ABSTRACTNursing incivility or lateral violence in the workplace has become an accepted culture in nursing (1). It is causing division among healthcare teams and a departmental decrease in effectiveness and productivity (2,3). Developing an environment that is conducive to safe, equal patient-care continues to be imperative. The purpose and goals of this scholarly-improvement project are to review available literature and employ a primary prevention method for incivility prevention in the operating room (4). This will be achieved through the development of a civility-training, educational seminar and follow-up evaluations.

PICO QUESTIONIn operatiating room nurses (P), how does civility educational training (I), compared to no civility training (C), affect unity and promote a decrease in incivility (O), in a one year time frame (T).

LITERATURE REVIEW• The American Nurses Association’s Position

Statement: Incivility, bullying, and workplace violence (4), provides evidence-based support that incivility crosses all departments and affects all demographic populations; it includes verbal, psychological, physical, sexual, emotional, and other harming behaviors.

• Conducting an in-depth literature review of incivility in nursing, five common themes immerged that guided the development of this quality, improvement project.

1) Frequency2) Types of incivility3) Nursing consequences4) Organizational effects5) Proposed solutions

• Incivility in the nursing environment is counterproductive to the quality and safety of patients and their families (5).

• Underreporting has been linked to decreased managerial support and perpetrator retribution (6).

Incivility: An Educational Training Solutionto Resolve Interpersonal Violence and

Promote Workplace Unity

Bryce Kunzler, BSN, RN, MSN Student

Methods and Plan• Brainstorm educational solutions with

manger, educator, professor, and staff• Analysis of incivility literature• Design civility-training workshop• Administer pre-workshop, knowledge

test and evaluation• Role-play cognitive rehearsal techniques,

using simulated scenarios (7) • Re-administer post-workshop,

knowledge test and evaluation• Follow-up observation and monitoring of

departmental incivility

Deliverables• Knowledge pre- and post-tests• Nursing Incivility Scale evaluations and

follow-up• PowerPoint lecture• Civility-training workshop• Incivility pamphlet • Conflict resolution role-playing

EvaluationUtilizing The Nursing Incivility Scale created by Guidroz, Burnfield-Geimer, Clark, Schwetschenau, and Jex (8), information will be measured on incivility prevalence in the operating room.• Determine main perpetrators of incivility in

the operating room• Measure statistical significance of

educational interventions• Evaluate consequences of nursing incivility

and determine common themes• Evaluations will be conducted before the

workshop and at periods of three, six, and twelve months post-workshop.

THEORETICAL FRAMEWORKDr. Jean Watson Theory of Human Caring• Codified in 1979, the Theory of Human

Caring focuses on how nurses can exhibit caring compassion to influence their patients and environment (9).

• The theory focuses on changing both the perpetrator’s views/personality towards the victim or environment and the victim’s response to received, interpersonal interactions in the workplace.

• Consists of nine carative factors for enhanced compassion and caring (10).

• Theory applied to project by changing the underlying culture within the department, from one of blame and conflict, to a culture of responsibility, accountability, and compassion for each individual.

CONCLUSIONSIncivility in the nursing workplace will continue to be a frontline problem, as staff with different personalities learn to work together (1,2,3,4). Educational solutions are an area of primary prevention of incivility and one that shows potetnial (4). Education can provide nursing staff with the needed, conflict-resolution skills required to deescalate uncivil situations. This scholarly-improvement project, paves the way for improved interprofessional collaboration in the operating room and higher quality of patient-care. Each of which, contribute to an environment safe for each nurse to practice professionally.

REFERENCES1. McKenna, B. G., Smith, N. A., Poole, S. J., & Coverdale, J. H. (2003). Horizontal violence:

experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96.

2. Berry, P. A., Gillespie, G. L., Gates, D., & Schafer, J. (2012). Novice nurse productivity following workplace bullying. Journal of Nursing Scholarship, 44(1), 80-87. doi:10.1111/j.1547-5069.2011.01436.x.

3. Chang, H. E., & Cho, S. (2016). Workplace violence and job outcomes of newly licensed nurses. Asian Nursing Research, 10(4), 271-276. doi:10.1016/j.anr.2016.09.001.

4. American Nurses Association. (2015). Position Statement: Incivility, bullying, and workplace violence. Retrieved from https://www.nursingworld.org/~49d6e3/globalassets/practiceandpolicy/nursing-excellence/incivility-bullying-and-workplace-violence--ana-position-statement.pdf.

5. Bigony, L., Lipke, T. G., Lundberg, A., McGraw, C. A., Pagac, G. L., & Rogers, A. (2009). Lateral violence in the perioperative setting. AORN journal, 89(4), 688-700.

6. Findorff, M. J., McGovern, P. M., Wall, M. M., & Gerberich, S. G. (2005). Reporting violence to a health care employer: A cross-sectional study. AAOHN journal, 53(9), 399-406.

7. Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257-263.

8. Guidroz, A., Burnfield-Geimer, J., Clark, O., Schwetschenau, H., Jex, S. (2010). The nursing incivility scale: Development and validation of an occupation-specific measurement. Journal of Nursing Measurement, 18(3), 176-200.

9. McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

10.Wayne, G. (2016). Jean Watson. Retrieved from https://nurseslabs.com/jean-watson/.

PROJECT METHODOLOGYIncivility is a dynamic, multi-faceted problem that requires an innovative, educational approach to empower nursing staff (4). Research in the field of conflict management techniques has revealed support of cognitive rehearsal for nursing staff in managing episodes of incivility (7). With support of the operating room unit manger, unit educator, and nursing staff, a mandatory in-service, civility training workshop will be designed. This workshop will educate nursing staff on incivility frequency, causes, consequences, and proposed solutions. Using a primary-prevention, intervention methodology, recommended by the American Nurses Association (4), nursing staff in the operating room will develop critical conflict resolution and reporting skills needed to prevent a culture of incivility.