Incivility in the Health Care Paradigm

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Table of Contents

Introduction
Incivility’s Impact on Individual Nurses’ Abilities
Issues That Might Occur due to the Clinical Site Incivility
Incivility’s Effect on the Clinical Site
Initiatives to Decrease Incivility in the Workplace
Conclusion
References

Introduction

In the context of constant health challenges, every healthcare worker must guarantee the population quality medical assistance, as well as an empathic approach. Respect for life, dignity and human rights is a fundamental tenet of the philosophy of nursing. The nurse acts both independently and in collaboration with other health care professionals to meet the health needs of the community and individual patients. Nursing has no restrictions on race, age, gender, political or religious beliefs, or social status. However, one of the most severe issues professional nurses experience during their work is the incivility brought out by the patients and their families.

Insulting the honor and dignity of medical professionals is the most common offense committed by patients. Cases of aggression directed at nurses and doctors during the performance of their professional duties are a serious public health problem. This aggression may manifest in many different forms, from verbal abuse and violent indignation with irritation and anger, up to sexual harassment and physical actions causing harm to people and objects.

Incivility’s Impact on Individual Nurses’ Abilities

The mid-level medical staff, such as nurses, usually has direct contact with the patients for a long time, therefore, they experience most of the positive and negative effects of patient-nurse communication. One of the main nurse’s tasks is to create a comfortable atmosphere that would help the patient to heal better by establishing a trustworthy and respectful relationship with them. However, this task might become complicated when a patient expresses uncivil behavior or even aggression towards the nurse.

The health care workers who have to endure years of emotionally intense work show high levels of anxiety, as well as a tendency to depression. These conditions are often accompanied by the use of various sedatives, drugs, and alcohol abuse, which only contributes to the further destabilization of the patient-nurse relationship due to the nurse’s improper mental state. Armstrong (2018) claims that “nurses have reported workplace incivility to have caused distractions and emotional upset, to the point that it has put patients at risk” (p. 403). The phenomenon of emotional burnout might also occur if the conflict between the patient and the nurse is too severe and takes on a form of a legal court case due to a variety of reasons.

Issues That Might Occur due to the Clinical Site Incivility

Incivility in the workplace holds, perhaps, the greatest influence on work performance for the health care industry specifically. The physical consequences of it for the nurses are quite unpleasant: increased fatigue, anxiety, and even premature mortality are among the most common problems. Higher levels of stress caused by uncivil behavior towards nurses potentially bring out an inability to concentrate on work, as well as difficulty in making decisions. Thus, a decreased nursing performance enhances the danger of a medical error exponentially, which may even result in fatal consequences for a patient’s health.

The uncivil attitude of patients towards nurses is often expressed in insults and slander – the dissemination of information that does not correspond to reality. Meanwhile, the latter is a criminal offense, which might affect the nurse in question severely by putting them in danger of losing their work or even being condemned in legal court. Even the most attentive and conscientious nurses may fall under the claims of unprofessionalism made by a disgruntled patient. Additionally, if these claims are made in written form, they require an immediate response from the hospital’s authorities. This might further distract health care workers from performing their immediate duties of providing quality medical care.

Incivility’s Effect on the Clinical Site

It is important to understand that, sometimes, through aggression, patients show their inner fear of death, helplessness, and illness. Thus, they pour out this fear on the doctor or the nurse, using it as a coping mechanism. Moreover, in certain cases, when the patient expresses uncivil behavior, one of the possible reasons for this may be insufficient communication between the doctor or nurse and the patient. Culturally and socially untailored approaches, as well as the health care worker’s ignorance or dismissiveness, affect the relationship between the patient and the nurse greatly. The uncivil behavior in these cases is a direct consequence of failed communication, and it might seem justified to the patient. Still, it might affect the clinical facility greatly in terms of damaged reputation and/or legal offense on behalf of the patient. Layne et al. (2019) suggest that “established consequences of uncivil behaviors include increased employee turnover rates, decreased job satisfaction, decreased productivity, and increased absenteeism” (p. 1506).

Additionally, if the patient is not content with their communication with the nurse, it might lead to the patient’s non-compliance with the prescribed treatment, which presents a direct danger to their health. Effective nurse-patient interaction is associated with increased patient satisfaction, adherence to recommendations, and subsequent health improvement, while conflicts might cause harmful situations to both clinical sites and their patients. Nurses have the unique opportunity to witness patients and their families at their most vulnerable moments, and this is another potential risk factor for the clinical site. Patients’ emotional instability is a significant factor that contributes to their compliance with the nurse’s recommendations. Therefore, if the patient’s emotional needs are not met, conflict might arise, potentially leading to the endangering of the patient’s health.

Initiatives to Decrease Incivility in the Workplace

An uncivil behavior towards health care workers should be addressed properly, with both administrative, educational, and organizational means. Bambi et al. (2017) claim that “the educational interventions are: improvement of basic communicative skills, increasing the desire of an effective communication, introduction of policies/procedures against disruptive behaviors, and adequate interaction with the perpetrators” (p. 44). Moreover, strong legal protections for the victims of workplace incivility are also highly needed, as of now, the existing procedures do not cover the cases of disruptive behavior properly.

The American Association of Critical Care Nurses, together with other nursing organizations, proposed the concept of a “Healthy Work Environment”. The project is directed at establishing an effective workplace environment free of incivility or any kind of abuse. Bambi et al. (2017) supply that “it has 4 key elements: minimize the barriers to delivery of care; design and implementing of technologies; focus on care directed to the patient; supporting “brand new” nurses” (p. 44). Another organizational initiative was designed by the American Nurses Association specifically on the problem of workplace abuse. The ANA presented a document with the guidelines and strategies to promptly recognize and address abusive behavior.

Conclusion

Inconsistency between the patient’s and nurse’s interests remains the main source of uncivil behavior, but the factors that can cause this behavior are extremely varied. These can include the personal characteristics of both patient and nurse: reduced self-criticism, their moods, overall well-being, intelligence, knowledge of human psychology, and communication skills. While the nurse, indeed, should understand and take into account the patient’s psychoemotional state, that does not mean that they have to endure incivility from them. Both patients and nurses must understand and respect each other for the latter to deliver high-quality, compassionate care. Lately, the increased incidence of attacks on health workers affects heavily the general atmosphere of the health care industry. Moreover, it also contributes to the outflow of personnel – for example, many experienced and talented doctors and nurses are leaving the profession.

References

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403–410. Web.

Bambi, S., Guazzini, A., De Felippis, C., & Lucchini, A. (2017). Preventing workplace incivility, lateral violence and bullying between nurses. A narrative literature review. Acta Biomed, 88(5-S), 39–47. Web.

Layne, D. M., Anderson, E., & Henderson, S. (2019). Examining the presence and sources of incivility within nursing. Journal of Nursing Management, 27(7), 1505–1511. Web.

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