Critical Review of Scales of Incivility Behaviors in Nursing Education

Incivility behavior is a multidimensional and growing behavior and effects of it are considered to be lasting and important. These behaviors not only crash the learning environment but also question the ethical values of the nursing profession. The American National Association of Nurses has considered the necessity of creation of an ethical environment and promotion of civic culture which is the same respect for human dignity in 2015 in its ethical codes and has considered behaviors such as humiliation, harassment and threats to be morally unacceptable. Hence, the measurement of incivility in nursing education will identify these behaviors and adopt appropriate strategies and interventions to reform nursing education. The have so far been a limited number of studies and scales in the field of incivility behavior in nursing education. It is necessary to evaluate the quality of methodological studies which explain the characteristics of such scales. This study has been carried out with the objective of having a critical review about psychometry of scales for evaluation of incivility behavior in nursing due to the importance of incivility behaviors in nursing education and its destructive effect on learning environment.
systematic search was used to conduct the study. For this purpose, related English and Persian articles were first searched for in Google Scholar without a time limit and then, specified search was done in Science Direct, ProQuest, Wiely Inter Science, PubMed databases using the keywords of incivility or nursing education or Nursing Educators or Nursing Students and Scale. The screening result of these articles was identification of 15 scales in the field of incivility behavior. The results were organized in two sections of introduction and critique of scales after studying and analyzing these scales. Scales were initially described based on the time of design and creation and the same scales were then criticized.
Ethical considerations: Integrity and trustworthiness were observed in analyzing, reporting and publishing the results.
Findings: From 80 received articles, 15 articles which were devoted to nursing were studied and analyzed. All the studied scales were designed in accordance with the culture of the target society and had satisfactory validity and reliability and could be used in different studies. Most studies showed a Cronbach’s Alpha between 0.80 - 0.90. Internal consistency, content validity and methodology have been referred from all necessary criteria raised for verifying the validity and reliability of all the examined scales. INE, OCS, NIS, and UBCNE scales demonstrate a good content validity in aspect of being related and comprehensive and are quite consistent with the target population.
Most scales evaluated the incivility behavior of instructors or students alone. The only tool which evaluates the incivility behavior of instructors or students with each other is incivility behavior measurement tool in nursing education by Clark et al. in which the validity and reliability of tool has been accurately mentioned while Casmin indexes are not met in other scales. The list of these scales is as follows: “Incivility in Nursing Education Scale (INES) “
“Work place Incivility Scale (WIS)"
“Workplace Aggression Tolerance Questionnaire (WATQ)”
“Uncivil Work place Behavior Questionnaire (UWBC)”
“Incivility in Nursing Education Scale (INES)”
“Bullying in nursing education Questionnaire (BNEQ)”
“Negative Acts Questionnaire –Revised (NAQ-R)”
“Nursing Education Environment Survey (NEES)”
“Nursing Incivility Scale (NIS)”
“Uncivil Behavior in Clinical Nursing Education (UBCNE)”
“Incivility in Online Learning Environments (IOLE)”
“Nurses Intervention for civility Education Questionnaire (NICE-Q)”
“Faculty –to-faculty Incivility Survey (F-FI)”
“Incivility in Nursing Education Scale- Revised (INES)-R”
Most studies showed Cronbach Alpha between 0.80 and 0.90. Burns & Groove (2005) write that high levels of internal correlation show high level of correlation between phrases that measures the concept of study. On the other hand, compatibility of an external instrument with the culture of the target society is essential for using this type of tool which will make comparison of scientific findings with other countries possible by creating a common language. Hence, proper translation and adaptation of the foreign scales with the culture of the research society is extremely important. In each society, there is the need to design and use scales appropriate to its social and cultural conditions. Since incivility behavior is a two-way interaction and on the other hand, some of the studied scales did not meet the social and cultural conditions of the society, these scales of behavior in two interacting groups should be designed in accordance with conditions of the society.