Document Type : Original articles
Authors
1 B.Sc. Nursing, Faculty of Nursing-Minia University
2 Assist Professor of Nursing Administration, Faculty of Nursing-Minia University
3 Lecturer of Nursing Administration, Faculty of nursing – Minia University
4 Lecturer of Nursing Administration, Faculty of Nursing, Minia University
Abstract
Highlights
Mohamed Fathy Rasheed 1; Sanaa Mohamed Aref 2; Ebtsam Ahmed Mohamed3; Amira Moustafa Fahmy4
1 B.Sc. Nursing, Faculty of Nursing-Minia University;
2Assist Professor of Nursing Administration, Faculty of Nursing-Minia University,
3Lecturer of Nursing Administration, Faculty of nursing – Minia University,
4Lecturer of Nursing Administration, Faculty of Nursing, Minia University.
Keywords
Introduction
A critical element in any learning environment is an atmosphere where the student can learn free of distractions or harassment. Additionally, the instructor should be able to teach in a productive, positive learning environment (Williamson, 2011). Carr et al. (2016) identified the importance and necessity of a safe teaching and learning environment in nursing education, and the current research suggests that the learning environment is negatively impacted when there is uncivil behaviors from one or more parties. Incivility refers to any rude or disrespectful speech, action or behavior that causes conflict and leads to psychological and physiological distress to the targeted persons. Incivility also encompasses the violation of etiquette or manners and deviance from societal norms (Knepp, 2012).
Academic incivility is characterized by behaviors that are disruptive, substantial or repeated, and that interfere with teaching and learning. Incivility is a considerable issue in academic environment. Even though it can be a small number of students who prove to be challenging, these students require a disproportionate amount of faculty staff time and energy (Luparell, 2011; Clark & Springer, 2010). Incivility in nursing education has additional, serious ramifications. Instructors who have experienced uncivil behavior from students report significant physical and emotional consequences such as loss of time, sleep, confidence, and even a need to quit teaching. There are different levels at which student incivility in education occurs. Some of these include student-to student and student to faculty incivility (DeGooyer, 2017).
The terms that have been used to refer to student incivility in nursing education include difficult student situations, inappropriate student behaviors, lateral violence, and disruptive behaviors. Some of the behaviors which nursing faculty members have reported to show student incivility include making disapproving groans, making sarcastic remarks or gestures, cheating on examinations, arriving late for class and leaving class early ( Thomas et al., 2015; Black et al., 2011).
Nursing students who engage in uncivil behaviors during nursing education may carry those same behaviors into the clinical practice once they become nurses. Incivility in the workplace may lead to unsafe working conditions, poor patient outcomes, and further exacerbate the national nursing shortage, as some nurses choose to leave the profession which then effect on the society at all (Clark et al., 2011).
Understanding the prevalence, source, forms, and consequences of incivility in nursing education is critical because of its implications for learning outcomes and the well-being of nursing faculty staff members. Incivility in nursing education undermines the culture of safety, and the intimidation created by such behaviors leads to an environment of hostility and disrespect, all of which reduces morale, and increases staff turnover, distraction, and number of errors (Coe et al., 2014).
Significance of the Study
Academic incivility has a high prevalence rate. The problem of incivility among nursing students requires special attention to prevent these negative behaviors from progressing into potentially violent and aggressive acts. Furthermore, if incivility is allowed to progress beyond the academic environment, it can have detrimental consequences for the nursing profession as a whole (Clark & Springer 2010).
Uncivil behaviors tolerated in academic setting may extend into the workforce. As nursing students engage in and observe acts of incivility, in which these interactions can likely shape their image of the profession (Robertson, 2012). In 2000, the Institute of Medicine reported that uncivil behaviors contributed to more than 98,000 patient deaths annually; so, it is imperative that uncivil student behaviors be addressed and modified in nursing schools before they are permanently incorporated into the nursing workforce environment.
In Egypt, few studies were conducted for academic incivility, there is one study done at Faculty of Nursing, Tanta University by Mahmoud (2015) which focused on studying civility among nursing students and the result show that more than 50% of students were sometimes do uncivil behaviors and also high percent of students about 75% of student perceived that aggressive and avoidance behaviors are uncivil student behaviors.
Through his experience as a clinical instructor at Faculty of Nursing, Minia University. The researcher observed that some students do misbehaviors such as arriving late for class, leaving class early, making disapproving sounds. Also, many faculty staff members complain that there are some students have misbehaviors such as acting bored or apathetic, using cell phone during class, being unprepared for class, and not paying attention in the class. Thus, there is a need to do this study to investigate the students' and staff members' perception about students academic incivility and its incidence.
Aim of the Study
The aim of the current study is to assess perception and incidence of students academic incivility at Faculty of Nursing.
Research Questions:
1) What is the perception of nursing students and faculty staff members about students academic incivility?
2) What is the incidence of uncivil student behaviors as perceived by nursing faculty staff members and students?
Methodology
Research design:
The study was conducted using descriptive research design.
Setting:
The study was conducted at the Faculty of Nursing, Minia University. This study included all nursing faculty academic departments.
Subjects:
The study subjects consisted of 30% from total numbers of nursing students enrolled at 2nd, 3rd, and 4th academic years during the academic year 2018-2019 which constituted (N=400), and 50 % from total number of faculty staff members and their assistants which calculated as (N=61).
N.B: The first academic year was excluded from the study because the aim of the study is to assess the students academic incivility in the past year at the Faculty of Nursing.
Data collection tool: The research data was collected using one tool consisted of two parts.
1) Part I: Socio Demographic data sheet: It was attached with tool to get information about Faculty of Nursing staff members, and students at Minia University. It contained staff member age, gender, position, residence, scientific degree and department. Student age, gender, residence, and academic year
2) Part II: Incivility in nursing education (INE). The INE tool developed by (Clark et al., 2009) and modified by the researcher to measure the perception of nursing students and staff members about student academic incivility and its incidence. The modification included (exclusion of the part that concerned with uncivil behaviors from faculty staff that were not suitable for the study, and the last part of questionnaire that include 4 open end questions), also included (adding an open end question " the other effects of students academic incivility on the educational process"). And furthermore, translation of questionnaire from English language to Arabic language.
INE consisted of 4 parts with 32 items divided as follow:
Part (1) students' disruptive behaviors, it consisted of 19 items, and was measured by using 2 types of scales.
First scale was measured by using (Yes, No) responses which measured perception of students and faculty staff members about student disruptive behaviors. The total scoring system was from 0 to 19 as follow: Low Perception (0 -9), Moderate Perception (10 – 13), High Perception > 13.
Reliability was done by Cronbach's Alpha test = 0.859 for staff members items, and = 0.883 for student items."
Second scale was measured by using 5 points likert scale ranged as (always =4, usually=3, sometimes=2, scarcely =1, never=0) which measured incidence of student disruptive behaviors as perceived by students and faculty staff members. The total scoring system was from 0 to 76 as follow: Low incidence (0 -24), Moderate incidence (25 – 50), High incidence > 50.
Reliability was done by Cronbach's Alpha test = 0.892 for staff members items, and = 0.940 for student items."
Part (2) students' threatening behaviors, it consisted of 9 items, and was measured by using (Yes, No) responses, which measured incidence of students threatening behaviors as perceived by students and faculty staff members. The total scoring system was from 0 to 9 as follow: Low incidence (0 -3), Moderate incidence (4 – 6), High incidence > 6.
"Reliability was done by Cronbach's Alpha test = 0.859 for staff members items, and = 0.840 for students items."
Part (3) consisted of 3 multiple choice questions related to student academic incivility.
Part (4) consisted of 1 open end question related to student academic incivility.
Validity of the tool:
The tool was tested for the content validity by a jury of seven experts in nursing administration (two professors & one assistant professor from Minia university, two professors & one assistant professor from Ain Shams university, and one Assistant professor from Beni Suef university) and necessary modifications was done.
Pilot Study:
A pilot study was conducted on 10% of participants which include (40 students & 6 staff members) to ascertain the clarity, comprehensiveness and applicability of the tools as well as to estimate the appropriate time required for filling the questionnaire. Results of the pilot study indicated that; the tool was applicable and didn’t need any changes. Hence, pilot study was included in the study subjects.
Data collection procedure:
Ethical and Legal Considerations:
Data processing and analysis:
The data of this study were processed and analyzed using number of sheets collected from the study subject as follows: For faculty staff members and their assistants (sheets= 61), and for students (sheets= 400). Data were fed to the computer and statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 20). Significance of the obtained results was judged at the 5 % level of significance. Quantitative data were expressed as frequency and percentage. For quantitative data, comparison between two variables was done using t-test, and comparison between more than two variables used ANOVA test. Probability (p-value) less than 0.05 was considered significant.
Results
Part I: The staff members
Table 1: Distribution of staff members according to socio demographic characteristics
|
Staff group N = 61 |
Socio demographic characteristics |
|
|
% |
NO. |
|
|
44.3% 47.5% 8.2% |
27 29 5 |
Age 24-30 31-37 38-44 |
|
|
31.6 ± 4.1 |
Mean ± SD |
|
14.8% 85.2% |
9 52 |
Gender Male Female |
|
39.3% 60.7% |
24 37 |
Residence Rural Urban |
|
11.5% 14.8% 18% 13.1% 13.1% 29.5% |
7 9 11 8 8 18 |
Departments Community Health Nursing Woman and Obstetrics Nursing Nursing Administration Pediatric Nursing Department Psychiatric Health Nursing Medical- Surgical Nursing |
Table (1) shows that the highest percentage regarding age of staff members was for range (31-37 year) with (47.5%) with mean score (31.6 ± 4.1). Regarding the gender, most of staff members (85.2%) were female. Concerning the residence, it was noted that more than half (60.7%) of staff members were from urban areas. In regarding to the department, majority of staff members (29.5%) were from medical- surgical nursing. Concerning the position,
Figure 1: Distribution of staff members according to their position.
Figure (1) reveals that the majority of staff members (39%) were assistant lecturer.
Table 2: Scores of different items of students academic incivility for the staff members (N = 61).
|
Mean ± SD |
Range |
% |
NO |
Item |
|
17.5± 2.7
|
9 – 19
|
3.3 8.2 88.5 |
2 5 54 |
Perception of disruptive behaviors Low (0 -9) Moderate (10 – 13) High > 13 |
|
37.8± 10.8
|
13-76
|
11.5 75.4 13.1 |
7 46 8 |
Incidence of disruptive behaviors Low (0 -24) Moderate (25 – 50) High > 50 |
|
3.3± 2.8 |
0 – 9
|
59 23 18 |
36 14 11 |
Incidence of threatening behaviors Low (0 -3) Moderate (4 – 6) High > 6 |
Table (2) reveals that staff members had high level of perception about student disruptive behaviors with (88.5%) with mean score (17.5± 2.7). Regarding scores of incidence of student disruptive behaviors, staff members stated that student disruptive behaviors occurred with moderate level with (75.4%) with mean score (37.8± 10.8). Also, the same table explained that, staff members noted that student threatening behaviors occurred with low level with (59%) with mean score (3.3± 2.8).
Part II: The students
Table 3: Distribution of students according to socio demographic characteristics
|
Students group N = 400 |
Socio demographic characteristics |
|
|
% |
NO. |
|
|
13.2% 63.8% 23%
|
53 255 92 |
Age 18-19 20-21 22-24 |
|
20.7 ± 1.1 |
Mean ± SD |
|
|
74.5% 25.5% |
298 102 |
Residence Rural Urban |
|
36% 35.5% 28.5% |
144 142 114 |
Academic year Second year Third year Fourth year |
Table (3) shows that the highest percentage regarding age of students was for range (20-21) years old with 63.8%, with mean score (20.7 ± 1.1). Concerning the residence, about three quarters (74.5%) of the students were from rural areas. In regard to academic year, the majority of the students were from second and third year with (36% and 35.5% respectively). Regarding the gender,
Figure 2: Distribution of students according to their gender
Figure (2) shows that more than half (58%) of the students were females.
Table 4: Scores of different items of students academic incivility for the students (N = 400).
|
Mean ± SD |
Range |
% |
NO. |
Item |
|
14.3± 5.4 |
0 – 19
|
17 9.3 73.8 |
68 37 295
|
Perception of disruptive behaviors Low (0 -9) Moderate (10 – 13) High > 13
|
|
31.7± 16.5 |
0 – 76
|
38.3 49.8 12 |
153 199 48 |
Incidence of disruptive behaviors Low (0 -24) Moderate (25 – 50) High > 50
|
|
2.3 ± 2.5 |
0 – 9
|
71.8 21 7.2 |
287 84 29 |
Incidence of threatening behaviors Low (0 -3) Moderate (4 – 6) High > 6 |
Table (4) reveals that students had high level of perception about student disruptive behaviors with (73.8%) with mean score (14.3± 5.4). Concerning incidence of student disruptive behaviors, students stated that student disruptive behaviors occurred with moderate level with (49.8%) with mean score (31.7± 16.5). In addition, the same table shows that students noted that student threatening behaviors occurred with low level with (71.8%) with mean score (2.3 ± 2.5).
Table (5) comparison between staff members and students regarding scores of different items of students' academic incivility behaviors (N = 400).
|
P – value |
t – test |
Students n=400 |
Staff members n=61 |
Item |
|
0.017* |
8.15
|
68 (17%) 37 (9.3%) 295 (73.8%)
|
2 (3.3%) 5 (8.2%) 54 (88.5%)
|
Perception of disruptive behaviors Low (0 -9) Moderate (10 – 13) High > 13
|
|
0.001* |
4.5
|
0 – 19 14.3 ± 5.4 |
9 – 19 17.5 ± 2.7 |
Range Mean ± SD |
|
0.001* |
17.5 |
153 (38.3%) 199 (49.8%) 48 (12%) |
7 (11.5%) 46 (75.4%) 8 (13.1%) |
Incidence of disruptive behaviors Low (0 -24) Moderate (25 – 50) High > 50
|
|
0.005* |
2.8
|
0 – 76 31.7 ± 16.6 |
13 – 76 37.8 ± 10.8 |
Range Mean ± SD |
|
0.015* |
8.4
|
287 (71.8%) 84 (21%) 29 (7.2%) |
36 (59%) 14 (23%) 11 (18%) |
Incidence of threatening behaviors Low (0 -3) Moderate (4 – 6) High > 6 |
|
0.006* |
2.7
|
0 – 9 2.3± 2.5 |
0 – 9 3.3 ± 2.8 |
Range Mean ± SD |
#Chi square test (X2) was used for qualitative data, while independent t test was used for quantitative data
*: Significant difference in between groups (p value ≤ 0.05)
Table (5) explains that the staff members had the highest level of perception of students' disruptive behaviors with (88.5%), with mean score (17.5 ± 2.7). Regarding scores of incidence of students disruptive behaviors, the highest percentage was for staff members view point with (75.4%) in favor to "moderate level" of occurrence, with mean score (37.8 ± 10.8). Concerning scores of incidence of students threatening behaviors, the highest percentage was for students view point with (71.8%) in favor to "low level" of occurrence, with lowest mean score was (2.3± 2.5).
In addition, the same table explains that there was statistically significant difference between students and staff members view point regarding scores of different items of students' academic incivility behaviors.
Discussion
Incivility in nursing education is a serious problem affecting faculty staff members, students, and the nursing profession. Incivility is described as “rude or disruptive behaviors which often result into psychological or physiological distress for the people involved, and if left un-addressed, may progress into threatening situations”. Incivility includes a broad range of behaviors and actions ranging from eye rolling to physical threats of harm, with disrespect as the common theme (Ziefle, 2018).
Incivility conflicts with the ethics of the nursing profession. The description of ethics of the nursing profession by the American Nurses Association (ANA) is respect for individuals, collegial relationships with one another, and working out conflict as stated in the Code of Nursing Ethics (ANA, 2015a). The ANA (2015b) recently revised a statement about incivility, bullying, and workplace violence stating that nurses are obligated to create a civil workplace environment. Nurses should not only create a civil environment but also use best practice techniques to prevent incivility and benefit the workplace environment, nursing practice, and patient care (Walrafen et al., 2012). This study aimed to assess perception and incidence of students academic incivility at Faculty of Nursing.
In the current study, regarding the socio demographic data of staff members. It was observed that, the majority of staff members were female. This result might be due to the fact that more than half of students that enter the Faculty of Nursing were female, also the general secondary coordination is lower for female students to enter the Faculty of Nursing than male students, and female students could study harder than male students so the majority of students that recruiting as clinical instructors and staff members were female. This result was supported by walling (2011) who mentioned that while the proportion of men entering the nursing profession has been growing, it remains a female dominated occupation.
Also, this result showed that more than half of staff members were from urban area. This result might be attributed to presence of the Faculty of Nursing in urban area, so staff members prefer to live in areas near the workplace for easy going to the workplace, also staff members could prefer to live in urban areas because it is the best in the standard of living and higher in the economic level than rural areas, and availability of all needs for staff members in urban areas. Moreover, this result showed that the majority of staff members were assistant lectures. This finding might be due to the highest percent of staff members in the Faculty of Nursing were assistant lectures.
Furthermore, this result explained that the majority of staff members were from Medical Surgical Nursing department. This result might be due to the rules of the College provides for the appointment of two clinical instructors in this department yearly because it provides teaching for students in the first and second year so the highest percent of staff members in the Faculty of Nursing are in the medical surgical nursing department.
Regarding the staff members perception about students academic incivility. The study revealed that staff members had high level of perception about students disruptive behaviors with (88.5%) with mean score (17.5 ±2.7). This result was supported by McCrink (2010) who asserted that staff members had high level of awareness about student disruptive behaviors. Also, a study of Mohamed (2016) that was done in the Faculty of Nursing, Zagazig University and who found that the total perception level of faculty staff members toward student incivility behaviors was high with (84%). Another author, Aul (2015) stated that student incivility has been reported as a serious problem by 71% of faculty staff members. Also, Cooper et al. (2011) explained that student incivility was a pervasive problem in nursing education. Moreover, Pyles (2016) reported that student incivility in nursing education is serious problem in nursing academic environment.
Incivility is not exclusive to nursing, Aul (2017) suggested that there has been student incivility in higher education as well as in the society. However, incivility is a visible problem in nursing academic environment. The environment of nursing education differs from other educational environments due to the nature of the classroom and clinical training requiring regular feedback and criticism (Marchiondo et al., 2010). Also, Palumbo (2018) stated that student incivility is serious phenomenon affecting nursing students in all aspects of their educational experience.
In the present study, as regard to the scores about incidence of students disruptive and threatening behaviors, staff members stated that student disruptive behaviors occurred with moderate level (75.4%) with mean score (37.8±10.8) and student threatening behaviors occurred with low level (59%) with mean score (3.3±2.8). These results were supported by a study of Mohamed (2016) that was done at Faculty of Nursing, Zagazig University and who found that staff members stated that student disruptive behaviors occurred with moderate level with (55.8%).Also, AlKandari (2011) found that 82.8% of faculty members indicated that uncivil student behaviors occurred with moderate frequency, and threatening behaviors occurred with low frequency. Moreover, the study of Ibrahim & Qawala (2016) that was done at the Faculty of Nursing, Port Said University and found that staff members stated that student threatening behaviors occurred with low level with (93.9%).
Moreover, DalPezzo & Jett (2010) reported that nursing faculty staff members are vulnerable to varied levels of student academic incivility. Another author, Matt (2012) added that there are moral, ethical, and legal considerations associated with incivility. This includes the principles of non-maleficence, beneficence and justice, and engaging in uncivil behaviors or acts lead to violating these ethical principles.
In the current study, regarding socio demographic data of students, it was observed that more than half of students were female. This result might be attributed to the fact that the majority of nurses who graduated from secondary diploma school and technical institute complete in nursing faculty were females. Also, the secondary coordination for entering nursing college is lower for female than male students and society's view about nursing profession considered it appropriate to females more than males. This result was in accordance with the study of (Abdelkader et al., 2012) that was done at the Faculty of Nursing, Minia University and they found that nearly two third of students were female.
Also, this result showed that more than two thirds of students were from rural areas. This finding might be due to the high cost of living requirements and low socioeconomic level in rural areas, so they held economic view of nursing profession because it provides immediate opportunities for employment after graduation which leads to positive attitude of nursing students toward their future profession. This result was supported by Fayz (2013) who clarified that increased unemployment, decreasing incomes and increasing costs of living had resulted in a surge in poverty and general decline in living condition of populations. These developments had triggered increased income and searching for governmental job to improve socioeconomic status.
Regarding the students perception about student academic incivility. The study revealed that students had high level of perception about student disruptive behaviors with (73.8%) with mean score (14.3± 5.4). This result was agreed with the study of Mohamed (2016) that was done at Faculty of Nursing, Zagazig University and who found that students had high level of perception about student uncivil behaviors in nursing academic environment with (88.5%). Also, Hoffman (2012) reported that students had high level of perception about student disruptive behaviors with (Mean=40.02), (SD=9.96). Another author, Smith (2018) found that students had high level of perception about student disruptive behaviors in nursing academic environment.
In the present study, concerning scores about incidence of students disruptive and threatening behaviors, students stated that student disruptive behaviors occurred with moderate level with (49.8%) with mean score (31.7± 16.5), and student threatening behaviors occurred with low level with (71.8%) with mean score (2.3 ± 2.5). These results were supported by the study of Mahmoud (2015) that was done at the Faculty of Nursing, Tanta University and who found that more than half of students sometimes do avoidance and disregard behaviors. Also, considerable percent (48.7%) of students were sometimes doing disruptive behaviors. Also, Mohamed (2016) reported that student disruptive behaviors occurred with moderate level in nursing education with (66%).
Another author, Swinney et al. (2010) reported an increasing level of occurrence of disruptive students' behaviors. Moreover, the study of Ibrahim & Qawala (2016) that was done at the Faculty of Nursing, Port Said University andfound that students stated that student threatening behaviors occurred with low level with (64%). Furthermore, Bassett (2016) found that students reported that student incivility behaviors occurred with moderate frequency in nursing academic environment. Also, Clark& Springer (2010) stated that the problem of student incivility in nursing education is increasing and had effect on teaching and learning within the disciplines.
Finally, as regard to the comparison between staff members and students about scores of their perception about student academic incivility behaviors and its incidence. The study explained that, that the staff members had the highest level of perception of students' disruptive behaviors with (88.5%), with mean score (17.5 ± 2.7). Regarding scores of incidence of students disruptive behaviors, the highest percentage was for staff members view point with (75.4%) in favor to "moderate level" of occurrence, with mean score (37.8 ± 10.8). Concerning scores of incidence of students threatening behaviors, the highest percentage was for students view point with (71.8%) in favor to "low level" of occurrence, with lowest mean score was (2.3± 2.5). In addition, the same table explains that there was statistically significant difference between students and staff members view point regarding scores of different items of students' academic incivility behaviors. It might be attributed to exposure of staff members to such behaviors from students many times during teaching, and lack of students experiences regarding uncivil behaviors.
These results were supported by Herrin (2014) who found that there was statistically significant difference between students and staff members regarding their perception about student uncivil behaviors and its incidence. Also, Ibrahim& Qawala (2016) reported that there was statistically significant difference between students and staff members regarding their perception about student incivility behaviors. Moreover, Aul (2015) found that there was statistically significant difference between students and faculty staff members' perception about student uncivil behaviors among nursing program types. While, these results were contradicted with Natarajan et al. (2017) who found that there was no statistically significant difference between students and staff members regarding student behaviors to be considered disruptive and its frequency. Also, Mellor (2011) reported that there was no statistically significant difference between students and staff members regarding scores of their perception of student incivility behaviors.
Conclusion
Student incivility is one of the biggest challenges in the learning environment; in which there is misunderstanding in relationship among faculty administrators, staff members and students in the educational environment. Moreover, from this study it can be concluded that, staff members had the highest level of perception regarding student academic incivility behaviors followed by students. Also, the highest percent regarding incidence of student disruptive behaviors was for moderate level of occurrence from staff members view followed by students view. Moreover, the highest percent regarding incidence of student threatening behaviors was for low level of occurrence from students view followed by staff members' view, with statistically significant difference between students and staff members view.
Recommendations
1) Creating and implementing new student orientation program, which considered a prim opportunity to prepare students for their undergraduate experiences by providing valuable resources and information.
2) Staff members should be role model in civil discussion, communicates effectively with the students in the class, and focus on creating respectful relationship with them and appreciating their effort and perspectives.
3) Staff members need to attend workshops regarding classroom management and how to deal with uncivil behaviors from students.
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