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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

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reading the article and completing the quiz.

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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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