question

Does context dictate morality, civil/uncivil behaviour?

answer

In all cases of perceived incivility, one must carefully consider context, meaning and intent of behaviour context does dictate morality and civil and uncivil behaviour

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what is a civil society

answer

Social relations & communications between citizens that may or may not be mandated by law or the state

question

issues of civility in toady's society has decreased civility

answer

Increased focus on the self, decreased focus on the collective Loss of community with few shared values Technology has resulted in decorum, loss of human interface Adults failure to correct youth Affluence has lead to increased self indulgence, sense of entitlement

question

link b/w civility and nursing

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The profession of nursing is founded on the principle of caring (Watson, 1994) and governed by a code of ethical standards. The American Nurses Association Code of Ethics and Interpretive Statements (2005)[CNA Code of Ethics (2008)] compels nurses to maintain compassionate and caring relationships with colleagues and to treat others fairly and with integrity. The code prohibits any form of harassment, threatening behaviour or disregard for others. One may assume that nursing education is a place where compassion and civility prevail, but in some instances, that is not the case. Creating a culture of civility based on respect and human dignity is integral for nursing education.

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what is civility

answer

Characterized by authentic respect for others when expressing disagreement, disparity, or controversy (Clark & Carnosso , 2008) A self consciousness that requires a balance and restraint between personal needs and interests versus public interests (Peck, 2002) Involves time, presence, a willingness to engage in genuine discourse, and a sincere intention to seek common ground (Clark & Carnosso, 2008) Learned from childhood, education, culture; Part of moral education; meaning of an encounter is based on one's attitudes, values, beliefs and life experiences

question

what is incivility

answer

A disregard and insolence for others causing an atmosphere of disrespect, conflict, and stress (Clark, 2008) A general term for social behaviour lacking in civility or good manners (on a scale from rudeness or lack of respect for elders, to vandalism and hooliganism, through public drunkenness and threatening behaviour) Derived from the Latin incivillis, meaning not a citizen Academic incivilty is defined as rude , discourteous speech or behaviour that disrupts the teaching learning environment (Feldman, cited in Clark, 2008)

question

What constitutes uncivil behaviour in nursing practice and education?

answer

Perceptions differ on what constitutes uncivil behavior, especially with less overt forms (e.g., rude comments, misuse of cell phones) Practice Code White situations Intra-professional marginalization (i.e., nurse-nurse interaction) Inter-professional marginalization Education (Clark, 2008) Faculty behaviours Student behaviours University behaviours

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Issues of Civility in Higher Education

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Focusing on self actualization decreases civility? Focus on Codes of Conduct to address uncivil behavior 'Siloed' faculty Power inherent in student-faculty relationships

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How is civility promoted in the workplace/profession?

answer

Reflection, professional pause Knowing self Caring for self Caring for others Community-centred > individual-centred mindset Activating/utilizing supports and resources Education Communication

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Oberle and Raffin (2009)

answer

Ethics Composite Model is a representation of how different factors and perspectives can effect thinking in nursing ethics Relational ethics is foundational to this model code of ethics, clinical competence bioethical principles, normative theories institutional values, legal context, social context, and other values virtue --> beneficence

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the importance of communication

answer

Internal communication - our reflection, knowing self, Dialogue The place where relational ethics is most easily realized (Bergum, 2004) The place where the themes of relational environment, embodiment, mutuality and engagement are enacted (Bergum, 2004) Is the beginning of treatment itself and we (nurses) are the therapeutic agent! always try to raise level of understanding - it is our best chance of being effective

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communication

answer

ethical mandate to become skilled communicators in nursing

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promote healthy, safe, workplaces CFNU, 2011

answer

Advance implementation of HWE Workload management Innovative staffing initiatives - make some allowances for autonomy (self scheduling based on their own life situation) Relief from non-nursing duties - cleaning rooms/changing linens, repetitive documentation Appropriate technologies - a lot of time spent looking for equipment Ergonomically efficient workplaces - mechanical lifts Promoting nurse autonomy

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healthy work environments

answer

HWE literature identifies importance of recruitment and retention (R & R) recruitment - employer attracting employees to work there " A healthy work environment is a practice setting that maximizes the health and well-being of nurses, quality patient/client outcomes, organizational performance and societal outcomes." Care for caregiver Interest in how you are treated in the workplace shows interests and high standards in yourself which are good qualities

question

HWE begins with you

answer

1. Becoming (aware of) Self-Deception 2. Becoming Reflective 3. Becoming Authentic 4. Becoming Mindful 5. Becoming Candid = becoming a skilled communicator

question

healthy workplaces

answer

Relationship between nurses' work environments, patient/client outcomes and organizational and system performance Studies have shown relationships between nurse staffing and adverse patient/client outcomes

question

RNAO BPG HWE

answer

HWE = practice settings that maximize the health and well-being of the nurse, quality patient outcomes, organizational performance and societal outcomes Growing understanding of the relationship between nurses' work environments, patient outcomes and organizational performance Direct correlation between absenteeism and quality of workplace

question

so what does this look like? physical/structural policy components

answer

individual: workload, changing schedules/shifts, heavy lifting, exposure to hazardous & infectious substances, threats to personal safety organizational: staffing practices, flexible/self scheduling, access to lifting equipment, OH&S policies, security personnel

question

cognitive/psycho/socio/cultural components

answer

individual: clinical knowledge, effective, coping skills, communication skills organizational: organizational stability, communication practices and structure labor management relations, and a culture of continuous learning and support system: the External Socio-cultural Factors include consumer trends, changing care preferences, changing roles of the family, diversity of the population and providers, and changing demographics - all of which influence how organizations and individuals operate.

question

professional/occupational components

answer

individual: commitment to patient care, the organization and the profession, personal values and ethics reflective practice, resilience, adaptability, self confidence, family work/life balance organizational: scope of practice, level of autonomy and control over practice, interdisciplinary relationships system: the External Professional/Occupational Factors include policies and regulations at the provincial/territorial, national and international level which influence health and social policy and role socialization within and across disciplines and domains.

question

select leadership practice recommendations

answer

Nurse leaders create an empowering work environment. Nurse leaders create an environment that supports knowledge development and integration. Nurse leaders can sustain change Nurse leaders balance competing values and priorities.

question

nurse leaders create an empowering work environment

answer

Increased job satisfaction for nurses Improved occupational mental health Increased perceptions of autonomy and control over nursing practice Improved work effectiveness and performance Improved retention of staff Improved patient outcomes

question

create environment that supports knowledge development & integration

answer

Enhanced personal and professional growth of staff and clinical leadership Increased desire to continue education Enhanced staff relationships Increased trust in the leader & organization Enhanced success of planned change Increased organizational commitment Decreased intent to leave

question

nurse leaders can sustain change

answer

Increased employee acceptance of the change Higher performing teams Increased productivity, lower absenteeism Increased job commitment Increased organizational commitment Increased staff motivation and willingness to work hard Increased job satisfaction

question

nurse leaders balance competing values & priorities

answer

Decreased stress for nurses Increased perceptions of their value and self-image Increased job satisfaction for nurses and their leaders Decreased disengagement from work Decreased intent to leave the organization or nursing Increased trust in leaders

question

new nurse retention

answer

Nursing faces a worker shortage Average age of Canadian nurse ~46 Shortage of ~60,000 nurses by 2022 High turnover amongst new grad nurses 34% (Beecroft, 2008) 30% in year 1, 57% by end of year 2 (Bowles & Candela, 2005) Contributing Factors: Feel underprepared for practice Transition period stressful Expectations vs reality Experiences of incivility & bullying

question

things we can do to address nursing shortage

answer

Have more fulltime positions available Control amount of over time work - not healthy Flexible scheduling Standardize nurse patient ratios to set a standard of what is safe

question

Boychuk Duchscher issues

answer

Newly graduating nurses lacking confidence and practice expertise Escalating levels of patient acuity Increasing workloads Intense and dynamic transition into the work force Creating and sustaining quality work environments

question

new graduate nurse professional role transition

answer

NGN Transition = process of making a significant adjustment to changing personal and professional roles at the start of one's nursing career "...journey...included anticipating, learning, performing, concealing, adjusting, questioning, revealing, separating, rediscovering, exploring, and engaging."

question

transition stages model 1-3 months

answer

orientation doing stage: learning, performing, concealing, adjusting, accommodating transition/shock

question

first 3-4 months

answer

sponges learning all the time doing stage will be offered full workload within a month of working need to know if you are competent enough to provide safe care and accept a full workload Lack of support from employers in transition holding employers more accountable now

question

3-7 months

answer

transition/crisis being: searching, examining, doubting, questioning, revealing doubting things, seeing things that are doubting you in the face that you have learned, ethical moral issues, consistent rapid advancement in your thinking/skill level, challenge issues because you know it isn't the way it is supposed to be, you are growing who you are as a person personally, more self efficacy, knowledge, skills, no longer feel in survival mode

question

final stage 7-12 months

answer

knowing: separating, recovering, exploring, critiquing, accepting expect stability, where your ability to cope has changed/become advanced, network with people who have likewise values, have collegial support and good leadership

question

professional role transition (again) 0-4 months "doing"

answer

Transition from a structured, relatively predictable life into a new set of expectations and responsibilities Feeling unprepared for the responsibilities and workload of their new role Idealistic vs realistic expectations of self and workplace Often lack of support and mentorship Understanding expectations, doing it well, and completing their tasks primary concerns.

question

5-9 months "being"

answer

consistent and rapid advancement in their thinking, knowledge level, and skill competency Increased awareness of professional self Seeking balance Increased comfort with roles and responsibilities of being a nurse desire for clarification and confirmation of their own thoughts and actions. Often placed in situations beyond their level of competence & comfort

question

9-12 months "knowing"

answer

Understanding professional relationships in the healthcare system Comfort and confidence with their roles, responsibilities, and routines Recovery from transition shock Desire to keep personal and work life separate

question

new graduate nurse support

answer

Solid orientation program (unit-specific) Experienced nurse mentorship Example: NGGI Progressive and thoughtful exposure to increasingly challenging situations Graduates require consistency, predictability, stability, and familiarity in their initial clinical practice situations for at least the first 4 months

question

common issues for new grads

answer

Lack of clinical knowledge Low confidence in skill performance Relationships with colleagues Workload demands Organization and time management Decision making and direct care judgments Communicating with physicians.

question

burnout

answer

negative psychological syndrome characterized by: emotional exhaustion cynicism

question

work engagement

answer

positive work related state of fulfillment characterized by feelings of: vigor dedication absorption

question

new grads & workplace mistreatment

answer

Undervalued by colleagues Learning opportunities blocked Emotional neglect Given too much responsibility without support Rude or humiliating comments Verbal threats (CNA, 2002; 2009)

question

incivility

answer

Incivility describes low-intensity rude or disrespectful behaviours with an ambiguous intent to harm others (Andersson & Pearson, 1999). Exposure to workplace incivility linked to... poor mental health (Hansen et al., 2006) emotional exhaustion and burnout (Cortina et al., 2001) job dissatisfaction and turnover intentions (Smith, Andrusyszyn, & Laschinger, 2010 ). May escalate into bullying if unchecked

question

bullying

answer

Leymann (1996) describes bullying as interpersonal conflict in which the target is subjected to systematic stigmatization, harassment, and social isolation over an extended period of time. Effects of bullying severe, long-lasting, and multidimensional -> poor health outcomes, increased absenteeism and high job turnover (Mikkelsen & Einarson, 2002)

question

psychological capital:

answer

1. self efficacy 2. hope 3. optimism 4. resiliency

question

areas of workalike

answer

6 areas of worklife that are significant for employees: 1. Workload 2. Control - do you know what you are supposed to be doing 3. Rewards - what you do and recognition for it does not have to be monetary 4. Sense of Community - social relationships 5. Fairness - justice and managerial support 6. Values Congruence - actions are congruent with beliefs of institution

question

results

answer

26.4% of nurses were bullied 39.6% reported high levels of emotional exhaustion 19.5% reported high levels of cynicism Model was a good fit for the data, supporting hypothesized model will be different depending on different areas help yourself prepare

question

what does this mean exactly?

answer

Personal resources have protective effect against burnout development & may lead to more positive interpretation of the workplace Positive work environments protect against emotional exhaustion Bullying has a significant negative effect on burnout development Burnout has a significant negative effect on new graduate nurses' mental and physical health

question

Yang et al., 2012

answer

Focus on physical violence in the workplace Consequences can be more immediate and severe (e.g. injury) Also tends to cause psychological & physiological damage

question

violence prevention climate

answer

1. Policies and procedures - rules and regulations that promote a safe workplace 2. Practices and response - nurses assessment to a degree of use with policies and procedures 3. Work pressure against violence prevention - violence prevention policies meet other demands (under-staffed) are they secondary? Violence prevention may be less of a priority than productivity

question

results of this study

answer

Perceived work pressure against violence prevention at Time 1 -> increased violence at Time 2 Nurses' exposure to physical violence did not influence the organizational violence prevention climate over time Nurses who were not assaulted had fewer physical health symptoms than those who were assaulted

question

discussion highlights

answer

Nurse managers & healthcare leaders need to take violence in the workplace seriously - causes dissatisfaction, burnout, hostility Potentially, leaders have to choose between prioritizing productivity and prioritizing violence prevention climate - prioritizing violence needs to be lifted

question

positive psychology movement

answer

Positive Psychology is the scientific study of human flourishing, and an applied approach to optimal functioning. Grounded in the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within them, and to enhance their experiences of love, work, and play.

question

4 major aims

answer

1. Rise to life's challenges, make most of setbacks and adversity 2. Engage and relate to other people 3. Find fulfillment in creativity and productivity 4. Look beyond oneself and help others to find lasting meaning, satisfaction, and wisdom (Keyes & Haidt, 2004)

question

Focusing on Positive Relationships at work

answer

Past research on new graduate nurses focused on incivility, bullying, and burnout These are important but there is also a need to understand positive relationships at work While negative workplace phenomena are important and deserve attention, need to examine how to create healthy, vibrant workplaces where nurses, patients, and organizations can thrive

question

Read & Laschinger, 2015 purpose

answer

To test a hypothesized model of the longitudinal effects of authentic, empowering leadership on new graduate nurses' relational social capital and subsequent mental health and job satisfaction.

question

authentic leadership

answer

Describes leader behaviour that demonstrates: Self-awareness Transparency (true self) Balanced processing Moral & ethical integrity Associated with: lower burnout (Laschinger, Wong & Grau 2012) interprofessional collaboration (Laschinger & Smith 2013) Better job performance and satisfaction (Leigh 2013, Wong & Laschinger 2012).

question

structural empowerment

answer

Definition: "Structural empowerment refers to access to organizational structures that enable employees to accomplish their work in meaningful ways" (Kanter, 1979) Assumption: Nurse managers can create effective work environments by providing access to structures of opportunity and power

question

four core components

answer

1. access to opportunities - a sense of challenge and the chance to learn and grow 2. access to information - knowledge and expertise, awareness of organizational goals 3. access to support - feedback and guidance received from superiors, peers, and subordinates 4. access to resources - time, supplies, and equipment to accomplish organizational goals

question

structural empowerment increased

answer

Increased Work engagement Work effectiveness Patient care quality Job & career satisfaction Organizational support & trust Organizational commitment

question

structural empowerment decreased

answer

Burnout Job strain Incivility & bullying Job & career turnover intentions

question

social capital in organizations

answer

Definition: Resources or credits created by and embedded within social relationships within an organization (Nahapiet & Ghoshal, 1998) Assumption: Positive relationships with others at work lead to increased exchange of social resources such as ideas, advice, cooperation, and help. Social capital requires investment in relationships and is not easily transferrable.

question

social capital in organizations 3 main types

answer

(1) Structural: Describes who knows who and how they know each other (social network or web) (2) Relational: Refers to the nature or quality of relationships that people have with one another (3) Cognitive: Refers to shared ways of thinking about work, shared jargon, and common experiences

question

social capital increased

answer

Organizational Commitment Job Satisfaction Unit effectiveness Patient care quality Patient safety Risk management behaviour

question

social capital decreased

answer

burn out mental health symptoms

question

discussion

answer

The results suggest that authentic leaders create structurally empowering work environments, which in turn positively influence new graduate nurses' relational social capital in the workplace, resulting in lower mental health symptoms and higher job satisfaction one year later. Authentic leaders had little direct influence on the quality of nurses' relationships in the workplace. This may be because hospital staff nurses and their managers do not spend a lot of time together. Instead, leaders influence social capital indirectly through their effect on structural empowerment. That is, empowering novice nurses may help them meet the demands of their new professional role.

question

discussion con't

answer

The quality of relationships on the work unit was an additional mediator between leader behaviours and new graduate nurses' job satisfaction. When new graduate nurses experience a strong sense of community at work, they are likely to experience high levels of job satisfaction and fewer mental health symptoms one year later. Having a strong sense of community at work may help prevent mental health symptoms and promote job satisfaction during this stressful transition period.

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