Incivility in Nursing Education: Experiences of Under-Graduate Nursing Students

Öz

Incivility in nursing education is a pervasive issue that significantly impacts nursing students' clinical experience and psychological well-being. This study explored the forms and frequency of incivility encountered by clinical nursing students, documented its impacts and the coping mechanisms employed, and provided recommendations for interventions. A qualitative research approach involved focus group discussions with nursing students from Ambrose Alli University. The data was transcribed and analyzed thematically. The findings revealed that nursing students frequently experience various forms of incivility, including verbal abuse, inappropriate behaviour, and unprofessional conduct from senior nurses. These behaviours led to demotivation, frustration, and psychological stress, adversely affecting students' clinical learning experiences. Coping mechanisms identified included avoidance, confrontation, and normalization, indicating a need for more effective support systems. Participants suggested several interventions to mitigate incivility, such as implementing robust regulatory frameworks, enhancing institutional support, providing education and training for senior nurses, and establishing clear reporting mechanisms. The recommendations emphasize the importance of creating a respectful and supportive learning environment for nursing students. The study's findings align with existing literature on the negative impacts of incivility in nursing education and underscore the critical need for comprehensive strategies to address this issue. Educational institutions should integrate professionalism and ethics into the curriculum, establish strong mentorship programs, and monitor clinical placements. Healthcare organizations must implement and enforce policies against incivility, provide continuous professional development, and encourage positive behaviours. Future research should focus on expanding the sample size, conducting longitudinal studies, and evaluating the effectiveness of interventions across different contexts. Addressing incivility is essential for the professional development of nursing students and the overall quality of patient care, ensuring a competent and resilient nursing workforce.

Anahtar Kelimeler

• Incivility
• Nursing Education
• Clinical Experience
• Psychological well-being
• Coping Mechanism

Hemşirelik Eğitiminde Nezaketsizlik: Lisans Hemşirelik Öğrencilerinin Deneyimleri

Öz

Hemşirelik eğitiminde nezaketsizlik, hemşirelik öğrencilerinin klinik deneyimlerini ve psikolojik refahlarını önemli ölçüde etkileyen yaygın bir sorundur. Bu çalışma, klinik hemşirelik öğrencilerinin karşılaştığı nezaketsizliğin biçimlerini ve sıklığını araştırdı, etkilerini ve kullanılan başa çıkma mekanizmalarını belgeledi ve müdahaleler için önerilerde bulundu. Nitel bir araştırma yaklaşımı, Ambrose Alli Üniversitesi'nden hemşirelik öğrencileriyle odak grup tartışmalarını içeriyordu. Veriler yazıya geçirildi ve tematik olarak analiz edildi. Bulgular, hemşirelik öğrencilerinin kıdemli hemşirelerden sözlü taciz, uygunsuz davranış ve profesyonel olmayan davranış dahil olmak üzere çeşitli nezaketsizlik biçimleriyle sıklıkla karşılaştığını ortaya koydu. Bu davranışlar motivasyon eksikliğine, hayal kırıklığına ve psikolojik strese yol açarak öğrencilerin klinik öğrenme deneyimlerini olumsuz etkiledi. Belirlenen başa çıkma mekanizmaları arasında kaçınma, yüzleşme ve normalleştirme yer aldı ve bu da daha etkili destek sistemlerine ihtiyaç olduğunu gösterdi. Katılımcılar, sağlam düzenleyici çerçeveler uygulamak, kurumsal desteği artırmak, kıdemli hemşireler için eğitim ve öğretim sağlamak ve net raporlama mekanizmaları oluşturmak gibi nezaketsizliği azaltmak için çeşitli müdahaleler önerdiler. Öneriler, hemşirelik öğrencileri için saygılı ve destekleyici bir öğrenme ortamı yaratmanın önemini vurgulamaktadır. Çalışmanın bulguları, hemşirelik eğitiminde nezaketsizliğin olumsuz etkilerine ilişkin mevcut literatürle uyumludur ve bu sorunu ele almak için kapsamlı stratejilere duyulan kritik ihtiyacın altını çizmektedir. Eğitim kurumları, müfredata profesyonellik ve etiği entegre etmeli, güçlü mentorluk programları oluşturmalı ve klinik yerleştirmeleri izlemelidir. Sağlık kuruluşları nezaketsizliğe karşı politikalar uygulamalı ve yürürlüğe koymalı, sürekli mesleki gelişim sağlamalı ve olumlu davranışları teşvik etmelidir. Gelecekteki araştırmalar, örneklem boyutunu genişletmeye, uzunlamasına çalışmalar yürütmeye ve müdahalelerin farklı bağlamlardaki etkinliğini değerlendirmeye odaklanmalıdır. Nezaketsizliği ele almak, hemşirelik öğrencilerinin mesleki gelişimi ve hasta bakımının genel kalitesi için, yetkin ve dayanıklı bir hemşirelik iş gücü sağlamak açısından önemlidir.

Anahtar Kelimeler

• Nezaketsizlik
• hemşirelik eğitimi
• klinik deneyim
• psikolojik iyilik hali
• başa çıkma mekanizmaları

Kaynakça

1. Agbaje, O. S., Arua, C. K., Umeifekwem, J. E., Umoke, P. C. I., Igbokwe, C. C., Iwuagwu, T. E., Iweama, C. N., Ozoemena, E. L., & Obande-Ogbuinya, E. N. (2021). Workplace gender-based violence and associated factors among university women in Enugu, South-East Nigeria: an institutional-based cross-sectional study. BMC Womens Health, 21(1), 124. https://doi.org/10.1186/s12905-021-01273-w
2. Alsadaan, N., Ramadan, O. M. E., & Alqahtani, M. (2024). From incivility to outcomes: tracing the effects of nursing incivility on nurse well-being, patient engagement, and health outcomes. BMC Nurs, 23(1), 325. https://doi.org/10.1186/s12912-024-01996-9
3. Amoo, S. A., Menlah, A., Garti, I., & Appiah, E. O. (2021). Bullying in the clinical setting: Lived experiences of nursing students in the Central Region of Ghana. PLoS One, 16(9), e0257620. https://doi.org/10.1371/journal.pone.0257620
4. Anarado, A. N., Agu, G. U., & Nwonu, E. I. (2016). Factors hindering clinical training of students in selected nursing educational institutions in Southeastern Nigeria. Nurse Educ Today, 40, 140-145. https://doi.org/10.1016/j.nedt.2016.02.022
5. Atashzadeh Shoorideh, F., Moosavi, S., & Balouchi, A. (2021). Incivility toward nurses: a systematic review and meta-analysis. J Med Ethics Hist Med, 14, 15. https://doi.org/10.18502/jmehm.v14i15.7670
6. Clark, C. (2008). Student perspectives on faculty incivility in nursing education: an application of the concept of rankism. Nurs Outlook, 56(1), 4-8. https://doi.org/10.1016/j.outlook.2007.08.003
7. Clark, C. M. (2017). An Evidence-Based Approach to Integrate Civility, Professionalism, and Ethical Practice Into Nursing Curricula. Nurse Educ, 42(3), 120-126. https://doi.org/10.1097/NNE.0000000000000331
8. Clark, C. M., & Springer, P. J. (2010). Academic nurse leaders' role in fostering a culture of civility in nursing education. J Nurs Educ, 49(6), 319-325. https://doi.org/10.3928/01484834-20100224-01

9. Committee Opinion No. 683: Behavior That Undermines a Culture of Safety. (2017). Obstet Gynecol, 129(1), e1-e4. https://doi.org/10.1097/AOG.0000000000001859
10. Cottingham, S., DiBartolo, M. C., Battistoni, S., & Brown, T. (2011). Partners in nursing: a mentoring initiative to enhance nurse retention. Nurs Educ Perspect, 32(4), 250-255. https://doi.org/10.5480/1536-5026-32.4.250
11. Curtis, J., Bowen, I., & Reid, A. (2007). You have no credibility: nursing students' experiences of horizontal violence. Nurse Educ Pract, 7(3), 156-163. https://doi.org/10.1016/j.nepr.2006.06.002
12. El Ghaziri, M., Johnson, S., Purpora, C., Simons, S., & Taylor, R. (2022). Registered Nurses' Experiences With Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-State Survey. Workplace Health Saf, 70(3), 148-160. https://doi.org/10.1177/21650799211024867
13. Elom, P., Agu, A., Unah, A., Azuogu, B., Ituma, B., Okah, O., Okocha, Y., Ugwunweze, J., Ossai, E., & Igwe, D. (2024). Prevalence and factors associated with workplace violence in a tertiary healthcare facility in Nigeria. Niger Med J, 65(2), 173-184. https://doi.org/10.60787/nmj-v65i2-336
14. Folkman, S., & Moskowitz, J. T. (2004). Coping: pitfalls and promise. Annu Rev Psychol, 55, 745-774. https://doi.org/10.1146/annurev.psych.55.090902.141456
15. Gong, Z., Van Swol, L. M., & Wang, X. (2022). Study on the Relationship between Nurses' Mentoring Relationship and Organizational Commitment. Int J Environ Res Public Health, 19(20). https://doi.org/10.3390/ijerph192013362 Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med, 292, 114523. https://doi.org/10.1016/j.socscimed.2021.114523
16. Hill, S. E. M., Ward, W. L., Seay, A., & Buzenski, J. (2022). The Nature and Evolution of the Mentoring Relationship in Academic Health Centers. J Clin Psychol Med Settings, 29(3), 557-569. https://doi.org/10.1007/s10880-022-09893-6
17. Huang, N., Qiu, S., Alizadeh, A., & Wu, H. (2020). How Incivility and Academic Stress Influence Psychological Health Among College Students: The Moderating Role of Gratitude. Int J Environ Res Public Health, 17(9). https://doi.org/10.3390/ijerph17093237
18. Hunt, C., & Marini, Z. A. (2012). Incivility in the practice environment: a perspective from clinical nursing teachers. Nurse Educ Pract, 12(6), 366-370. https://doi.org/10.1016/j.nepr.2012.05.001
19. Khan, M. S., Elahi, N. S., & Abid, G. (2021). Workplace Incivility and Job Satisfaction: Mediation of Subjective Well-Being and Moderation of Forgiveness Climate in Health Care Sector. Eur J Investig Health Psychol Educ, 11(4), 1107-1119. https://doi.org/10.3390/ejihpe11040082
20. Kim, E. H., & Yi, Y. (2023). Associations among workplace incivility, stress coping, and nursing performance in hospital nurses: A path analysis. J Nurs Scholarsh, 55(4), 834-842. https://doi.org/10.1111/jnu.12864
21. Laschinger, H. K. (2014). Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. J Nurs Adm, 44(5), 284-290. https://doi.org/10.1097/NNA.0000000000000068
22. Lewis, C. (2023). The impact of interprofessional incivility on medical performance, service and patient care: a systematic review. Future Healthc J, 10(1), 69-77. https://doi.org/10.7861/fhj.2022-0092
23. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic Inquiry SAGE, Thousand Oaks, 289-331. https://doi.org/http://dx.doi.org/10.1016/0147-1767(85)90062-8
24. Lofgren, U., Walivaara, B. M., Stromback, U., & Lindberg, B. (2023). The nursing process: A supportive model for nursing students' learning during clinical education - A qualitative study. Nurse Educ Pract, 72, 103747. https://doi.org/10.1016/j.nepr.2023.103747
25. Luparell, S. (2011). Incivility in nursing: the connection between academia and clinical settings. Crit Care Nurse, 31(2), 92-95. https://doi.org/10.4037/ccn2011171
26. McDonald, P. (2012). Workplace sexual harassment 30 years on: A review of the literature. International Journal of Management Reviews, 14(1), 1–17. https://doi.org/10.1111/j.1468-2370.2011.00300.x
27. Naseri, V., Pour, M. B., Atashzadeh-Shoorideh, F., & Emami, P. (2023). Nursing students' experience of incivility behaviours and its correlation with their nursing professional values: A cross-sectional descriptive study. Nurs Open, 10(1), 135-141. https://doi.org/10.1002/nop2.1288
28. Odiri, V. I. O. (2024). Workplace Incivility and Firms’ Productivity in Nigeria: Evidence from Governmental Enterprises. International Journal of Entrepreneurship and Business Innovation, 7(1). https://doi.org/https://doi.org/10.52589/ijebi-bhfyjhhx
29. Penconek, T., Hayduk, L., Kunyk, D., & Cummings, G. G. (2024). A nursing perspective on the antecedents and consequences of incivility in higher education: A scoping review. Int J Nurs Stud Adv, 6, 100204. https://doi.org/10.1016/j.ijnsa.2024.100204
30. Peng, X. (2023). Advancing Workplace Civility: a systematic review and meta-analysis of definitions, measurements, and associated factors. Front Psychol, 14, 1277188. https://doi.org/10.3389/fpsyg.2023.1277188
31. Polit, D. F., & Beck, C. T. (2014). Essentials of Nursing Research: Appraising Evidence for Nursing practice (8 ed.). Wolters Kluwer Health; Lippincott Williams & Wilkins.
32. Rushton, C. H., & Stutzer, K. (2015). Addressing 21st-century nursing ethics: implications for critical care nurses. AACN Adv Crit Care, 26(2), 173-176. https://doi.org/10.1097/NCI.0000000000000083
33. Sumpter, D., Blodgett, N., Beard, K., & Howard, V. (2022). Transforming nursing education in response to the Future of Nursing 2020-2030 report. Nurs Outlook, 70(6 Suppl 1), S20-S31. https://doi.org/10.1016/j.outlook.2022.02.007
34. Thomas, S. P. (2010). Transforming Nurses' Stress and Anger: Steps toward Healing. Springer Publishing Company.
35. Urban, R. W., Smith, J. G., Wilson, S. T., & Cipher, D. J. (2021). Relationships among stress, resilience, and incivility in undergraduate nursing students and faculty during the COVID-19 pandemic: Policy implications for nurse leaders. J Prof Nurs, 37(6), 1063-1070. https://doi.org/10.1016/j.profnurs.2021.08.011
36. van der Velden, P. G., Contino, C., Das, M., & Wittmann, L. (2023). To what extent do post-traumatic mental health and other problems reflect pre-existing problems? Findings from the prospective comparative population-based VICTIMS-study. Int J Soc Psychiatry, 69(4), 841-852. https://doi.org/10.1177/00207640221140287