility at Time 2. Our results not only support the stability of levels of classroom incivility across time, but also provide empirical support for classroom incivility as a precursor to bullying behavior. Our study suggests that classroom incivility can not only negatively impact the learning environment but may also be implicated in contributing to the circumstances that promote bullying behavior in adolescence, highlighting the importance of limiting uncivil behavior before it escalates into more severe forms of behavior.

597 Incivility in the Operating Theatre

Abstract Aim To establish the prevalence of incivility within operating theatres, understand its impact on wellbeing, team performance, training, and direct future studies. Method A systematic search was conducted using keywords for incivility in healthcare. Studies reporting incivility from all operating theatre MDT members were included. Data extraction was designed to establish prevalence of incivility, compare experiences in different specialties, assess the potential impact on performance and wellbeing and establish questions for inclusion in a national cross-sectional study. Results Incivility can be defined as ‘un-civil behaviour, characteristically rude and discourteous, displaying a lack of regard for others.’ 62 papers discussing incivility, bullying and harassment within healthcare settings were identified. 14 focused specifically on incivility in surgical teams. 48-98% of healthcare staff reported experiencing incivility, with surgeons being the most likely perpetrators. It was more commonly experienced by female, non-heterosexual, and inexperienced members of staff, including trainees. Incivility was associated with reduced performance, higher complication rates, workplace withdrawal, reduced organisational commitment, productivity, and wellbeing. Reduction strategies largely focused on education surround incivility, which appears to have minimal impact. Conclusions Incivility has only recently been discussed within a healthcare setting. Its consequences can have a significant impact on teams, and it warrants attention to improve performance, wellbeing and retention. Surgical theatres offer unique challenges from a teamwork perspective and should therefore be studied at an MDT level. These results have informed the design of a national, cross-sectional mixed methods study of incivility in the operating theatre MDT, which will be conducted throughout 2023.

Mixed-methods Assessment of Incivility During Surgical Mortality and Morbidity Conference.

This study assessed incivility during mortality and morbidity (M&M) conference. A psychologically safe environment at M&M conference enables generative discussions to improve care. Incivility and exclusion demonstrated by "shame and blame" undermine generative discussion. We used a convergent mixed-methods design to collect qualitative data through nonparticipant observations of M&M conference and quantitative data through standardized survey instruments of M&M participants. The M&M conference was attended by attending surgeons (all academic ranks), fellows, residents, medical students on surgery rotation, advanced practice providers, and administrators from the department of surgery. A standardized observation guide was developed, piloted and adapted based on expert nonparticipant feedback. The Positive and Negative Affect Schedule Short-Form (PANAS) and the Uncivil Behavior in Clinical Nursing Education (UBCNE) survey instruments were distributed to the Department of Surgery clinical faculty and categorical general surgery residents in an academic medical center. We observed 11 M&M discussions of 30 cases, over 6 months with 4 different moderators. Case presentations (virtual format) included clinical scenario, decision-making, operative management, complications, and management of the complications. Discussion was free form, without a standard structure. The central theme was that limited discussion participation from attending surgeon of record, as well as absence of a systems-approach led to blame and then blame then set the stage for incivility. Among 147 eligible to participate in the survey, 54 (36.7%) responded. Assistant professors had a 2.60 higher Negative Affect score ( P =0.02), a 4.13 higher Exclusion Behavior score ( P =0.03), and a 7.6 higher UBCNE score ( P =0.04) compared with associate and full professors. Females had a 2.7 higher Negative Affect Score compared with males ( P =0.04). Free-form M&M discussions led to incivility. Structuring discussion to focus upon improving care may create inclusion and more generative discussions to improve care.

Experienced incivility undermines the positive effects of job autonomy on mental and physical health

Integrating insights from conservation of resources theory related to both the positive effects of resources and the detrimental effects of resource loss, this paper examines the effect of job autonomy (an organizational-level resource) on subjective physical pain as mediated by mental health, with experienced workplace incivility (a social stressor) included as a boundary condition. Drawing from the results of a state-wide survey of local government professionals (N = 289), we test a moderated mediation model that estimates the relationships amongst job autonomy, mental health, and physical pain, at differing levels of experienced incivility. Mental health is found to fully mediate the negative relationship between job autonomy and physical pain. When the moderating effect of workplace incivility is incorporated into the model, higher levels of uncivil behavior weaken the otherwise positive and significant effect of job autonomy on mental health. However, the relationship between mental health and physical pain does not depend on levels of workplace incivility. This research has important implications for the management of physical and mental health at work. In particular, the results point to a need to develop human resource policies and practices that both promote job autonomy and tackle experiences of workplace incivility, particularly in local governments.

Translation and validation of the Italian version of the incivility in nursing education-revised scale

BackgroundIncivility in nursing education is present worldwide and impacts all those involved and the teacher-student relationship. The revised Incivility in Nursing Education (INE-R) is a validated and reliable instrument to measure academic incivility, but it is not available in Italian language. The aim of the study was to translate and validate the INE-R tool with an Italian sample. MethodsThe INE-R was translated from English into Italian, culturally adapted and piloted for content and linguistic clarity. The questionnaire was administered online to Nursing Faculty (NF) and Nursing Students (NS) of Sapienza University of Rome to assess uncivil behaviors and their frequency of occurrence. The psychometric properties of the Italian version were investigated. Results79 Italians participated, of which 63.3 % were NS. Four-factor models provided the best fit for NF and NS scales. The models explained 78.2 % (NF) and 73.2 % (NS) of the variance of the scales. The Root Mean Square Error of Approximation for both models was 0.07, indicating an acceptable fit. INE-R reliability for all 48 NF and NS incivility items was 0.962 and 0.954, respectively. Measuring the degree of incivility and establishing codes of conduct were recommended. ConclusionsIncivility in nursing education negatively impacts the teaching-learning environment and could cause emotional or physical distress for those involved. Zero-tolerance policy regarding incivility, routine evaluation, and raising awareness among students and faculty could improve the quality of academic settings. The Italian INE-R is a valid and reliable tool that can be used to evaluate incivility in Italian nursing programs.