Abstract
Nurse-to-nurse incivility remains a persistent threat to psychological safety, professional relationships, and patient outcomes. Despite growing reliance on cognitive rehearsal training as a targeted strategy, studies suggest incivility is a multidimensional issue shaped by individual behavior, organizational culture, leadership practices, and socio-behavioral forces. This integrative review examined how nine theoretical frameworks collectively deepen understanding of nursing incivility and illuminate a comprehensive, multilevel approach to intervention.
Twenty-one studies published between 2018 and 2023 and retrieved from CINAHL, Medline, ProQuest, and Ovid were appraised using the Johns Hopkins Evidence-Based Practice Model [1]. Braun and Clarke’s thematic analysis guided data synthesis. Oppression Theory [2], the Transactional Model of Stress and Coping [3], the Social-Ecological Model [4], Social Cognitive Theory [5], the Theory of Interpersonal Relations [6], Relationship-Based Care [7], and Wounded Healer Theory [8]—provided a rich conceptual foundation for understanding how power imbalances, stress responses, learned behaviors, environmental conditions, and relational maturity shape the experience and perpetuation of incivility.
Across recent empirical research, cognitive rehearsal training consistently improved participants’ awareness of incivility, communication confidence, and ability to respond effectively [9–12]. However, application of skills in real-world practice varied significantly. Participants frequently noted that leadership responsiveness, unit culture, psychological safety, and the presence or absence of organizational accountability strongly influenced whether cognitive rehearsal behaviors were used [11–15].
Implications for the nursing profession are substantial. A theory-informed, multilevel strategy is essential to meaningfully reduce incivility. Effective approaches must combine recurring cognitive rehearsal training with leadership engagement, clear and consistently enforced zero-tolerance policies, confidential and trustworthy reporting systems, and organizational cultures that promote autonomy, accountability, and respectful communication. Integrating theoretical foundations with evidence-based training and structural supports can strengthen retention, enhance teamwork, promote psychological safety, and protect patient outcomes—ultimately advancing the overall standard of professional nursing practice.
Notes
References:
1. Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
2. Roberts, S. J. (1983). Oppressed group behavior: Implications for nursing. Advances in Nursing Science, 5(4), 21–30.
3. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.
4. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377.
5. Wood, R., & Bandura, A. (1989). Social cognitive theory of organizational management. Academy of Management Review, 14(3), 361–384.
6. Forchuk, C. (1991). Peplau’s theory: Concepts and their relations. Nursing Science Quarterly, 4(2), 54–60.
7. Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. Creative Health Care Management.
8. Conti-O’Hare, M. (2002). The theory of the nurse as wounded healer. Jones & Bartlett.
9. Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44(2), 64–68.
10. Clark, C. M., & Gorton, K. L. (2019). Cognitive rehearsal, HeartMath, and simulation. Journal of Nursing Education, 58(12), 690–697.
11. Howard, M. A., & Embree, J. L. (2020). Educational intervention improves communication abilities of nurses encountering workplace incivility. Journal of Continuing Education in Nursing, 51(3), 138–144.
12. Olsen, J. M., et al. (2020). Mixed-methods systematic review of interventions to address incivility. Journal of Nursing Education, 59(6), 319–326.
13. Jang, S. J., Son, Y., & Lee, H. (2022). Intervention types and their effects on workplace bullying among nurses. Journal of Nursing Management, 30(6), 1788–1800.
14. Kousha, S., et al. (2022). Effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses. BMC Nursing, 21(1).
15. Seibel, L. M., Fehr, F. C., Sarwal, S., & Panchuk, H. J. (2022). Impact of cognitive rehearsal training over time for new registered nurses. Journal of Continuing Education in Nursing, 53(5), 203–211.
Sigma Membership
Mu Phi at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Integrative Review
Research Approach
Other
Keywords:
Continuing Education, lncivility, Politics and Advocacy, Nurse-to-Nurse Incivility, Bullying Prevention, Prevention of Violence in the Workplace, Work Environment, Bullying
Recommended Citation
Givler, Janet and Varagona, Lynn, "A Theoretical Roadmap for Understanding and Mitigating Nursing Incivility" (2026). International Nursing Research Congress (INRC). 212.
https://www.sigmarepository.org/inrc/2026/presentations_2026/212
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
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
2026-08-25
A Theoretical Roadmap for Understanding and Mitigating Nursing Incivility
Toronto, Ontario, Canada
Nurse-to-nurse incivility remains a persistent threat to psychological safety, professional relationships, and patient outcomes. Despite growing reliance on cognitive rehearsal training as a targeted strategy, studies suggest incivility is a multidimensional issue shaped by individual behavior, organizational culture, leadership practices, and socio-behavioral forces. This integrative review examined how nine theoretical frameworks collectively deepen understanding of nursing incivility and illuminate a comprehensive, multilevel approach to intervention.
Twenty-one studies published between 2018 and 2023 and retrieved from CINAHL, Medline, ProQuest, and Ovid were appraised using the Johns Hopkins Evidence-Based Practice Model [1]. Braun and Clarke’s thematic analysis guided data synthesis. Oppression Theory [2], the Transactional Model of Stress and Coping [3], the Social-Ecological Model [4], Social Cognitive Theory [5], the Theory of Interpersonal Relations [6], Relationship-Based Care [7], and Wounded Healer Theory [8]—provided a rich conceptual foundation for understanding how power imbalances, stress responses, learned behaviors, environmental conditions, and relational maturity shape the experience and perpetuation of incivility.
Across recent empirical research, cognitive rehearsal training consistently improved participants’ awareness of incivility, communication confidence, and ability to respond effectively [9–12]. However, application of skills in real-world practice varied significantly. Participants frequently noted that leadership responsiveness, unit culture, psychological safety, and the presence or absence of organizational accountability strongly influenced whether cognitive rehearsal behaviors were used [11–15].
Implications for the nursing profession are substantial. A theory-informed, multilevel strategy is essential to meaningfully reduce incivility. Effective approaches must combine recurring cognitive rehearsal training with leadership engagement, clear and consistently enforced zero-tolerance policies, confidential and trustworthy reporting systems, and organizational cultures that promote autonomy, accountability, and respectful communication. Integrating theoretical foundations with evidence-based training and structural supports can strengthen retention, enhance teamwork, promote psychological safety, and protect patient outcomes—ultimately advancing the overall standard of professional nursing practice.
Description
Despite growing reliance on cognitive rehearsal training as a targeted strategy for incivility, results across studies suggest incivility is a multidimensional issue shaped not only by individual behavior but also by organizational culture, leadership practices, and broader socio-behavioral forces. This integrative review examined how nine theoretical frameworks collectively deepen understanding of nursing incivility and illuminate a comprehensive, multilevel approach to intervention.