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Running head: NURSING RESEARCH 1

Nursing Research

Student’s Name

Institution of Learning

NURSING RESEARCH 2

Nursing Research

The study conducted provides relevant perspectives and theories on civility, the

occurrence, and impacts of stressors among the nursing students. Different strategies have been

proposed to reduce stress levels and support the students in addressing mental pressures resulting

from academic demands. Mentorship is one of the methods outlined in the study, and this is

effective since it motivates students in different areas of life and increases self-esteem. Exercise

and social activities have been outlined as part of the strategies of reducing incivility.

Background

The student's civility plays a significant role in ensuring that the nursing students manage

different academic challenges and stressors (Alzayyat & Al‐Gamal, 2014). In a case where

students fail to manage different challenges, incivility occurs. This is a situation where students

are unable to conduct themselves as required. It affects academic performance and patients care

during clinic practice. Academic incivility weakens different teaching and learning activities; it

influences negatively impacts the learning environment leading to poor academic performances

(Milesky, et al., 2015).

Nursing students often encounter mental distress due to the challenging coursework

which requires much attention and commitment (Clark et al., 2014). The stress experienced in

the clinical setting during the coursework practice has also contributed to high levels of stress

(Labrague, 2014). Exposure to emergency cases in the clinical environment causes mental

disorders to some student. The situation, therefore, could result in poor attitudes to the

coursework and depression in a case where a student might not endure different incidences that

are handled in the nursing environment.

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Personal issues have contributed to incivility cases among students. For instance, some

of them find a difficult time addressing the financial issues during academic programs. Most of

the students fail to manage such kind of stressors. Therefore, the situation leads to increased

levels of incivility among most of the faculty-students and student-student relationships (Clark et

al., 2014)

The effect of stress involves physical illness, poor communication, mental disorder,

burnout, and poor student performance (Babenko-Mould & Laschinger, 2014). Students tend to

cope with the effects in different ways. Some of the students decide to cope with the situation

positively while others deal negatively. For instance, the students who cope with stress levels

positively would address the problems through communication, seeking to counsel and managing

academic workloads by planning on time. The students who would mitigate the issues negatively

would often avoid the problems. Avoidance as one of the methods to reduce the stress levels,

drug abuse, and procrastination is often shared among this group of students (Milesky et al.,

2015). Therefore, effective strategies should be established to address the psychological well-

being of the nursing students.

The incivility problem contributes to different challenges regarding academic

competitiveness. It leads to stressful learning environments (Labrague, 2014). Therefore, the

relationship between stress, coping and incivility have been outlined as the key issues that

require effective strategies to reduce its academic and personal impact. The relationship among

most of the faculty students is also affected due to poor attitude and student depression. The

physical illness affects students due to high-stress levels that expose an individual to

inflammations.

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Hypotheses

The study aimed at determining changes on overall civility as a result of stress-reducing

activities that were conducted weekly. Furthermore, it should examine and analyze the top

stressors among nursing students. It should also focus on how different strategies would improve

civility in the nursing program. The stress reducing activities in the study positively impacted on

the number of civility and incivility cases. This was determined through analyzing the perception

of nursing students in coping with stress. The variables determined involved the number of hours

that were spent in implementing stress-reducing strategies. The number and the level of student

class played a critical role since it ensured that the maximum number of responses was collected

during the study. Quality of student relationship was to be determined through the hypotheses

hence access to different factors that contribute to stressors at faculty-student and student-student

relationship.

Study Design

The study design involved surveys and questionnaires. A pilot test was conducted on the

survey on students that were not in nursing school. The content validity was determined

readability and the logical flow (Clark et al., 2014). Civility quality of relationship and stress

were analyzed individually for relevant quantitative measures. This was significant since it

would ensure that the variances that could result from the study would be accounted. Items that

could result in biases were analyzed, which included gender, ethnicity and the year of the nursing

program. The 6-point Likert scale was used. Qualitative measures are based on verbal and textual

responses from the participants (Milesky et al., 2015).

The formulation of the experiment was set based on the years of study of students. The

intensity of the problem was then determined using different responses from the students. An

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increase or decrease in civility would determine effective methods of addressing the problem.

The size of the problem was determined by carrying out the study longitudinally hence

determining various factors affecting the group. The study was further set to determine student's

perspectives on the strategies of addressing incivility.

Methodology

The methodology involved descriptive methods and repeated measures conducted on the

participants. The methods aimed to determine further the perception of the nursing students on

dealing with incivility and stressors. A longitudinal study was conducted where a group of

participants was analyzed based on the responses they provided.

Surveys were conducted at different times in 2010, 2011 and 2012. The survey aimed the

nursing student at different academic levels. 68 nursing students had n=54, 79.4% response rate

at the beginning of the entry program. The response of the students who were 12 months old into

the program reported n=66, 97% response rate. The course scheduling conflicts had affected the

absence of some of the students during the survey.

The population sample demographics involved four quantitative items that measured the

perception of the nursing students which included the level of civility in the nursing program by

using 6 points Likert scale. The quality of students faculty and student relationship was also

determined using the 6-point Likert scale. The quality of students was determined using a similar

method. Open ended questions were also involved in determining different factors that

contributed to increased levels of incivility and poor student-student relationship.

The data collection tools involved survey and questionnaires. The methods were relevant

to the group of participants since they were familiar with the answering of questions writing and

responding accordingly. The tools were reliable to the group of participants hence enhancing the

NURSING RESEARCH 6

process of data collection. Verbal responses are usually acquired through interviews with the

participants (Milesky et al., 2015).

The procedure involved acquiring an approval for the study in the American College

campuses. The participants were identified from the nursing school. Planning and scheduling

activities were conducted based ion the time. A 13-item questionnaire was provided for the

responses of the students. The results were anonymously collected from the questionnaires were

used to collect aggregate data (Clark et al., 2014). The procedures were safe for the participants

since it aimed to address ways of coping with different stressors. The participant's health was not

affected during the process. Psychological impacts of the procedure could be minimal since the

students only answered what they were asked without explaining their psychological views on

the topic.

Ethical Consideration

The practices that were utilized during the study were safe and ethical. The approach to

participant did not violate human rights, and safety was assured before the study was conducted.

The IRB ensures that safety of human subjects was protected (Alzayyat & Al‐Gamal, 2014). IRB

approval played a significant role in ensuring the researchers in the institution were also

protected and those of the institution. The participants were further assured of confidentially with

the information they were going to provide on the questionnaires. For instance, before the

students took the surveys, they were assured that their responses were not going to affect their

grades.

Analysis

Quantitative and qualitative data were analyzed differently. SPSS method was used to

analyze quantitative data. During the survey items were examined using ANOVA method, the

NURSING RESEARCH 7

method is a one-way analysis between a group of variances (Clark et al., 2014). The survey

treated the groups independently since different participants were involved and the study was

conducted at different times.

The textual content analysis was used to analyzed narrative responses from the qualitative

research question. The verbal information was organized and ranked according to the research

questions. The textual content should often be confidential and valid, therefore to ensure its

validity external reviewers were involved to ensure that the information provided was relevant

(Alzayyat & Al‐Gamal, 2014).

The results show that 91% of participants were female with an average age of 27.93 and

an SD, 7.97 years during sophomore years. Significance difference was noted in overall levels of

civility among the groups (Clark et al., 2014). It further proved that civility decreased from

sophomore years to senior years. The number of hours spent in stress-reducing activities showed

no difference across the groups. However, faculty student relationship differed significantly

across the group where quality relations decreased from sophomore junior to senior groups.

There was no difference noted in the quality of student-student links across the group.

Implication of the Study

The study has shown a decrease in civility was noted among students (Clark et al., 2014).

Therefore, strategies should aim at reducing incivility among students through different methods

such as providing civility instructions as part of the coursework for every year of study.

Awareness should be created among students where different factors that reduces civility are

outlined. Therefore, students should be provided with various consequences of incivility on the

nursing profession. Civility closely relates to mental wellness of a person. Therefore,

NURSING RESEARCH 8

Psychotherapy could be introduced into the school program to ensure that issues related to

mental distress are addressed (Labrague, 2014).

Communication is one of the strategies that could reduce incivility. The students in the

study identified communication as an effective means of addressing creating positive student

relationship hence a positive learning environment (Clark et al., 2014). Students often address

different challenges through communication hence improving the relationship and civility

reduced. It improves quality of the student-student relationship. Problems can be identified and

addressed early when relevant communication exists between students and the faculty members.

It improves social skills and various means of dealing with academic issues.

Fitness and relaxation activities improve muscle relaxation and mental pressures.

Therefore, the institutions should introduce it as part of the curriculum (Labrague, 2014) Social

activities would contribute to an improved relationship between the faculty and the students.

Therefore if the nursing school hosts social activities incivility could be reduced.

Mentorship programs should be introduced in the school. It creates positive attitude

among the students and builds self-esteem hence improved civility medication, and mental

imagery would play a key role in ensuring that effective stress management is achieved (Milesky

et al., 2015). The program would ensure that students engage in positive activities during and

after classes.

Poorly managed stress levels lead to an individual being inflexible with poor perception

of learning activities (Clark et al., 2014). Poor and outdated teaching practices have contributed

to incivility. Therefore, the faculty should be updated and informed on relevant teaching methods

and provided with guidelines for handling stress among the students. Furthermore, the mental

NURSING RESEARCH 9

disorder could increase leading to students attempting violent activities with other colleagues and

isolate themselves during class work discussions (Alzayyat & Al‐Gamal, 2014).

Students desire for respect should be created among the students. This would create a

culture of learning to respect aspects of learning relationships and career requirement (Clark et

al., 2014). Debates and discussions should be introduced to address different challenges

encountered by the students. Respect should be encouraged by the faculty members so that

students emulate such behavior from the faculty members

Cognitive behavioral techniques should be encouraged to ensure that a student accounts

for his or her actions (Griffin & Clark 2014). Self-reflection assignments should be introduced

for the students to access their behaviors and attitudes toward academics. Students should further

be encouraged to observe the norms for the school. Cognitive rehearsal is an effective means of

addressing incivility. For instance, the use of verbal interaction and interactive instruction would

ensure that students understand the relevant means of handling different problems (Babenko-

Mould & Laschinger, 2014). Furthermore, this would encourage ethical behavior as far as the

nursing career is concerned.

Incivility often contributes to an unethical career during the clinical practice in the

nursing school (Alzayyat & Al‐Gamal, 2014). Such situation could create different perspectives

from their supervisors. The problem should be addressed by guiding students before and during

practical activities to ensure that ethical behavior is encouraged. Close supervision improves

behavioral conducts of the students, hence increasing civility.

Summary

Civility has often been associated with right conduct hence ethical practices during and

after the nursing program. The study has summarized different aspects of civility levels among

NURSING RESEARCH 10

students from the sophomore years to senior years in the nursing school. During the study, the

participants and institution for study were identified. The study was conducted through different

methods, which involved surveys, interviews, and questionnaires. The methods were relevant to

the group of participants since they were familiar with the concept of answering questions

relating to civility. Confidentiality was assured to the students before the study was conducted

hence enabling students to answer the questions without fear. The result proved hypotheses

where civility decreases across academic years. Students observed civility more at sophomore

years compared to the final years of their studies. Different strategies for dealing with incivility

were provided by the students where students outlined introduction of social activities as one of

the methods that would decrease incivility. The study design involved a 3-year longitudinal study

that determined students independently. Therefore, in result analysis, ANOVA test was used to

analyze the groups of students since the repeated test was not conducted on similar students over

the three years.

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References

Alzayyat, A., & Al‐Gamal, E. (2014). A review of the literature regarding stress among nursing

students during their clinical education. International Nursing Review, 61(3), 406-415.

Babenko-Mould, Y., & Laschinger, H. K. (2014). Effects of incivility in clinical practice settings

on nursing student burnout. International journal of nursing education

scholarship, 11(1), 145-154.

Clark, C. M., Nguyen, D. T., & Barbosa-Leiker, C. (2014). Student perceptions of stress, coping,

relationships, and academic civility: A longitudinal study. Nurse educator, 39(4), 170-

174.

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against

incivility and lateral violence in nursing: 10 years later. The Journal of Continuing

Education in Nursing, 45(12), 535-542.

Labrague, L. J. (2014). Stress, stressors, and stress responses of student nurses in a government

nursing school.

Milesky, J. L., Baptiste, D. L., Foronda, C., Dupler, A. E., & Belcher, A. E. (2015). Promoting a

culture of civility in nursing education and practice. Journal of Nursing Education and

Practice, 5(8), 90.

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