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An Integrative Review Examining Student-to-Student Incivility and Effective Strategies to Address Incivility in Nursing Education

Rose, Kristine MSN, RN; Jenkins, Sheryl PhD, RN; Mallory, Caroline PhD, RN; Astroth, Kim PhD, RN; Woith, Wendy PhD, RN, FAAN; Jarvill, Melissa PhD, RN, RNC-NIC, CHSE, CNE

doi: 10.1097/NNE.0000000000000719
Nurse Educator: PDF Only

Background Incivility is a low-intensity, discourteous behavior intended to disrupt or harm positive interaction. If allowed, student-to-student incivility can undermine the educational environment.

Purpose The purpose of the integrative review was to examine factors influencing incivility among nursing students and teaching strategies used to reduce incivility in nursing education.

Methods Qualitative and quantitative studies were reviewed. The Johns Hopkins Research Evidence Appraisal tool was used to narrow down the selection of articles. Content analysis was used to evaluate the qualitative research.

Results Five major points of interest were identified: workload and high expectations contributed to incivility, degrees of incivility, effects of incivility, coping mechanisms among individuals, and effective teaching strategies addressing incivility.

Conclusion Continued research on innovative teaching strategies that raise awareness of civility while reducing incivility is warranted.

Author Affiliations: Instructor (Ms Rose), College of Nursing, Michigan State University, East Lansing; Professor (Dr Jenkins), Director of Graduate Programs (Dr Astroth), Professor (Dr Woith), and Director of Nursing Simulation and Assistant Professor (Dr Jarvill), Mennonite College of Nursing, Illinois State University, Normal; Professor (Dr Mallory) and Dean of Health and Human Services and College of Health and Human Services, Indiana State University, Terre Haute.

The authors declare no conflicts of interest.

Correspondence: Ms Rose, College of Nursing, Michigan State University, 1355 Bogue Street, Room A203, East Lansing, MI 48824 (

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Accepted for publication: May 21, 2019

Published ahead of print: July 18, 2019

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