Abstract
Nurses need to be able to advocate for their patients, even if they face verbal abuse or incivility. Current literature indicates that 66.2%-95.1% of nurses experience verbal abuse (Dadfar & Lester, 2021) with younger, inexperienced nurses having higher levels of abuse (Zulfan et al., 2022). Nurses who face workplace violence, including verbal abuse, have higher levels of stress, impacting their mental and physical health (Sauer & McCoy, 2017).
A mixed-method study was conducted with undergraduate nursing students to determine their response to a simulation that included difficult communication with a healthcare provider. Students were provided with tools and strategies to address incivility before the simulation. Students wrote reflections on the simulation within days after completing the simulation. Researchers conducted a content analysis of the reflection journals.
Participants (N=47) in this study were 93.6% female, and the mean age of participants was 22.72 (SD 5.31). Most students (93%) reported experience dealing with conflict, while 61.4% said they were comfortable or somewhat comfortable addressing conflict. Three themes were identified from the analysis of reflection journals: 1) Fear/frustration about the problem of incivility or rude interactions; 2) increased anxiety; 3) empowered to handle these issues and make changes. Examples of the fear and frustration “Couldn’t focus when HCP was rude”, “Didn’t focus, I froze with Dr. responses,” “Didn’t listen to me! Hung up on me! When I was trying to talk”, “The worst this is knowing you are not being heard because you are believed to be incompetent.” Examples from theme 2) “Felt anxious and fear about being able to perform, I do not conflict.” “Afraid that I won’t be able to advocate for the patient.” Examples from theme 3: “Positive reaction, I have tools to use!” and “I can advocate for patient, I found my voice,” Stand up for myself and patient,” “Need to stand up and let it be known when a patient needs something.”
It is imperative that nurses can advocate for their patients in all situations. In this simulation, students had to address a provider who was rude and didn’t listen if they couldn’t explain what they needed. This simulation was very realistic. Students were surprised that someone didn’t make the time to hear their concerns. During debriefing and reflection, students realized that they can influence the response they get by how information is presented. Communication continues to be a challenge in healthcare settings. This simulation helped students utilize tools (SBAR and CUS) to relay critical information.
Notes
References:
Dadfar, M., & Lester, D. (2021). Workplace violence (WPV) in healthcare systems Nursing Open, 8(2), 527-582. https://doi.org/https://doi.org/10.1002/nop2.713
Sauer, P. A., & McCoy, T. P. (2017). Nurse Bullying: Impact on nurses’ health. Western Journal of Nursing Research, 39(12), 1533-1546. https://doi.org/10.1177/0193945916681278
Zulfan, M., Syarif, H., & Wardani, E. (2022). Determinants of verbal abuse among nurses at a Government-Owned General Hospital in Indonesia. International Journal of Nursing Education, 14(2), 151-158. https://doi.org/10.37506/ijone.v14i2.18007
Sigma Membership
Nu Omega
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Nursing Students, Incivility, Professional Knowledge, Work Environment, Cognition -- Education, Culture, Workplace Violence
Recommended Citation
Sauer, Penny A. and Verzella, Margaret M., "Student’s Experience with Cognitive Rehearsal to Address Incivility" (2026). Creating Healthy Work Environments (CHWE). 89.
https://www.sigmarepository.org/chwe/2024/presentations_2024/89
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-24
Student’s Experience with Cognitive Rehearsal to Address Incivility
Washington, DC, USA
Nurses need to be able to advocate for their patients, even if they face verbal abuse or incivility. Current literature indicates that 66.2%-95.1% of nurses experience verbal abuse (Dadfar & Lester, 2021) with younger, inexperienced nurses having higher levels of abuse (Zulfan et al., 2022). Nurses who face workplace violence, including verbal abuse, have higher levels of stress, impacting their mental and physical health (Sauer & McCoy, 2017).
A mixed-method study was conducted with undergraduate nursing students to determine their response to a simulation that included difficult communication with a healthcare provider. Students were provided with tools and strategies to address incivility before the simulation. Students wrote reflections on the simulation within days after completing the simulation. Researchers conducted a content analysis of the reflection journals.
Participants (N=47) in this study were 93.6% female, and the mean age of participants was 22.72 (SD 5.31). Most students (93%) reported experience dealing with conflict, while 61.4% said they were comfortable or somewhat comfortable addressing conflict. Three themes were identified from the analysis of reflection journals: 1) Fear/frustration about the problem of incivility or rude interactions; 2) increased anxiety; 3) empowered to handle these issues and make changes. Examples of the fear and frustration “Couldn’t focus when HCP was rude”, “Didn’t focus, I froze with Dr. responses,” “Didn’t listen to me! Hung up on me! When I was trying to talk”, “The worst this is knowing you are not being heard because you are believed to be incompetent.” Examples from theme 2) “Felt anxious and fear about being able to perform, I do not conflict.” “Afraid that I won’t be able to advocate for the patient.” Examples from theme 3: “Positive reaction, I have tools to use!” and “I can advocate for patient, I found my voice,” Stand up for myself and patient,” “Need to stand up and let it be known when a patient needs something.”
It is imperative that nurses can advocate for their patients in all situations. In this simulation, students had to address a provider who was rude and didn’t listen if they couldn’t explain what they needed. This simulation was very realistic. Students were surprised that someone didn’t make the time to hear their concerns. During debriefing and reflection, students realized that they can influence the response they get by how information is presented. Communication continues to be a challenge in healthcare settings. This simulation helped students utilize tools (SBAR and CUS) to relay critical information.
Description
Qualitative analysis of student reflections after using cognitive rehearsal to address incivility. Students completed a de-escalation module, including tools to manage incivility in the workplace. Students described being flustered and frustrated and didn’t know how to respond, but afterward said they were prepared but didn’t use the tools.