Clark Civility Index for Students*
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ClarkCivilityIndexforStudentsPage1Self-AssessmentAccessible.docxClark Civility Index for Students and Classmates©
SOURCE: Clark, C.M. (2017). Creating and sustaining civility in nursing education, 2nd ed, Indianapolis, IN: Sigma Theta Tau International Publishing.
The Clark Civility Index for Students and Classmates © used herein is copyrighted property of Dr. Cynthia Clark. This material should not be reproduced in any form without Dr. Clark’s expressed written permission.
To complete the index, consider the 20 statements listed below. Read each statement carefully. Using a scale of 1- 5; (5) always, (4) usually, (3) sometimes, (2) rarely, (1) never, select the response that most accurately represents the frequency of each behavior by asking yourself...
Ask yourself, how often do I:
|
1. Role model civility, professionalism, and respectful discourse |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
2. Add value and meaning to the educational experience |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
3. Communicate respectfully (by e-mail, telephone, face-to-face) and really listen— |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
4. Avoid gossip and spreading rumors |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
5. Avoid making sarcastic remarks or gestures (staged yawning, eye-rolling) |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
6. Pay attention and participate in class discussion and activities |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
7. Use respectful language (avoid racial, ethnic, sexual, gender, religiously biased terms) |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
8. Avoid distracting others (misusing media, devices, side conversations) during class |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
9. Avoid taking credit for someone else’s work or contributions |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
10. Co-create and abide by classroom and clinical norms |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
11. Address disruptive student behaviors and promote a safe, civil learning environment |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
12. Take personal responsibility and stand accountable for my actions |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
13. Speak directly to the person with whom I have an issue |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
14. Complete my assignments on time and do my share of the work |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
15. Arrive to class on time and stay for the duration |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
16. Avoid demanding make-up exams, extensions, grade changes, or other special favors |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
17. Uphold the vision, mission, and values of my organization |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
18. Listen to and seek constructive feedback from others |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
19. Demonstrate an openness to other points of view |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
20. Apologize and mean it when the situation calls for it |
1-Never |
2-Rarely |
3-Sometimes |
4-Usually |
5-Always |
|
TOTAL EACH COLUMN |
|
|
|
|
|
Scoring the Civility Index: Add up the number of 1-5 responses to determine your ‘civility’ score
90-100—Very civil
80-89—Civil
70-79—Moderately civil 60-69—Mildly civil
50-59—Uncivil
Less than 50—Very uncivil
Identify one area of personal strength and how you plan to continue developing this area of strength.
Identify one area for personal growth, how you plan to achieve it, within which time frame?
© 2017 Clark
