Advancing the Investigation of Incivility in Nursing Education
Creators: Penconek, Tatiana K
Publisher: name: University of Alberta Library
Year: 2024

<p>Background: Incivility is a major problem in nursing education which can have damaging effects on both nursing students and faculty including strained relationships, emotional distress, and decreased program or job satisfaction. Research to date has mainly focused on exploring the nature of uncivil behaviours and its frequency. While important to understand, what appears to be understudied is why and how incivility occurs suggesting a need to find new ways of investigating this problem.<br>
Purpose: The overarching purpose of my dissertation research was to critically examine incivility in nursing education. To achieve this, I: 1) mapped the nature, extent, and range of research focused on the antecedents and consequences of incivility, 2) developed and employed a set of questions appropriate for the context of nursing students, and 3) examined the influences on and effects of incivility in nursing education.<br>
Methods: This dissertation research was completed across three phases. The first phase consisted of a rigorous scoping review on the nature, extent, and range of research related to the antecedents and consequences of incivility in higher education. In phase 2, I developed 44 items to measure undergraduate nursing students’ perceptions of faculty and student incivility and potential consequences of incivility including program satisfaction, general and academic stress, and mental and physical well-being. The beginning and end of the survey also included the real time measurement of a manual radial pulse. In the third phase, I conducted a pilot study, data collection with the revised survey, then estimated and tested a structural equation model of the influence of nursing faculty and student incivility on student well-being, stress, academic experience, and program satisfaction. I employed descriptive statistics, correlations, paired t-tests, multiple regressions, and structural equation modeling to analyze the data and test the theoretical model.<br>
Results: One hundred and nineteen studies reporting on a total of 91 antecedents and 50 consequences were included in the scoping review, which located reports that faculty incivility contributed to, triggered, and even justified student incivility. Student incivility and competition among students also contributed to students behaving uncivilly. Following development of the survey, the pilot study included 112 students in the third and fourth years in one nursing program in Western Canada. Final data collection included 110 third- and fourth-year undergraduate nursing students from three universities in Western Canada. In both samples, students reported observing, receiving, and engaging in students gossiping or competing with each other. Students did not observe similar uncivil behaviours from course or clinical instructors. Receiving uncivil behaviours was statistically correlated with engaging in uncivil behaviours. Students were highly stressed about their academic life yet satisfied with their nursing program. Students’ manual radial pulse was statistically significantly higher after completing the survey. Despite making theoretically comfortable and data driven changes to the model based on diagnostic evaluation, the structural equation model continued to significantly fail.<br>
Conclusions: Receiving incivility potentially triggered or justified engaging in uncivil behaviours highlighting the dynamic and reciprocal nature of incivility. My findings also highlight potential unknown variables contributing to incivility in nursing education. Innovative research designs, advanced statistical analysis, and theory development could identify further information on the nature of incivility in nursing education and practice. Structural equation modeling can also be used to further test the causal relationships between newly identified concepts. Designing interventions to increase nursing students’ and faculty awareness of incivility may influence whether they engage in uncivil behaviours. Future research should also examine the cumulative effects of physiological and psychological negative outcomes on nursing students and faculty over time. Interventions targeting the experience of stress and incivility in nursing education could be implemented and the effectiveness of these interventions be examined in future research.<br><br>
Implications for Nursing Education: Supporting nursing faculty to develop role modeling of civility through educational interventions or structured formal mentorship programs may foster positive academic experiences and collaboration among nursing students. A supportive learning environment to combat the stress of the academic setting is critically influenced by supportive faculty. Nursing students may also need help to understand uncivil behaviours, which may influence whether a nursing student engages in incivility. Strategies and interventions targeted at the development and maintenance of collegiality, collaboration, and effective communication are important to fostering positive relationships among nursing students. </p>