Experiences of Incivility Among Australian Perioperative Nurses

Amy Corbet

doi:10.25907/01075

Background: Workplace incivility is a common experience among healthcare professionals. It encompasses a range of low-intensity, yet rude and/or disrespectful behaviours that violate workplace norms (Andersson & Pearson, 1999). These behaviours can be initiated by either patients or staff and are directed towards any type of worker. Despite efforts to raise attention to the serious psychological, social, and organisational impacts, incivility remains a serious problem within the Australian healthcare system and in specific contexts, such as the perioperative environment (Birks et al., 2018; Hartin et al., 2020; Westbrook et al., 2021). The perioperative environment is a complex, dynamic, and critical care area. Patient safety is critical in all areas of healthcare, but surgery introduces heightened vulnerability for patients. Environmental and workplace pressures are among the factors thought to influence perioperative nurses’ exposure to workplace incivility behaviours. However, little research has explored these behaviours within the perioperative context in Australia. Aim: This thesis seeks to explore nurses’ experiences of workplace incivility within an Australian perioperative environment. This aim is underpinned by the following research questions: RQ1: What evidence exists on workplace incivility in perioperative nursing? RQ2: What are the characteristics of workplace incivility behaviours reported in the literature? RQ3: What gaps remain in the literature regarding workplace incivility within perioperative nursing? RQ4: Is near-real-time data collection on workplace incivility feasible in a perioperative environment? Methods: This thesis addressed these questions through two phases: a scoping review of the available evidence, followed by a pilot and feasibility study examining the utility of a mobile Ecological Momentary Assessment (mEMA) methodology to capture perioperative nurses’ experiences of workplace incivility. An incivility exposure survey was designed for ease of use and rapid completion, considering the high cognitive load of nurses working in the fast-paced, dynamic perioperative environment. The target sample size was twenty participants; seventeen enrolled, and sixteen completed the roster survey to varying degrees. Ten participants completed at least one incivility exposure survey, with over half (n = 6/10, 60%) completing more than thirteen of the twenty surveys required. Findings: This study reveals that current research on incivility in perioperative environments is hampered by methodological limitations, including retrospective recall bias. The scoping review analysed thirty-one studies revealing that incivility is measured inconsistently, potentially affecting study results and interpretations. The scoping review further suggested that future research into incivility in perioperative nursing should focus on validating methods and tools for capturing incivility in real- time. This supported the second phase of this project, a pilot and feasibility study exploring the use of ecological momentary assessment methodology. The pilot and feasibility study using a smartphone application indicated that this methodology for collecting real-time data on incivility shows promise and could improve the quality of workplace incivility data. However, there are limitations, such as the number of incivility exposure surveys submitted per shift, and the ability to actively educate and recruit participants. Conclusion: The experience of conducting this research project has reinforced the need for further investigation into exposure to workplace incivility among Australian perioperative nurses. There is also an appetite for real-time data collection evident in the workplace incivility literature (Cortina et al., 2017). However, as highlighted in the current study, some challenges exist in conducting research in the perioperative environment. This research project was designed to inform further research on Australian perioperative nurses’ experiences of incivility and possible strategies to mitigate it. As such, recommendations are provided to guide the refinement of this methodology and the incivility exposure survey for potential future use in the Australian perioperative environment.

Experiences of Incivility Among Australian Perioperative Nurses

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