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Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility

Clark, Cynthia M. PhD, RN, ANEF, FAAN

doi: 10.1097/NNE.0000000000000563
Feature Articles

Background Nurses have a professional and ethical obligation to foster civility and healthy work environments to protect patient safety. Evidence-based teaching strategies are needed to prepare nursing students to address acts of incivility that threaten patient safety.

Problem Incivility in health care must be effectively addressed because the delivery of safe patient care may depend on these vital skills.

Approach Cognitive rehearsal (CR) is an evidence-based technique where learners practice addressing workplace incivility in a nonthreatening environment with a skilled facilitator. The author describes the unique combination of CR, simulation, evidence-based scripting, deliberate practice, and debriefing to prepare nursing students to address uncivil encounters.

Outcomes Learners who participated in CR identified benefits using this approach.

Conclusions Combining CR with simulation, evidence-based scripting, repeated dosing through deliberate practice, and skillful debriefing is an effective method to provide nursing students with the skills needed to address incivility, thereby increasing the likelihood of protecting patient safety.

Author Affiliation: Strategic Nursing Advisor, ATI Nursing Education, Boise, Idaho.

The author declares no conflicts of interest.

Correspondence: Dr Clark, 279 E Danskin Dr, Boise, ID 83716 (

Accepted for publication: April 21, 2018

Published ahead of print: July 13, 2018

Cite this article as: Clark CM. Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educ. 2019;44(2):64–68. doi: 10.1097/NNE.0000000000000563

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