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Revisiting Cognitive Rehearsal as an Intervention Against Incivility and Lateral Violence in Nursing: 10 Years Later Griffin, Martha; Clark, Cynthia M.
The Journal of Continuing Education in NursingThe Journal of Continuing Education in Nursing; Thorofare; Thorofare Vol. 45, Iss. 12, (Dec 2014):
535-542.
DOI:10.3928/00220124-20141122-02
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Abstract
Read the article, "Revisiting Cognitive Rehearsal as an Intervention Against Incivility and Lateral
Violence in Nursing: 10 Years Later,â[euro]* found on pages 535-542, carefully noting any tables
and other illustrative materials that are included to enhance your knowledge and understanding
of the content. Be sure to keep track of the amount of time (number of minutes) you spend
reading the article and completing the quiz.
Read and answer each question on the quiz. After completing all of the questions, compare your
answers to those provided within this issue. If you have incorrect answers, return to the article for
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Dr. Griffin is Director of Nursing Research, Education, and Simulation, Boston Medical Center,
Boston, Massachusetts; and Dr. Clark is Professor, Boise State University, School of Nursing,
Boise, Idaho, and Nurse Consultant, Ascend Learning/ATI Nursing Education, Leawood, Kansas.
The authors have disclosed no potential conflicts of interest, financial or otherwise.
According to a recent survey conducted by the Work-place Bullying Institute (2014), 27% of
Americans have suffered abusive conduct or incivility at work. Another 21% have witnessed such
behaviors, and 72% are aware that workplace incivility happens. The impact of these behaviors
can be devastating and lasting. For example, workplace incivility can negatively impact employee
physical and mental health, job satisfaction, productivity, and commitment to the work
environment (Clark, 2013a; Spence-Laschinger, Wong, Cummings, & Grau, 2014). Workplace
incivility also creates a heavy financial burden for health care organizations. Some estimates
suggest that the annual cost of lost employee productivity due to workplace incivility may be as
high as $12,000 per nurse (Lewis & Malecha, 2011). In addition, the costs of incivility escalate
when the expenses associated with supervising the employee, managing the situation, consulting
with attorneys, and interviewing witnesses (i.e., doctors, nurses, patients, and others impacted by
the offender or who witnessed the incivility) are included (Clark, 2013a; Pearson & Porath, 2009).
Clearly, incivility in the workplace is a serious problem and must be addressed--especially since
incivility by health care professionals can result in serious mistakes, preventable complications,
and even death (Tarkan, 2008).
One evidence-based strategy to address incivility and lateral violence is through the use of
cognitive rehearsal, a behavioral technique generally consisting of three parts:
Participating in didactic instruction about incivility and lateral violence.
Identifying and rehearsing specific phrases to address incivility and lateral violence.
Practicing the phrases to become adept at using them.
Defining Incivility, Bullying, and Workplace MobbingDefining Incivility, Bullying, and Workplace Mobbing
There are several terms in the nursing literature used to describe undesirable and intimidating
behaviors and interactions that occur between and among nurses and other health care workers.
This section provides working definitions for three of the more common examples--incivility,
bullying, and workplace mobbing. Historically, many nurse scholars have housed these terms all
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under the rubric of horizontal (also known as lateral) violence (Roberts, Demarco, & Griffin, 2009);
however, although these terms are sometimes used interchangeably, each definition is distinctive
and unique.
IncivilityIncivility
Clark (2013a, 2013b) defines incivility as rude or disruptive behaviors that often result in
psychological or physiological distress for the people involved (including targets, offenders,
bystanders, peers, stakeholders, and organizations), and if left unaddressed, these behaviors may
progress into threatening situations or even result in temporary or permanent illness or injury.
Typically, incivility is generally considered to be a one-on-one experience and perceived to be less
threatening than bullying or mobbing behavior. Some examples of uncivil behaviors include eye-
rolling, making demeaning remarks, excluding and marginalizing others, and issuing sarcastic
remarks (Clark, 2013a).
Although considered to be a lesser form of intimidation, if perpetuated in a patterned way over
time, incivility can have serious detrimental effects on individuals, teams, and organizations. In
health care, the results of incivility can be devastating by negatively impacting team performance
and the delivery of safe patient care, ultimately putting self and others at risk. How one perceives
and responds to the uncivil encounter affects the level and intensity of the impact (Clark, 2013a).
The same is true for bullying.
BullyingBullying
In her influential work on bullying in nursing, Randle (2003) citing Adams (1992), defined bullying
as the "persistent, demeaning and downgrading of humans through vicious words and cruel acts
that gradually undermine confidence and self-esteemâ[euro]* (p. 399). In essence, bullying is
considered to be an ongoing, systematic pattern of behavior designed to intimidate, degrade, and
humiliate another. Some examples of bullying behaviors include threatening and abusive
language, constant and unreasonable criticism, deliberately undermining another person, hostile
verbal attacks, and rumor spreading. Lateral violence, also referred to as horizontal violence, is a
form of bullying based on the theoretical construct of oppression theory and contextualized by
viewing nursing as an oppressed group (Roberts et al., 2009).
Workplace MobbingWorkplace Mobbing
In 1990, Leymann described "workplace mobbingâ[euro]* as employees "ganging upâ[euro]* (p.
119) on a target employee and subjecting him or her to psychological harassment that may result
in severe psychological and occupational consequences for the victim. Simply stated, workplace
mobbing is a type of bullying in which more than one person commits egregious acts to control,
harm, and eliminate a targeted individual. In some cases, targets of mobbing may be excellent
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and exceptional workers. For example, Westhues (2004) suggested that mobbing behaviors
among faculty in academic workplaces may be related to the envy of excellence and jealousy
associated with the achievements of others. The authors further noted that some of the most
common mobbing techniques are completely nonviolent, such as words spoken or written, while
delivered politely with a smile.
Incivility, bullying, and workplace mobbing exact a heavy toll on individuals, teams, and
organizations by negatively impacting employee retention, recruitment, and job satisfaction
(Clark, 2013a; Spence-Laschinger et al., 2014). In addition, these behaviors can have devastating
and lasting effects on self-worth, self-confidence, clinical judgment, and ultimately patient safety.
For example, when a nurse who is giving a hand-off report uses an abrupt or antagonistic
communication style with an oncoming nurse, and the oncoming nurse feels intimidated or ill-
equipped to deal with this type of communication, he or she may not ask for a full patient report,
which in turn may negatively impact patient care. Workplace incivility within the nursing
profession is of particular concern as the nursing shortage becomes more critical and the
profession is called on to lead the advancement of the nation's health. Therefore, creating and
sustaining civil workplaces is an imperative for the profession.
Theoretical Background: Overview of Oppression TheoryTheoretical Background: Overview of Oppression Theory
The conceptualization of the profession of nursing as an oppressed group is and has been held
by many nursing scholars (Dunn, 2003; Roberts, 1983, 1997, 2000; Roberts et al., 2009; Skillings,
1992) and is theoretically grounded in the original work on oppressed group behavior (Fanon,
1963, 1967; Freire, 1971; Memmi, 1965, 1968). In Freire's (1971) sentinel work, Pedagogy of the Oppressed , he described the psychological and sociological behaviors that are often manifested by those who are oppressed and as such are marginalized and controlled by others perceived to
have more power. The theory contends that nurses lack power and control in their workplaces as
a result of health care moving into a physician-controlled hospital setting. Thus, the theory serves
to connect nurses to other oppressed groups based on their similarly predictable
interrelationship behaviors related to how they treat each other. The terminology used to describe
the strife and communication style within oppressed groups often has been applied to those in
the nursing profession. Oppressed group behavior has a negative impact on nurses in the
workplace, and the act of not speaking up (known as silencing) is one of the most frequently
described oppressed group behaviors in nursing (Roberts et al., 2009).
The terms horizontal violence and lateral violence evolved from oppression theory and refer to the behaviors often seen and described as bullying type behaviors that members of the
oppressed group manifest toward each other as a result of being members of a powerless group.
The descriptor language of lateral and horizontal refers to the relationship each of the members
has to each other and in that context it is considered as all the same and linear.
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Currently, the contemporary nursing scholars who study oppressed group behaviors in nursing
(Hutchison, Vickers, Jackson, & Wilkes, 2006; Lewis, 2006; Randle, 2003; Roberts, 1983, 1996,
2000; Roberts et al., 2009), particularly as it relates to these bullying type behaviors (lateral and
horizontal violence), have suggested two perspectives to be considered in conceptualizing the
nursing profession in this context. The first is to understand that to solely ascribe these
behaviors as willful acts of nurses alone would be incorrect. The understanding of context is
essential. Thus, a more collective understanding that these behaviors can be and often are an
expression of the character of the workplace and its inherent perception and treatment of the
nurses is indicated. Roberts et al. (2009) sought support and understanding for the necessity to
view oppressed group behavior theory, as it is described, and recognition that it does not attribute
blame to flawed nurses but rather attempts to explain the negative behaviors and uncivil
environments manifested by an unequal power balance in the nurses' workplace.
The quest to equilibrate the power gradient in any work environment starts with the individual,
and in this case, it begins with the individual nurse who plays an important role in establishing
the tenor of the workplace. Nurses most vulnerable to uncivil work environments are most often
of a particular cohort, such as new to nursing practice, new to a particular area of practice,
transitioning to a new health care environment, and floating and per diem nurses (Griffin, 2014).
Therefore, establishing respectful, professional communication in health care environments leads
to better outcomes for patients and more civil, collegial nurses (Clark, 2013a; Simons & Mawn,
2010).
As a result, all nurses, especially those most vulnerable to incivility, must be equipped to
effectively address uncivil behaviors as they occur. The simple act of speaking up is often an
effective intervention. Through the use of cognitive rehearsal, nurses can learn prerehearsed
phrases designed to confront and stop bullying behaviors. The rehearsed and learned retort is
matched in some fashion to the offense that has occurred. Griffin (2004) found that by
rehearsing a preprogrammed retort to a colleague's uncivil affront or an individual uncomfortable
situation, the level of both personal comfort and confidence in a cohort of new to practice nurses
was raised. Smith (2011) also found the use of scripted language within many health care
settings led to greater patient satisfaction because it allows nurses to use words and phrases
already understood to express a specific meaning or to ask for additional information.
Cognitive RehearsalCognitive Rehearsal
In 2004, Griffin published the findings of her ground-breaking exploratory descriptive study using
cognitive rehearsal as a tool against lateral violence for a cohort of 26 newly licensed nurses.
During general orientation to the hospital, the newly licensed nurses learned the history and
construction of lateral violence and its impact on patient care and nursing practice. Participants
were given interactive instruction on cognitive rehearsal and practiced appropriate responses to
frequent forms of lateral violence. The newly licensed nurses also received laminated cards that
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summarized accepted behavioral expectations for professionals and appropriate responses to
the 10 most frequent forms of lateral violence. At the end of the 1-year study, 96.1% of newly
licensed nurses stated that they had witnessed lateral violence on the units, and 46% reported
being direct victims of lateral violence. Most important, the newly licensed nurses who used
cognitive rehearsal to address lateral violence resulted in a complete stoppage of behaviors
against newly licensed nurses.
Griffin (2004) concluded that the use of cognitive rehearsal as a tool for practicing intervention
strategies in a safe and nonthreatening environment can be highly effective in preparing newly
licensed nurses to address uncivil behaviors in the workplace. For example, a newly licensed
nurse involved in the study was scheduled to work the evening shift during her first week of
orientation and was somewhat unfamiliar with the unit and patient population. The nurse
reported anecdotally:
I had four patients in three different rooms, but fortunately, they had the same attending
physician so I felt pretty confident with my ability to provide quality care. However, just as the
shift was beginning, the charge nurse changed my assignment and reassigned two patients with
two different attending physicians. I had received only a minimal report, and when I got one of the
patients up in a chair upon his [the patient's] request, the attending physician entered the room
and screamed "everybody knows I need my patients in bed so I can complete my exam.â[euro]*
Because of my CR [cognitive rehearsal] class, I responded "the individuals I learn the most from
are clearer in their directions and feedback. Is there some way we can structure this type of
learning?â[euro]* It sounded contrite but it came out maybe not exactly as it was on my card, but
it got out!
The use of cognitive rehearsal as an intervention strategy has been replicated in subsequent
studies and found to be an effective way to prepare nurses to identify and address incidents of
lateral violence (Embree, Bruner, & White, 2013; Stagg, Sheridan, Jones, & Speroni, 2011, 2013). In
Embree et al. (2013), nurses employed in non-patient care roles, such as nursing leadership,
physicians' offices, and hospital staff, received didactic content about lateral violence and
cognitive rehearsal, and were provided laminated cue cards containing appropriate responses to
common forms of lateral violence. Although there was no statistically significant difference
between pre- and postsurvey data, trends indicated a positive sense of empowerment and self-
esteem; this was further supported by anecdotal data.
In their pilot study, Stagg et al. (2011) used a similar cognitive rehearsal method and reported a
significant increase in nurses' knowledge of workplace bullying management, nurses' likelihood
to report bullying behaviors, and nurses' preparedness to handle workplace bullying. In 2013,
Stagg et al. replicated the study and found that among study participants, 50% witnessed
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bullying behaviors, 70% changed their own behaviors, and 40% reported a decrease in bullying
behaviors. However, only 16% actually responded to bullying at the time the bullying occurred,
which indicated the need to prevent and manage workplace bullying more effectively.
Smith (2011) also used scripts and role-playing for cognitive rehearsal and found that the
technique can prepare staff and students to improve communication in critical encounters,
especially when interpersonal conflict existed. In a two-part study conducted by Clark, Ahten, and
Macy (2013, 2014), the researchers used live actors to simulate an uncivil nurse-to-nurse
encounter using a problem-based learning (PBL) scenario in an academic setting. Nursing
students enrolled in a senior leadership course participated in the first part of the study, which
included preparatory readings and a 1-hour faculty-led didactic session on the topic of workplace
incivility and the use of cognitive rehearsal as a strategy to counter incivility and bullying in the
health care practice setting. The students observed the scenario, provided written feedback on its
effectiveness, and participated in small group discussions to debrief the scenarios. This
approach provided the students with effective strategies to manage conflicts in similar situations
they may encounter as new nurses in the practice setting.
In a 10-month follow-up study, the students, now newly licensed, were asked to describe how they
transferred the PBL knowledge presented in the classroom setting to their nursing practice; how
their behavior had changed since participating in the PBL scenario; and what barriers and
benefits they experienced to using the PBL scenario knowledge in the practice setting. The
participants reported that the classroom-centered PBL scenario was an effective teaching
strategy for preparing them to recognize and address nurse-to-nurse incivility in the workplace.
Their comments mirrored Griffin's (2004) finding that having knowledge of incivility and bullying
and using cognitive rehearsal for countering uncivil behaviors can empower nurses to confront
instigators and episodes of incivility. Despite gaps in the literature, cognitive rehearsal has been
identified as a best practice to prevent and manage workplace bullying among staff nurses
(Stagg & Sheridan, 2010).
Primary Prevention as a FrameworkPrimary Prevention as a Framework
Incivility is detrimental in any work setting, and organizations must take deliberate steps to
prevent and eradicate the problem. Putting measures in place to prevent or preempt the problem
of civility is recommended. To do this, leaders must openly and boldly address the problem of
incivility and bullying; they must call it by name and encourage shared responsibility to
effectively address the problem. The end goal is to create and sustain a safe, healthy, and thriving
work environment where the organizational vision, mission, and values are shared, lived, and
embedded in civility and respect (Clark, 2013a).
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To begin, health care organizations must ensure that their foundational documents (i.e., vision,
mission, philosophy, and shared values) are closely aligned with the concepts of civility and
respect, and that the spirit and intent of these foundational documents are shared and embraced
by employees throughout the organization. Next, making a commitment to coworkers to foster a
healthy work environment can go a long way in fostering civility, especially when the commitment
is focused on patient safety and quality patient care (Table 1Table 1 ).
After a commitment has been made, it is important to co-create and establish behavioral norms
of decorum that are essential to successful team functioning, quality patient care, and a safe
work environment. Behavioral norms form the foundation for effective team functioning and stem
from the organization's vision, mission, philosophy, and statement of shared values. Without
functional norms, desired behavior is ill-defined, and thus, team members are left to make things
up as they go along.
Unfortunately, there are times when prevention measures are unsuccessful. In such instances,
intervention methods must be relied on to effectively address incivility and bullying behaviors.
Cognitive rehearsal can be an effective intervention against incivility and bullying behaviors.
Cognitive Rehearsal as an InterventionCognitive Rehearsal as an Intervention
It is imperative to understand the nature of workplace incivility and lateral violence to prevent and
effectively address the problem. Being treated in an uncivil manner changes an individual's
natural neurobiological state, and the impact of this can be felt instantly. Some individuals flush,
sweat, get angry or tear-up, or worse, they become silent. Griffin (2014) noted that some
individuals ruminate internally about the exchange and wish later they had addressed the
offender. These reactions call for an intervention because the longer the clock ticks after an
uncivil assault, the less of an impact confrontation may have (Randall, 2003). Cognitive rehearsal
is an evidence-based strategy to effectively communicate and deliver a message to uncivil or
laterally violent colleagues that it is not okay for them to behave in an uncivil manner.
Addressing the uncivil encounter when it happens may have the greatest success in stopping the
behavior. Randall (2003) noted that confronting bullies grabs their attention; however, many
targets may lack the skill set or assertiveness to confront a bully and may need to learn to do so.
Most individuals can recall a time or multiple times when they wish they had spoken up to
someone or at the very least said, "I wish that I had the exact right words to say in that
situation.â[euro]* Typically, these situations occur during times of stress when a creative or
effective response is momentarily unavailable. According to Randall, the strategy for addressing
the uncivil behavior should occur "in private, [with] no witnesses, and when the bully is
unpreparedâ[euro]* (p. 136).
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Cognitive rehearsal is a technique often used in behavioral health for impulse control disorders
that calls for the memorization (learned, although not necessarily "rote verbatimâ[euro]*
memorization) of a thought or an expression designed to help an individual "stop an
impulse,â[euro]* "cue a certain behavior,â[euro]* or "express a desire to othersâ[euro]* (Glod, 2008,
pp. 58-59; Smith, 2011). The use of cognitive rehearsal in social situations has been proven to be
an effective way for some individuals to control their environment.
For nurses, cognitive rehearsal is an effective intervention for addressing incivility and workplace
bullying (Griffin, 2004). The cognitive rehearsal process typically consists of three parts:
Participating in didactic instruction.
Learning and rehearsing specific phrases to use during uncivil encounters.
Participating in practice sessions to reinforce instruction and rehearsal.
Cognitive rehearsal can take on various forms. For example, the TeamSTEPPS approach (Agency
for Healthcare Research and Quality, 2014) is a communication system designed for health care
professionals and provides a powerful evidence-based framework to improve patient safety
within health care organizations. This approach helps to improve communication and teamwork
among health care professionals. CUS, an acronym for Concerned, Uncomfortable, and Safety, is
one specific communication structure provided by TeamSTEPPS to assist with conflict
negotiation. When a health care professional uses CUS, it issues an alert that a patient safety
problem has been identified. For example, a CUS framework may be used in the following way: "I
am Concerned about Mr. Jones. I am Uncomfortable with his recent activity. I think we may have
missed something, and I am worried about his Safety.â[euro]*
A similar response may be used in the case of incivility. For example, if a nurse encounters an
uncivil experience, he or she may respond in the following way: "I am Concerned about the tone of
this interaction. I am Uncomfortable and beginning to feel stressed. I'm worried that my
discomfort and stress may impact the Safety of our patients. Please address me in a respectful
way.â[euro]* Table 2Table 2 lists some common uncivil behaviors among nurses and associated
cognitive rehearsal responses.
DiscussionDiscussion
Many of the articles reviewed for this retrospective article were a synthesis of three decades of
research concerning incivility in nursing. It is evident that when nursing environments harbor
uncivil or bullying behaviors, patients are put at risk, and nursing as a profession is disparaged
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and maligned. Although prevention is clearly the best approach toward minimizing or eliminating
incivility in the nursing workplace, cognitive rehearsal is a valuable tool for effective conflict
negotiation and a positive step toward resolving disagreements.
In her original work, situated in the context of oppression theory, Griffin (2004) raised awareness
about the negative consequences of workplace incivility and lateral violence in nursing and
concluded that cognitive rehearsal is an effective behavioral technique to address the problem.
Since then, several researchers have used cognitive rehearsal in a variety of workplace and
academic settings (Clark et al., 2014; Embree et al., 2013; Stagg et al., 2011, 2013) and found the
use of cognitive rehearsal to be an effective intervention in addressing incivility and lateral
violence. In some cases, the use of cognitive rehearsal resulted in a heightened sense of nurse
empowerment and self-esteem, an increased awareness in nurses' knowledge of workplace
bullying and ability to address the offender (Stagg et al., 2011), and improved communication
(Smith, 2011), and helped prepare new graduate nurses to effectively address incivility (Clark et
al., 2014).
The essence of cognitive rehearsal as an intervention is rehearsing and practicing ways to deal
with a situation between two individuals when incivility occurs. This is important because in
addition to descriptive studies exploring incivility and bullying in nursing, nurses now are
equipped with an evidence-based strategy to address some of the specific uncivil behaviors.
How individual nurses treat each other and what a nursing practice environment looks and feels
like is predicated on what behaviors are fostered by the nurses themselves. Continued research
on the impact of incivility in different domains in nursing practice as well as in the academic
environment produces and informs the profession. Therefore, the continuation of intervention
studies using cognitive rehearsal is recommended. For example, one of the authors (C.M.C.) and
her research partners will be conducting an intervention study using a laboratory-simulated
experience to explore how emotional stress caused by an uncivil nurse-to-nurse encounter
impacts a nurse's work performance and patient safety. The researchers will measure the effects
of stress on the participant (nurse) using biomarkers found in saliva, heart rate, blood pressure
readings, and self-assessment scales to determine whether the prepared cognitive rehearsal
response was effective in countering the stress effects of the uncivil encounter and was effective
to the extent that work performance and patient safety were unaffected.
ConclusionConclusion
Cognitive rehearsal was revisited as a shield for incivility and lateral violence, and the use of
cognitive rehearsal as a strategy for addressing incivility and bullying behaviors in nursing
continues to be a valuable tool. Being well-prepared, speaking with confidence, and using
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respectful expressions to address incivility can empower nurses to break the silence of incivility
and oppression. The intent of the original study was to improve nurse communication in health
care settings and to ensure a safer environment for patients.
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Table 1Table 1
Commitment to my Coworkers
As your coworker and with our shared organizational goal of excellent service to [our patients]
and customers, I commit the following:
I will accept responsibility for establishing and maintaining healthy interpersonal relationships
with you and every other member of this team.
I will talk to you promptly if I am having a problem with you. The only time I will discuss it with
another person is when I need advice or help in deciding how to communicate with you
appropriately.
I will establish and maintain a relationship of functional trust with you and every other member of
this team. My relationship with each of you will be equally respectful, regardless of job titles or
levels of educational preparation.
I will not engage in bickering, back-biting, and blaming (3Bs). I will practice caring, committing,
and collaboration (3Cs) in my relationship with you and ask that you do the same with me.
I will not complain about another team member and ask you not to as well. If I hear you doing so,
I will ask you to talk to that person.
I will accept you as you are today, forgiving past problems and ask you to do the same with me.
I will be committed to finding solutions to problems rather than complaining about them or
blaming someone for them, and ask you to do the same.
I will affirm your contribution to the quality of our service.
I will remember that neither of us is perfect, and that human errors are opportunities not for
shame or guilt, but for forgiveness and growth.
From "Commitment to My Co-Workers,â[euro]* by M. Manthey, 1988. Copyright 1988, 2014, by
Creative Health Care Management (
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http://www.chcm.com). Reprinted with permission.
Table 2Table 2
Common Uncivil Behaviors among Nurses with Associated Cognitive Rehearsal Responses
Uncivil BehaviorUncivil Behavior
Verbal ResponseVerbal Response
Using nonverbal behaviors or innuendo (e.g., eye-rolling, making faces, deep sighing)
"I sense/see from your facial expression that there may be something you wish to say to me. It is
OK to speak to me directly.â[euro]*
Name-calling, verbal affronts, demeaning comments, putdowns, sarcastic remarks
"I learn best from individuals who address me with respect and who value me as a member of the
team. Is there a way we can structure this type of interaction?â[euro]*
Using silent treatment or withholding important information
"It is my understanding that there was/is more information available regarding this situation.
Please share any other important information since patient care depends on a full report.â[euro]*
Using anger, humiliation, and intimidation
"When the words that I hear make me fearful or shamed, I need to seek a respectful professional
explanation. What was your intent?â[euro]*
Spreading rumors, gossiping, failing to support, sabotaging a coworker, or sharing information
you were asked to keep private
"I don't feel right talking about him/her/situation when I wasn't there and don't know the facts.
Perhaps the information was taken out of context. I suggest you check it out with
him/her.â[euro]*
Making fun of another nurse's appearance, demeanor, or personality trait
"She/he is a valuable member of the team and deserves our support. How can we be more
inclusive and work more efficiently as a team?â[euro]*
Failing to support or encouraging others to turn against a coworker
a
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"I am not feeling like a valued coworker. Can we approach this differently? What helped you to fit
in here?â[euro]*
Taking credit for others' work, ideas, or contributions
"I didn't expect your nonsupport. Behaving this way is unprofessional and makes me feel
disrespected. How can we work together and support one another?â[euro]*
Distracting and disrupting others during meetings
"Can I speak with you about your sense of urgency in our meetings? It distracts me and interrupts
my thoughts.â[euro]*
aa
Excerpts from Clark, 2013b; Dellasega, 2009; and Griffin, 2004.
Key PointsKey Points
Revisiting Incivility in NursingRevisiting Incivility in Nursing
M. Griffin
C.M. Clark (2014).
Revisiting Cognitive Rehearsal as an Intervention Against Incivility and LateralRevisiting Cognitive Rehearsal as an Intervention Against Incivility and Lateral
Violence in Nursing: 10 Years LaterViolence in Nursing: 10 Years Later . The Journal of Continuing Education in Nursing,
45(12), 535-542.
11
This article scaffolds working definitions for three of the more common examples of undesirable
behaviors and interactions that occur between and among nurses and other health care workers:
incivility, bullying, and workplace mobbing.
22
A historical and updated review of the literature on the use of cognitive rehearsal as an effective,
evidence-based intervention is provided.
33
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Common language for addressing uncivil encounters is provided to empower nurses to effect
change by focusing on the unifying and essential need to deliver safe, quality patient care.
Copyright 2014, SLACK Incorporated
Copyright © 2021 ProQuest LLC.
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