Integrating Trauma-Informed Teaching and Learning Principles Into Nursing Education.

BACKGROUND: Trauma-informed teaching and learning (TITL) considers the effect of trauma on learners stemming from sources such as political tensions, racial and gender inequities, health disparities, poverty, community violence, bullying, and most recently, the coronavirus disease 2019 (COVID-19) pandemic. METHOD: TITL is an inclusive, learner-centered teaching methodology that has evolved during the past two decades to become more relevant in times of crisis. The foundation for effective TITL practice is the educator's grasp of how trauma affects learner behavior, performance, relationships, and coping. RESULTS: The principles of TITL are described as well as how each principle can be implemented to enhance learner engagement, strengthen relationships, and foster an inclusive learning environment aimed at facilitating learning and enhancing personal and professional growth. CONCLUSION: Nursing faculty can implement TITL learner-centered, inclusive, inquiry-based, and adaptive strategies to promote learner engagement and empowerment, improve academic performance, and foster stronger faculty-learner connections. [J Nurs Educ. 2023;62(3):133-138.].

Pilot Study Using Cognitive Rehearsal, Simulation, and Biomarker Data to Address Workplace Incivility.

BACKGROUND: Workplace incivility poses a threat to patient safety. This intervention pilot study used simulation and biomarker data with newly graduated nurses to explore the impact of incivility on patient care and tested whether cognitive rehearsal could mitigate the effects of workplace incivility. METHOD: A clinical scenario and script were used by actors to deliver either an uncivil or a hurried but not uncivil handoff report to participants before they conducted a focused patient assessment and administered medications to a standardized patient. RESULTS: Participants identified gaps in understanding of both handoff reports that resulted in compromised patient care. Quantitative trends showed lower resilience scores and higher stress appraisal scores for participants who received the uncivil handoff report. CONCLUSION: Although participants expressed confidence using cognitive rehearsal as an intervention before the simulation, responses indicated that a 60-minute session was insufficient to adequately prepare them to effectively address an uncivil nurse encounter. [J Contin Educ Nurs. 2023;54(2):79-88.].

Civility: A concept analysis revisited.

BACKGROUND: Nurses have an ethical obligation to create cultures of civility, treat others with respect and dignity, and foster healthy, inclusive work environments that protect worker and patient safety. PURPOSE: Because concepts are known to change over time, this concept analysis compares the original concept of civility published in 2008 with the current concept analysis of civility. METHODS: The Walker and Avant method of concept analysis was utilized. FINDINGS: Antecedents, defining attributes, ideal and unintended consequences, relevant cases, and an operational definition of civility are presented. A conceptual model illustrates antecedents, defining attributes, consequences of civility, and the role perception plays when assessing, interpreting, experiencing, and responding to incivility. DISCUSSION: Authentic civility, rather than "mere civility," is urgently needed to build meaningful relationships, create healthy, productive work and learning environments, and foster organizational cultures of inclusivity and belonging.

Assisting Learners to Understand and Incorporate Functions of Clinical Judgment Into Nursing Practice.

BACKGROUND: Mastering clinical judgment (CJ) skills is an essential competency for nurses in all health care environments. PROBLEM: Complexities of the health environment combined with the intricacies of nursing practice can pose potential risks to client safety. APPROACH: Over a 2-year period, a 3-phased approach using (1) survey results from nurses in education and practice, (2) discussion forums, and (3) a series of think tanks that comprised nurse educators resulted in the development of the Guide for CJ. OUTCOMES: The Guide for CJ provides nurse educators with an evidence-based resource to promote CJ skills in nursing students. The environmental and individual factors and expected nurse responses and behaviors contained in the Guide are well-aligned with the cognitive operations contained in the National Council of State Boards of Nursing Action Model. CONCLUSIONS: Educators may use the Guide to support faculty development and operationalize CJ to develop a variety of learning strategies for use in multiple learning environments.

Faculty development workshop on gender-associated incivility in nursing education.

BACKGROUND: Men comprise the minority of entry-level baccalaureate nursing students and are at increased risk of experiencing gender-associated incivility. PROBLEM: Uncivil peer-to-peer behavior can negatively affect students' mental and physical well-being, and learning experience. Nursing faculty must be able to identify and address gender-associated incivility among students. AIM: The purpose of this quality improvement program was to train nursing faculty to prevent, identify, and manage gender-associated incivility in the educational environment. METHODS: A day-long interactive workshop utilizing trigger films, small group discussions, and interactive theater was developed to train nursing faculty to implement proactive and reactive techniques to address uncivil behavior which will enhance the learning environment for all students. Utilizing Kirkpatrick's Model of Evaluation, participants were surveyed at the conclusion of the workshop and four months postworkshop to evaluate their learning and its implementation. RESULTS: Participants gained greater understanding of the impact of gender-associated incivility and felt both empowered and better prepared to manage gender-associated conflict. CONCLUSION: Similar approaches may be useful for schools of nursing that wish to empower their nursing faculty to support an equitable nursing education environment free of gender-associated incivility.

National Study on Faculty and Administrators' Perceptions of Civility and Incivility in Nursing Education.

BACKGROUND: Incivility among nursing faculty and administrators lowers morale, damages relationships, and threatens workplace health and productivity. PURPOSE: This national study examined nursing faculty and administrators' perceptions of civility and incivility in nursing education, ways to address the problem, and psychometric properties of the Workplace Incivility/Civility Survey (WICS). METHODS: A convergent mixed-methodological study was used to conduct the study. A factor analysis and other reliability analyses were conducted on the WICS. RESULTS: Respondents included 1074 faculty and administrators who identified types and frequency of incivility, severity and contributors to the problem, reasons for avoiding incivility, and strategies to improve civility. Eight themes of uncivil behaviors were garnered. The WICS was shown to be a psychometrically sound instrument to measure civility and incivility. CONCLUSION: This study reported faculty and administrators' perceptions of civility and incivility in nursing education and provided evidence-based strategies to prevent and address the problem.

Fostering Civility in Learning Conversations: Introducing the PAAIL Communication Strategy.

BACKGROUND: Civility, psychological safety, and effective stress management are essential for meaningful learning conversations. PROBLEM: Incivility triggers fear and humiliation, impairs clinical judgment and learning, reduces psychological safety, and increases cognitive load. These factors converge to make learners less likely to incorporate feedback, speak up when there is a problem, and discuss practice errors and patient safety issues. APPROACH: The authors combined the Basic Assumption and the PAAIL (Preview, Advocacy1, Advocacy2, Inquiry, and Listen) conversational strategy to help surface (rather than obscure) both educators' and learners' thinking. The synergy of these 2 strategies allows educators to identify individual learning needs and develop the learners' clinical judgment skills. This process improves learning by reducing incivility and cognitive load, improving psychological safety, and strengthening clinical judgment skills. CONCLUSION: This conversational strategy can minimize stress and anxiety in learners and optimize learning.

Civility Mentor: A Virtual Learning Experience.

BACKGROUND: Incivility and disrespect in health care weaken teamwork and collaboration, diminish communication, and can impact an individual's ability and willingness to speak up and advocate for patient care. PROBLEM: Evidence-based teaching strategies are needed to prepare nursing students to address incivility in academic and practice settings. APPROACH: The authors describe a virtual learning experience designed to prepare students to prevent and address incivility in academic and health care environments and report preliminary assessment data from student users. OUTCOMES: More than 90% of 22 000 student respondents indicated they were satisfied with the learning experience, were made aware of the consequences of incivility and its effects on patient safety, and planned to apply techniques for addressing incivility into their nursing practice CONCLUSION: Civility mentor is effective in educating students about the consequences of incivility, developing skills to foster civility, communicating more assertively, and addressing incivility in academic and health care environments.

Cognitive Rehearsal, HeartMath, and Simulation: An Intervention to Build Resilience and Address Incivility.

BACKGROUND: The detrimental impact of incivility in health care is well documented. Nursing students and new graduate nurses are particularly vulnerable to its effects. Evidence-based civility education strategies are urgently needed to address incivility, which can protect patient safety. METHOD: Using a mixed methodology, 188 incoming, upper division, prelicensure nursing students participated in an intervention study that combined cognitive rehearsal, HeartMath, and simulation using TeamSTEPPS™ Concerned, Uncomfortable, and Safety model to address acts of incivility that threaten patient safety. RESULTS: Student evaluations immediately following the intervention and 6 months postintervention rendered positive results. Eight themes emerged describing uncivil experiences occurring in the patient care environment. CONCLUSION: This intervention provided nursing students with evidence-based tools to build resilience to effectively address incivility in the patient care environment. Nurse educators are urged to provide civility education in conjunction with tested techniques to build resilience and address uncivil encounters in health care. [J Nurs Educ. 2019;58(12):690-697.].

Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility.

BACKGROUND: Nurses have a professional and ethical obligation to foster civility and healthy work environments to protect patient safety. Evidence-based teaching strategies are needed to prepare nursing students to address acts of incivility that threaten patient safety. PROBLEM: Incivility in health care must be effectively addressed because the delivery of safe patient care may depend on these vital skills. APPROACH: Cognitive rehearsal (CR) is an evidence-based technique where learners practice addressing workplace incivility in a nonthreatening environment with a skilled facilitator. The author describes the unique combination of CR, simulation, evidence-based scripting, deliberate practice, and debriefing to prepare nursing students to address uncivil encounters. OUTCOMES: Learners who participated in CR identified benefits using this approach. CONCLUSIONS: Combining CR with simulation, evidence-based scripting, repeated dosing through deliberate practice, and skillful debriefing is an effective method to provide nursing students with the skills needed to address incivility, thereby increasing the likelihood of protecting patient safety.

Development and Psychometric Testing of the Workplace Civility Index: A Reliable Tool for Measuring Civility in the Workplace.

BACKGROUND: Fostering civility in practice and academic health care settings is a desirable goal for individuals, teams, and organizations and is paramount to safe patient care. METHOD: A convenience sample of 393 nursing faculty and practice-based nurses in the United States participated in a study to test the psychometric properties of the Workplace Civility Index (WCI). RESULTS: A factor analysis and other reliability analyses support the use of the WCI as a valid and reliable measurement to measure perceptions of workplace civility acumen. CONCLUSION: The WCI is a 20-item psychometrically sound instrument used to measure perceptions of workplace civility among individuals and groups within work environments. The index may be completed as an individual exercise; however, it is highly recommended that the index be completed with a trusted coworker, colleague, or work group to improve self-awareness, give and receive constructive feedback, and form the basis for continuing strengths and addressing areas for improvement. J Contin Educ Nurs. 2018;49(9):400-406.

Policy to Foster Civility and Support a Healthy Academic Work Environment.

BACKGROUND: Incivility in academic workplaces can have detrimental effects on individuals, teams, departments, and the campus community at large. Alternately, healthy academic workplaces generate heightened levels of employee satisfaction, engagement, and morale. METHOD: This article describes the development and implementation of a comprehensive, legally defensible policy related to workplace civility and the establishment of a healthy academic work environment. RESULTS: A detailed policy exemplar is included to provide a structure for fostering a healthy academic work environment, a fair, consistent, confidential procedure for defining and addressing workplace incivility, a mechanism for reporting and subsequent investigation of uncivil acts if indicated, and ways to foster civility and respectful workplace behavior. CONCLUSION: The authors detail a step-by-step procedure and an incremental approach to address workplace incivility and reward policy adherence. [J Nurs Educ. 2018;57(6):325-331.].

An Evidence-Based Approach to Integrate Civility, Professionalism, and Ethical Practice Into Nursing Curricula.

This article presents an evidence-based approach to integrate concepts of civility, professionalism, and ethical practice into nursing curricula to prepare students to foster healthy work environments and ensure safe patient care. The author provides evidence to support this approach and includes suggestions for new student orientation, strategies for the first day of class, exemplars for incorporating active learning strategies to enhance student engagement, an emphasis on positive faculty role modeling, and suggestions for curricular integration.

Promoting Civility in the OR: An Ethical Imperative.

Recognizing, addressing, and preventing incivility in the health care environment, including the perioperative area, requires an intentional and informed approach to foster healthy workplaces and protect patient safety. Several important foundational documents and position statements speak directly to the nurse's responsibility to protect patient, coworker, and personal safety and promote civility and respect. In the complex, fast-paced environment of the OR, the pressure to meet patient needs, performance outcomes, and patient safety standards can lead to conflict and incivility. In this article, we present a case-based scenario to illustrate a multilevel evidence-based response to an uncivil encounter that could negatively affect patient safety in the OR. After the scenario, we discuss the responses to the encounter from the organization, the nurse manager, and the individual nurse. When nurses speak up and resolve issues, they report better patient outcomes, greater satisfaction in the workplace, and heightened organizational commitment.

Development and Testing of the Healthy Work Environment Inventory: A Reliable Tool for Assessing Work Environment Health and Satisfaction.

BACKGROUND: Fostering healthy work environments that enhance job satisfaction and reflect high levels of employee engagement and productivity is imperative for all organizations. This is especially true for health care organizations where unhealthy work conditions can lead to poor patient outcomes. METHOD: A convenience sample of 520 nursing faculty and practice-based nurses in the United States participated in a study to test the psychometric properties of the Healthy Work Environment Inventory (HWEI). RESULTS: A factor analysis and other reliability analyses support the use of the HWEI as a valid and reliable instrument to measure perceptions of work environment health. CONCLUSION: The HWEI is a 20-item psychometrically sound instrument to measure perceptions of the health of the work environment. It may be completed either as an individual exercise or by all members of a team to compare perceptions of work environment health, to determine areas of strength and improvement, and to form the basis for interviewing. [J Nurs Educ. 2016;55(10):555-562.].