IACN. Nursing presentation Cultivating civility

1. CULTIVATING CIVILITY IN THE LEARNING
ENVIRONMENT
Lori Doeschot RN MSN
Cheryl Harrington RN MSN MHA

2. OBJECTIVES
• Describe actions and behaviors which reflect the principles of civility.
• Describe the relationship between the ANA Code of Ethics, AACN Baccalaureate
Essentials, professionalism,, and civility.
• Describe actions and behaviors that reflect incivility.
• Discuss triggers/influencing factors that may lead to incivility.
• Discuss the outcomes of incivility on nursing education and healthcare.
• Discuss strategies to prevent or manage incivility and promote a cooperative learning
atmosphere.
• Discuss the process for developing and implementing an incivility policy in nursing
education.

3. TAKE A MOMENT…WHAT DOES CIVILITY MEAN
TO YOU?

4. CIVILITY…RULES OF DECENT BEHAVIOR
• Definitions
• …an authentic respect for others requiring time, presence, a willingness to
engage in genuine discourse, and an intention to seek common ground. (Clark,
2009)
• The act of showing regard for others.
• Showing deference or respect.
• A courteous expression (by word or deed) of esteem or regard.
• Civilized conduct; especially COURTESY.
• A polite act or expression. (The Common Good)

5. “Civility is not another piece to be added
on to the plate of an educator, it is the
plate upon which all else is placed.”
(As cited by Clark 2009, revised 2012).

6. HOW IS THAT WORKING FOR US???
• 17.1=average number of times Americans encounter incivility in
a 7-day week, or 2.4 times per day
• 8.5 = average number of times Americans encounter incivility in
real life or offline in a week
• 8.6 = average number of times Americans encounter incivility
online in a week (Civility in America, 2013)
• Estimated 20% display active resistance to learning in the
college classroom

7. ANA CODE OF ETHICS
• Excerpts from Provision 1
• “The nurse, in all professional relationships, practices with
compassion and respect for the inherent dignity, worth, and
uniqueness of every individual…”
• “1.5: Principles of respect extend to all individuals with whom
the nurse interacts…”

8. WHO’S PAYING ATTENTION?
• The Joint Commission (TJC 2009)
• Robert Wood Johnson Foundation (RWJF2010 report in collaboration with IOM)
• Institute of Medicine (IOM 2010 report in collaboration with RWJF)
• American Association of Colleges of Nursing (AACN)
• Essentials of Baccalaureate Education for Professional Nursing Practice (2008)
• Magnet recognition
• Quality and Safety Education for Nurses (QSEN, 2012)

9. WHAT DOES INCIVILITY MEAN TO YOU?

10. INCIVILITY…
• Definition
• “Rude or disruptive behavior that may result in psychological distress for
the people involved and, if left unaddressed, may progress into
threatening situations.” (Clark, 2010)
• “Classroom incivility is any action that interferes with a harmonious and
cooperative learning atmosphere in the classroom.” (AlKandari, 2011)
• “Rude and discourteous speech or behavior that disrupts the academic
environment, and violates the norms of mutual respect in the learning
environment.” (Feldman, 2001)

11. • Physical Aggression
• Assault / battery
• Throwing objects
• Violent outbursts
• Inappropriate touching
• Harassment
THE INCIVILITY CONTINUUM
• Negative Behavior
• Rude comments
• Insensitive actions
• Unintentional slights
• Complaining
• Gossip / rumors
• Crude jokes / profanity
• Verbal Aggression
• Yelling / loud voice
• Belittling comments
• Intimidation / threats
• Discriminatory comments
• Cursing
• Humiliation

12. • Annoyances
• Sleeping in class
• Not paying attention –side
conversations,
• Leaving early/ arriving late
• Misusing cell phones – texting
• Non-verbal (eye rolling)
• Working on non-class related
material/media
• Intimidating Behavior
• Making threats to others
• Intentionally tarnishing reputations
• Bad-mouthing faculty through
anonymous teaching evaluations
• Unreasonable demands/ expectations
• Inappropriate emails to faculty
• Threats of Violence
• Physical attack
UNCIVIL BEHAVIOR
(Feldman, 2010)

13. SETTINGS AND RELATIONSHIPS
• Classroom
• Clinical
• Simulation Lab
• Faculty office
• Student-to-Faculty
• Faculty-to-Student
• Student-to-Student
• Student-to-Healthcare Worker
• Healthcare Worker-to-Student
• Student-to-Patient
• Nurse-to-Nurse

14. CONTRIBUTING FACTORS…STUDENT TRIGGERS
• Fear of inability to succeed
• Will I fail
• Lack of clinical experience…fear of
harming a patent
• Can I maintain my position on the
team, in the band, choir, theater,
etc.
• Pressure
• I have to work
• There is so much to do
• My parents expect good grades
• I must get an A
• Competing for grades
• NCLEX
• Meeting deadlines
• Stress
• Physical
• Emotional
• Coping skills
• Balancing multiple roles
• Financial worries
• Finding a job
• Faculty

15. STUDENT PERCEPTIONS OF FACULTY
• Clark (2006)
• Faculty demeaning and belittling students
• Treating students unfairly
• Pressure to conform to unrealistic faculty demands
• Gender bias
• Violation of due process
• Subjective grading – “weeding students out”
• Threatening to fail students if they didn’t conform to demands

16. CULTURE OF ENTITLEMENT… BUT IT’S MY
RIGHT!!!

17. CONTRIBUTING FACTORS…FACULTY TRIGGERS
• Nurse educators under substantial pressure
• Scholarly competence (research, publications, external funding)
• Clinical expertise
• Increased work loads
• Work inequity
• Promotion and tenure
• Pressure to pursue doctoral degree
• Hiring, retaining and mentoring part-time and adjunct faculty
• Problematic students
• Changing technology
• Financial pressures and low salaries
• Curriculum revisions, program additions, course development, committee work, clinical schedules
• External obligations
• Uncivil behavior from others
(Adapted from Clark, 2013)

18. OUTCOMES OF INCIVILITY - STUDENTS
• Compromised/negative learning environment
• Psychological and/or physical distress
• Feeling of hopelessness, fear, hostility, resentment
• Decreased performance
• Participation in self-destructive behavior
• Withdrawal from the institution
• Respond with varying degrees of uncivil behavior

19. OUTCOME OF INCIVILITY - FACULTY
• Decreased job satisfaction
• Dread teaching
• Lack of reporting
• Fear of losing job
• Fear of impact on promotion and tenure
• Fear of lack of support from administration
• Lower performance and impaired productivity
• Increased Turnover
• Fear for personal safety
• Physical and psychological distress
• Doubt ability as an educator

20. STRATEGIES
• Raise awareness/ define appropriate conduct
• Incorporate civility information explicitly into agenda for incoming students
• Make civility training an intentional part of student orientation
• After beginning of semester, incorporate civility and professionalism into curriculum
and classroom teaching
• Positive role modeling and mentoring
• Stress management and self-care
• Effective and meaningful communication
• Positive and collaborative learning environment

21. STRATEGIES CONTINUED…
• Spell out expectations in the syllabus
• Use mid-term teaching feedback
• Use peer observations
• Reframe potential conflicts
• Re-engage students
• Use the student grievance process
• Use a back-to-basics faculty orientation
• Remain respectful
• Partner with Student Services
• Written Behavioral Contract

22. CREATING CHANGE – DR. CLARK’S CIVILITY
WISDOM (2013)
• Practice forgiveness
• Express gratitude
• Affirm others
• Seek to live in a state of grace
• Respect the earth
• Make a difference
• Listen and be present
• Smile and spread goodwill
• Address unkindness
• Be kind to animals
• Exceed expectations
• Stand for something god
• Don’t interrupt
• Be on time
• Avoid making assumptions
• Suspend judgment
• Don’t butt in line
• Say please and thank you
• Put yourself in others’ shoes
• Think before you speak

23. POLICY
• Review literature
• Clear definition (civility AND incivility)
• Consequences for uncivil behavior
• Reinforce awareness of policy
• Faculty consistency with implementation
• Evaluation
• Shared responsibility – student and faculty

24. FROM VIRGINIA TECH
• …students will pursue and embrace the value of civility which will be carried
throughout life. At the heart of this pursuit is a basic commitment to
consideration, respect, and courtesy. Civility is a shared gift that we give and
receive in turn. Accordingly, civility expects that: we strive to listen, as well as
to speak to each other; we try to understand each other in our commonalities
and differences; we give respect due to all members of the university
community; we favor courtesy over rudeness and encourage considerate
treatment over dismissive behavior; and we combine free speech with
reasoned expression so that liberty and peace are both served.

25. References available upon request