Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals.

BACKGROUND: Unprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program "Ethos" implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for 'reflection' or 'recognition'. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos. METHODS: A survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5-3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as 'extreme' (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics. RESULTS: In total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32-41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message. CONCLUSION: The Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.

Health workers' disrespectful and abusive behaviour towards women during labour and delivery: A qualitative study in Durban, South Africa.

BACKGROUND: A high prevalence of disrespectful and abusive behaviour by health workers towards women during labour and delivery has been widely described in health facilities, particularly in Africa, and is a worldwide public health concern. Such behaviours are barriers to care-seeking, and are associated with adverse outcomes for mothers and newborns. This paper reports experiences of disrespectful care among informal working women in three public health facilities in Durban, South Africa. METHODS: A qualitative longitudinal study was conducted among a cohort of informal working women recruited during pregnancy in two clinics in Durban. The study comprised a series of in-depth interviews conducted at different time points from pregnancy until mothers had returned to work, followed by focus group discussions (FGDs) with cohort participants. We present data from participatory FGDs, known as 'Journey with my Baby', conducted at the end of the study, during which women's experiences from pregnancy until returning to work were reviewed and explored. Thematic analysis was used with NVIVO v12.4. RESULTS: Three 'Journey with my Baby' FGDs were conducted with a total of 15 participants between March and October 2019. Many participants narrated experiences of disrespectful behavior from nurses during labour and childbirth, with several women becoming very distressed as a result. Women described experiencing rudeness and verbal abuse from nurses, lack of privacy and confidentiality, nurses refusing to provide care, being denied companionship and being left unattended for long periods during labour. Women described feeling anxious and unsafe while in the labour ward because of the behaviour they experienced directly and observed other patients experiencing. Such experiences created bad reputations for health facilities, so that women in the local community were reluctant to attend some facilities. CONCLUSION: Disrespect and abuse continues to be a serious concern in public health facilities in South Africa. We challenge the health system to effectively address the underlying causes of disrespectful behavior among health workers, initiate robust monitoring to identify abusive behavior when it occurs, and take appropriate actions to ensure accountability so that women receive the high-quality maternity care they deserve.

Self-Reported Academic Misconduct among Medical Students: Perception and Prevalence.

Academic integrity is the basis of an education system and must be taught as an ethical behavior during academic training. Students who reflect honesty and truthfulness during the academic years are more likely to follow this path, develop professional integrity, and thus become responsible and dependable professionals. Here, we determine the prevalence of academic lapses among medical students by a cross-sectional descriptive survey based on a self-assessment questionnaire. Students' perception of 37 behaviors comprising five domains, plagiarism, indolence, cheating, disruptive behavior, and falsifying data, were explored. A high percentage of students (83%) indicated that all 37 behaviors constitute misconduct. Approximately 65% of students thought that their fellow students were involved in dishonest behaviors, and 34% answered that they were indulged in some form of misconduct. Content analysis identified some prevalent behaviors such as doing work for another student (82.5%), getting information from the students who already took the exam (82.5%), copying the answer from neighbors (79%), and marking attendance for absent friends (74.5%). Multiple regression analysis points out that future indulgence in a behavior is significantly (p ≤ 0.5) correlated with understanding a behavior as wrong, perceiving that others do it and whether one has already indulged in it. This study can serve as a diagnostic tool to analyze the prevalence of misconduct and a foothold to develop the medical school system's ethical guidelines.

What became of the 'eyes and the ears'?: exploring the challenges to reporting poor quality of care among trainee medical staff.

The importance of trainee medical staff in alerting Trusts to patient safety risks and low-quality care was established by the Francis Report, yet many remain hesitant about speaking up. Known barriers include lack of feedback, sceptical attitudes to the likelihood of change and fear of consequences. The author explores other factors including moral orientation in the workplace, role modelling by senior clinicians, discontinuity, 'normalisation of deviance', human reactions to burnout/moral injury, loyalty and the spectrum of motivation. The issues of absent feedback and fear are discussed in detail. Challenges met by those receiving reports are also described, such as how to collate soft intelligence, putting concerns into context (the 'bigger picture') and stewardship of resources. Initiatives to encourage reporting of trainees' concerns such as speak up guardians, 'Speak Up for Safety' campaign and simulation training are described. A proposal to embed proactive intelligence-gathering arrangements is presented.

Radiology Trainees' Perceptions of Speaking up Culture Related to Safety and Unprofessional Behavior in Their Work Environments.

OBJECTIVE. The purpose of this study was to compare radiology trainees' perceptions of the culture regarding speaking up about patient safety and unprofessional behavior in the clinical environment and to assess the likelihood that they will speak up in the presence of a medical hierarchy. MATERIALS AND METHODS. The study included radiology trainees from nine hospitals who attended a communication workshop. Trainees completed questionnaires assessing their perceptions of the support provided by their clinical environment regarding speaking up about patient safety and unprofessional behavior. We also queried their likelihood of speaking up within a team hierarchy about an error presented in a hypothetical clinical vignette. RESULTS. Of 61 participants, 58 (95%) completed questionnaires. Of these 58 participants, 84% felt encouraged by colleagues to speak up about safety concerns, and 57% felt encouraged to speak up about unprofessional behavior (p < .001). Moreover, 17% and 34% thought speaking up about safety concerns and unprofessional behavior, respectively, was difficult (p < .02). Trainees were less likely to agree that speaking up about unprofessional behavior (compared with speaking up about safety concerns) resulted in meaningful change (66% vs 95%; p < .001). In a vignette describing a sterile technique error, respondents were less likely to speak up to an attending radiologist (48%) versus a nurse, intern, or resident (79%, 84%, and 81%, respectively; p < .001). Significant predictors of the likelihood of trainees speaking up to an attending radiologist included perceived potential for patient harm as a result of the error (odds ratio [OR], 6.7; p < .001), perceptions of safety culture in the clinical environment (OR, 5.0; p = .03), and race or ethnicity (OR, 3.1; p = .03). CONCLUSION. Radiology trainees indicate gaps in workplace cultures regarding speaking up, particularly concerning unprofessional behavior and team hierarchy.

Academic dishonesty among university students: The roles of the psychopathy, motivation, and self-efficacy.

Academic dishonesty is a common problem at universities around the world, leading to undesirable consequences for both students and the education system. To effectively address this problem, it is necessary to identify specific predispositions that promote cheating. In Polish undergraduate students (N = 390), we examined the role of psychopathy, achievement goals, and self-efficacy as predictors of academic dishonesty. We found that the disinhibition aspect of psychopathy and mastery-goal orientation predicted the frequency of students' academic dishonesty and mastery-goal orientation mediated the relationship between the disinhibition and meanness aspects of psychopathy and dishonesty. Furthermore, general self-efficacy moderated the indirect effect of disinhibition on academic dishonesty through mastery-goal orientation. The practical implications of the study include the identification of risk factors and potential mechanisms leading to students' dishonest behavior that can be used to plan personalized interventions to prevent or deal with academic dishonesty.

Speak-Up Culture in Academic Nursing: Empowering Junior Faculty.

BACKGROUND: Faculty-to-faculty incivility in academic nursing is well documented, yet speaking up about the unprofessional behaviors of academic colleagues is still a challenge, particularly for junior faculty. METHOD: A unique faculty development session presented an opportunity to explore junior faculty experiences and perceptions of incivility, with the objectives of addressing concerns in a safe environment, identifying appropriate responses and resources for managing incivility, and supporting decisional influences on speaking up. RESULTS: Junior faculty were valued for their unique perspectives of the institutional culture and empowered as members of speak-up culture in the academic setting. CONCLUSION: Administrators benefit from intentionally seeking junior faculty perspectives regarding unprofessional faculty behaviors in the academic setting. Overall school culture benefits from ongoing efforts toward discussion, resource development, and upholding policies related to incivility. [J Nurs Educ. 2020;59(4):210-213.].

An Innovative Civility Intervention Created by a Faculty and Student Action Research Team.

BACKGROUND: Incivility is a significant issue in nursing education and practice, contributing to ineffective learning, unprofessional nursing practice, and negative patient outcomes. METHOD: A team of nursing faculty and students used Action Research to develop a quality improvement project targeting civility. A two-part, evidence-based training was offered to prelicensure nursing students, faculty, and staff. Part one was designed to increase incivility awareness, and part two was intended to enhance communication skills. RESULTS: Program evaluation data were collected through an anonymous survey and analyzed descriptively for themes. Results indicated students, faculty, and staff perceived the educational innovation as valuable and useful. CONCLUSION: By using free resources, a college of nursing was able to implement a cost-effective program to begin a conversation and offer a communication strategy to address incivility for students, faculty, and staff. This program design can be adopted by others for use in their organization. [J Nurs Educ. 2020;59(4):214-217.].

Providers' perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya.

Disrespect and abuse during childbirth are violations of women's human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers' perspectives on the topic are limited. We examined providers' perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women's empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.

Two angles of overqualification-the deviant behavior and creative performance: The role of career and survival job.

Overqualification has both positive and negative outcomes; however, extant literature exhibits a tilt in favor of its negative aspect against its positive side. This tilted approach results in derision of a condition which could produce positive results. We argue, through empirical evidence, that there might be some circumstances/conditions, like the intentions of employees about their current job, that may play an important role in enabling organizations to be benefitted from the surplus KSAs of the overqualified employees and overqualification can be used as a tool to mitigate the effects of its negative consequences. To empirically test this condition, a sample of 193 teachers and 193 students have been selected through cluster sampling technique. The results exhibited that if overqualified employees perceive their current job as a career job then there is a more likelihood that they will be involved in some innovative and creative behaviors instead of deviating negatively from the organization norms. The results provide some new research insights that could be used to better understand the phenomenon of overqualification. The results of the study have practical implications for HR managers.

Perceptions of Work-Related Stress and Ethical Misconduct Amongst Non-tenured Researchers in Italy.

The relationship between stress and unethical behaviour amongst non-tenured research staff in academia is a relatively unexplored phenomenon. The research reported herein was therefore carried out with the aim of exploring the relationship(s) between stress, the socio-organisational factors which contribute to it, job satisfaction, perceptions of job instability, and the occurrence of unethical behaviour in research. 793 Italian researchers participated in the research-all of whom were working on fixed-term contracts-after being individually requested to complete an online questionnaire. The data indicate that unethical behaviours occur with alarming frequency. The stress level reported is quite high, as is the level of perceived job insecurity, both of which impact upon levels of job satisfaction. Perceived stress levels also seem to play a role in the commission of unethical behaviours, but this relationship is irrelevant when one considers the role of social and organisational factors that are known to induce it. Indeed, it seems that there are various socio-organisational determinants of stress that have an obvious direct negative influence on the commission of unethical behaviours more than the stress level per se. This research paints a worrying picture in relation to the psycho-physical state of non-tenured researchers as a result of the working conditions in which they find themselves in Italian universities.

Korean medical students' attitudes toward academic misconduct: a cross-sectional multicenter study.

PURPOSE: This study investigated medical students' attitudes toward academic misconduct that occurs in the learning environment during the pre-clinical and clinical periods. METHODS: Third-year medical students from seven medical schools were invited to participate in this study. A total of 337 of the 557 (60.5%) students completed an inventory assessing their attitudes toward academic misconduct. The inventory covered seven factors: scientific misconduct (eight items), irresponsibility in class (six items), disrespectful behavior in patient care (five items), dishonesty in clerkship tasks (four items), free riding on group assignments (four items), irresponsibility during clerkship (two items), and cheating on examinations (one item). RESULTS: Medical students showed a strict attitude toward academic misconduct such as cheating on examinations and disrespectful behavior in patient care, but they showed a less rigorous attitude toward dishonesty in clerkship tasks and irresponsibility in class. There was no difference in students' attitudes toward unprofessional behaviors by gender. The graduate medical school students showed a stricter attitude toward some factors of academic misconduct than the medical college students. This difference was significant for irresponsibility in class, disrespectful behavior in patient care, and free riding on group assignments. CONCLUSION: This study indicates a critical vulnerability in medical students' professionalism toward academic integrity and responsibility. Further study evidence is needed to confirm whether this professionalism lapse is confined only to this population or is pervasive in other medical schools as well.

Beyond mistreatment: Learner neglect in the clinical teaching environment.

Medical student mistreatment has been recognized as a deterrent to education as it interferes with the learning process and contributes to student burnout and attrition. Medical schools and leaders in undergraduate medical education have expended tremendous effort in addressing this phenomenon in hopes of eradicating mistreatment. However, there is a spectrum of behaviors that negatively impact the learning environment beyond that which is considered frank mistreatment. In this conceptual article, the authors propose the concept of learner neglect for the consideration by educators and researchers. This is a term for a range of behaviors exhibited intentionally or unintentionally by a supervisor that prevent a learner from reaching his or her potential. While the behaviors may overlap with mistreatment, they do not always fit within the definition of mistreatment. This concept is illustrated in the context of optimal and suboptimal teaching behaviors that commonly occur within the ecosystem of clinical education. Descriptions and examples are provided for both intentional and unintentional learner neglect. The authors hypothesize possible short- and long-term impacts of learner neglect, describe contributors to its prevalence, and offer questions for key stakeholders to consider in an effort to recognize, study, and ameliorate this issue within medical education programs.

Underreported and unknown student harassment at the Faculty of Science.

Reports of sexual harassment at medical faculties throughout the world, including the Radboud University, raised the question how prevalent this is at the Faculty of Science. We performed a survey among students to assess their experiences with harassment. This questionnaire consisted of questions from the EGERA survey, a questionnaire held among staff of multiple European Universities. We found that 9% of the respondents had observed or experienced harassment at the Faculty. Hardly any of these cases were reported to one of the institutional services. Moreover, most students did not now any of the provided services. We therefore suggest raising awareness on harassment and to make students more familiar with the trust person.

[Abuse in healthcare - lessons learned during two decades of research]. / Kränkningar i vården är vanligt förekommande - Viktigt med aktivt arbete mot att patienter kränks.

Patients' experience of abuse in health care (AHC) is common, and may cause long-lasting suffering. In Sweden, lifetime prevalence is estimated at 20 per cent among female patients and 8 per cent among male patients, and a background of other abuse is a risk factor. Most health care staff have experience of patients who have been abused, but the topic is surrounded by silence from both patients and caregivers. Models for training staff in groups have been evaluated and a more proactive stance can be fostered. Department heads and health care authorities are responsible for providing staff with options to counteract AHC. Caregivers need training in how to carry out consultations with patients who say they have been abused in health care, and this training should be included in efforts to increase quality of care. Changes are within reach but educational efforts are urgent.

Experiences, behaviors, and perceptions of registered nurses regarding research ethics and misconduct.

BACKGROUND: Nurses engaging in research are held to research ethics standards. RESEARCH AIM: Examine experiences, behaviors, and perceptions of nurses in Israel regarding research ethics and explore possible related factors. RESEARCH DESIGN: An original investigator-designed self-administered questionnaire measured five variables: (a) ethics in research, (b) encountered research misconduct during the course of one's studies, (c) the inclination to fabricate data, (d) the inclination to select or omit data, and (e) knowledge of research misconduct in the workplace. Additionally, demographic data were collected. PARTICIPANTS AND RESEARCH CONTEXT: The questionnaire was completed by 151 Israeli registered nurses. 10.2% hold a PhD, 34 % hold an MA, 42.2% hold a BA, and 13.6% with no academic degree. ETHICAL CONSIDERATIONS: The study was approved by the University's ethics committee; anonymity and consent of the respondents were respected. FINDINGS: Registered nurses' level of studies achieved was significantly associated with a lower inclination to fabricate data, with one exception-PhD nurses were more inclined to fabricate data than nurses with a Master's degree. A trend was found in which a higher level of studies is associated with higher knowledge of research misconduct in the workplace. DISCUSSION: Results indicate that nurses' perceptions of research ethics change throughout their academic studies, indicating a positive influence of level of studies, research experience, and work experience on ethics perceptions. Nevertheless, PhD nurses showed a greater inclination to actually select, omit, or even fabricate data than MA nurses. This may be related to pressure to publish. CONCLUSION: PhD nursing programs should include ethics training. Academic faculty members should serve as role models regarding research integrity. Research ethics deserves further emphasis on all levels of nurse education in Israel, as well as in the nurses' code of ethics and related documents. This may positively impact ethical research practices.

A practical framework for remediating unprofessional behavior and for developing professionalism competencies and a professional identity.

The relatively new term "Professional Identity Formation" (PIF) complements behavior-based and attitude-based perspectives on professionalism. Unprofessional behavior and its remediation should also be addressed from this perspective. However, a framework is needed to guide discussion and remediation of unprofessional behavior, which can encompass behavior-based, attitude-based, and identity-based perspectives on professionalism. To this end, the authors propose a multi-level professionalism framework which describes, apart from professional behavior, more levels which influence professional performance: environment, competencies, beliefs, values, identity, and mission. The different levels can provide tools for educators to address and discuss unprofessional behavior with their students in a comprehensive way. By reflecting on all the different levels of the framework, educators guard themselves against narrowing the discussion to either professional behavior or professional identity. The multi-level professionalism framework can help educators and students to gain a better understanding of the root of unprofessional behavior, and of remediation strategies that would be appropriate. For despite the recent emphasis on PIF, unprofessional behavior and its remediation will remain important issues in medical education.