The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis.

AIM: Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety. METHODS: A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies. DATA SOURCES: Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023. RESULTS: The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety. CONCLUSION: Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT: This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility. REPORTING METHOD: This report adheres to PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.

Bullying in nursing: How has it changed over 4 decades?

AIM: This study sought to explore how bullying in the nursing profession in Australia has changed over four decades, and why it continues to persist. BACKGROUND: Bullying in nursing is recognized as a pervasive problem. While much attention has been given to demonstrating the existence and impact of bullying in the nursing profession, little is understood about the evolution of this phenomenon and factors that contribute to its persistence. METHODS: This study employed an historical methodology using the testimony method of data collection. Testimonies were collected online and via interview from seventy registered nurses across Australia. Data were analysed using a three-dimensional analysis to produce a chronological historiography. RESULTS: This study found that the antecedents, manifestations, responses to and impacts of bullying in the nursing profession changed according to context and over time. The findings shed light on the role of nurse managers in the prevention and appropriate management of bullying in the workplace. CONCLUSION: Prevention and intervention approaches must be developed to combat the complex and changing factors that allow bullying to persist. IMPLICATIONS FOR NURSING MANAGEMENT: This study shows the role that management plays in tackling the problem of bullying in nursing. It can no longer be acceptable for culture to be used as an excuse for unacceptable behaviour, nor for power to be abused to protect perpetrators of workplace bullying. The findings discussed in this paper reveal that inexperienced nurse managers are often ill-equipped to identify and manage bullying. Nurses in management positions must recognize and acknowledge this deficit if the problem of bullying is to be effectively tackled.

Bullying in Nursing: Is it in the Eye of the Beholder?

The nursing profession is presented with numerous definitions of workplace bullying. This study provides an in-depth analysis of the concept of bullying in the nursing profession in Australia through a scoping review of definitions presented in literature published up until 2018. The research questions used to guide the search were as follows: How has the definition of bullying in nursing in Australia been conceptualized in the literature? How do these definitions of bullying differ? How has the definition of bullying, as used in the literature, evolved over time? The review was informed by the approach of Arksey and O'Malley, containing explicit definitions of bullying in nursing literature. The findings reveal that the literature does not reflect a shared and integrated vision of the exact nature of bullying in the nursing profession. The conceptualization of bullying in the nursing profession has become more dynamic over time. The myriad ways in which bullying in nursing is defined in Australia has important implications for research, practice, education, and policy.

A debate about the merits of debate in nurse education.

In this 'Issues for Debate' paper, the issue is debate. Today's nurses must be able to advocate, lead, and grow 'big ideas', as well as knowing their way around a patient's body and mind. This paper reports, partly, on a research study into the use of debate to develop clinical reasoning and thinking skills in nursing students. The study was conducted with first and third-year nursing students enrolled at an Australian regional university. Students were asked to comment on the effectiveness of debate as an educational strategy. We combine the results of this research study with literature and discussion into the educational uses of debate to put the argument that using debate in nursing education can be an effective way to foster the type of creative, intelligent, thoughtful and forward-thinking nurses needed in the modern healthcare system.

Students' perceptions of the use of eportfolios in nursing and midwifery education.

ePortfolios have been introduced into many higher education degrees in the past decade in an effort to help students to link theory, practice and personal experiences. This pilot study used a survey to examine ePortfolio use from the perspective of undergraduate nursing and postgraduate midwifery students. Fifty-seven students from a regional Australian university completed an online questionnaire which contained questions about the following areas of ePortfolio use: understanding of the tool; psychological perceptions; challenges around use; assessment; outcomes of use; benefits; maintenance of the ePortfolio; and enhanced learning. The majority of respondents were female, undergraduate students, aged 21-30 years. Results indicated that many students found ePortfolio use frustrating; in particular, technological and logistical challenges in using ePortfolios were highlighted. Most students, however, noted ePortfolios could be useful repositories for documents, reflections and learning experiences. Undergraduate students were more likely than postgraduate students to see the positive potential of ePortfolio use. The findings, coupled with the literature, raise questions about the effectiveness of ePortfolio use in nursing and midwifery education and, particularly, whether ePortfolios have been implemented with misguided and misinformed good intention. Further research is required to better understand the logistical and technological aspects of successful implementation of ePortfolios and fully capitalise on their benefits for nursing and midwifery education.