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Abstract Nursing workplace incivility affects the patient, the nursing profession, and the healthcare organization. Incivility can result in intimidation, which can impair professional judgment, jeopardize patient safety, and ”may be a contributing factor to the 98,000 patient deaths each year in acute care settings” because nurses lack the skills to intervene when connected with or experiencing uncivil behaviors. Furthermore, because workplace incivility influences nurse turnover and retention, it has a significant financial impact on healthcare organizations. Workplaces are characterized by large numbers of relationships, each at different levels of development. Relationships are mechanisms through which colleagues and staff are mobilized, support is garnered, and work is performed the quality of relationships impacts the efficiency of the organization in which those relationships exist. One of these relationships is peer relationships. PR are just informal interactions in the workplace that have more influence, motivation, and control over individuals than those in positions of authority. PR can also help nurses to develop new skills and knowledge. When co-workers trust and respect each other, they are more likely to be open to sharing information and offer help when needed; WPI can affect a nurse’s peer relationship. Aim of the study The present study aims to identify the relationship between WPI and PR as perceived by nurses. Study design: A descriptive correlational design was used in this study. With this design, phenomena are described and the relationship between variables is examined statistically without any intervension from the researcher. Setting: This study was conducted in all Medical Care Units and its specialties include 24 units and all Surgical Care Units and its specialties include 15 units at Alexandria Main University. The hospital is affiliated to Alexandria University and provides public non-paid health services. It is the largest educational university hospital in Alexandria also this hospital with different specialties has a large number and different categories of nurses. This study was conducted in all Medical Care Units and their specialties including 24 units with a total bed number of (614 beds) and all Surgical Care Units and their specialties including 15 units with a total bed number of (756 beds) at Alexandria Main University Hospital. This hospital is affiliated with Alexandria University and provides public, non-paid health services. It is the largest educational university hospital in Alexandria also this hospital includes different specialties and employs nurses with different qualifications. It is the biggest hospital in Alexandria preparing for accreditation by General Authority for Healthcare Accreditation and Regulations (GAHAR). Subjects: The subjects of the study were: The study subjects included all nurses working in the previously mentioned setting, the total study sample was (N= 343) classified as follows; medical units (N=145) and surgical units (N=198) were available at the time of data collection, with a work experience of at least 6 months (to ensure that participants have at least some familiarity with the job, colleagues, and organization) and have direct contact with patients and not occupying any managerial position and accept to participate in the study. Tools: Two tools were used in this study for data collection: Tool (I) Nursing Incivility Scale (NIS) This scale was developed by Guidroz et al. (2010) to measure the nurses‘ exposure to incivility behaviors at their working units. It consists of 43 items covering exposure to uncivil behaviors and is classified under five main sources of incivility namely; General incivility contains (9 items), Nurse Incivility contains (10 items), Supervisor incivility contains (7 items) Physician incivility contains (7 items) and Patient incivility contains (10 items). Nurses‘ responses were measured on a 5-point Likert-type scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The minimum and maximum scores ranged from (43-215). A score from (43-100) indicates a lower rate of exposure to incivility behavior. A Score from (101-158) indicates a moderate rate of exposure to incivility behavior, and a Score from (159- 215) indicates a higher rate of exposure to incivility behavior. Tool (II) Peer relationship scale (PRS) It was developed by the researcher based on the review of the related literature; (Levi and Stoker (2000); Luthans et al. (2006); Rigby (2006); Vyas and Vyas (2018))to measures the level of PR among nurses, it consists of 24 items. Negatively scored items are contained in the scale (2, 4, 5, 6, 7, 10, 12, and 15) and are reverse scored. Participants indicated their agreement with items using the 5-point Likert scale: 1=strongly disagree, 2=somewhat disagree, 3=neutral, 4=somewhat agree 5=strongly agree. The minimum and maximum scores ranged from (24-120). A Score from (24-<65) indicates Low PR., Score from (65-<88) indicates moderate PR., and score from (88-120) indicates high Peer relationship. In addition, socio- demographic data sheet was developed by the researcher and it included personal information related to sex, age, and professional information related to educational qualification, Years of experience since graduation, Years of experience in the working hospital, Years of experience in the current working unit, working unit and Working hours per week. Method: - An approval was obtained from the Ethical Research Committee as well as all the administrative permissions for conducting the study and collects the necessary data - The study tools validity and relability were done. - Pilot studu was conducted; the amount of time needed to fill the questionnaires was about 10-15 minutes, data collected in a period more than 2 months from 15/10/2021 to 31/12/2021. - All ethical considerations were maintained - Appropriate descriptive and inferential statistical measures were used to analyze the study data. The main results of the present study were as follows: The overall WPI and its dimensions had a highly statistically significant negative correlation with PR. There were statistically significant positive correlations between all dimensions of WPI and each other namely; General incivility, Nurse Incivility, Supervisor, Physician and Patient, and total WPI. The nurses perceived a moderate level of overall WPI with a mean score and standard deviation of (90.97±26.79). In this context, the highest perceived dimension was ―nurse incivility‖ and ranked first with a mean score of (22.47±6.871) followed by patient incivility, General incivility, and Physician incivility with a mean score of (21.75±8.218, 18.56±6.118, 14.71±5.933) respectively, while; ―Supervisor incivility‖ ranked as the least perceived dimension of WPI by nurses with a mean score of (13.48±6.064). The nurses perceived a moderate level of PR with a mean score and SD. of (80.21±7.247), and a Mean Percent Score of (66. 84%). The subjects’ perception of the variables composites of their PR, which was perceived as a moderate level of PR with a mean score and SD of (80.21±7.247). Based on the study findings the following recommendations are suggested for: A. Hospital administrator • Create a clear policy for preventing WPI and make sure that managers, supervisors, nurses, patients, and vistores are all aware of it. Additionally, support WPI’s zero tolerance policy in order to protect hospital standards and encourage courteous discussion as the norm. Stablish and maintain safe work environment for patients and staff to minimize incidence of WPI in working unit in form of: - Provide alerts, monitoring systems, and emergency signalling. - Installing security equipment, like metal detectors, can stop armed individuals from entering the hospital. - Design waiting areas that can accommodate and provide resources for patients and visitors who may experience delays in services - Provide a mechanism to notify security staff when rudeness is in jeopardy. - Make sure that a culture of safety and respect is closely aligned with the organization’s mission, vision, philosophy, and shared values. Develope a program for teaching civility as one of the organizational staff development initiatives. Create a respectful and encouraging workplace environment where management and coworkers value nurses by implementing conflict resolution strategies to assist staff members in resolving their conflicts. B. Managers/leaders In your capacity as manager, serve as an exemplar in your interactions with nurses. Take steps to determine the kind and severity of rudeness and create plans of action to address issues and lighten workloads. Encourage nurses to report incivility incidents as soon as possible and offer suggestions for reducing or eliminating risks. Encourage kindness among nurses by teaching them conflict resolution and courteous communication skills, as well as by including them in team-building activities. Implement measures that incentivize There were statistically significant positive correlations between all dimensions of WPI and each other namely; General incivility, Nurse Incivility, Supervisor, Physician and Patient, and total WPI. The nurses perceived a moderate level of overall WPI with a mean score and standard deviation of (90.97±26.79). In this context, the highest perceived dimension was ―nurse incivility‖ and ranked first with a mean score of (22.47±6.871) followed by patient incivility, General incivility, and Physician incivility with a mean score of (21.75±8.218, 18.56±6.118, 14.71±5.933) respectively, while; ―Supervisor incivility‖ ranked as the least perceived dimension of WPI by nurses with a mean score of (13.48±6.064). The nurses perceived a moderate level of PR with a mean score and SD. of (80.21±7.247), and a Mean Percent Score of (66. 84%). The subjects’ perception of the variables composites of their PR, which was perceived as a moderate level of PR with a mean score and SD of (80.21±7.247). Based on the study findings the following recommendations are suggested for: A. Hospital administrator • Create a clear policy for preventing WPI and make sure that managers, supervisors, nurses, patients, and vistores are all aware of it. Additionally, support WPI’s zero tolerance policy in order to protect hospital standards and encourage courteous discussion as the norm. Stablish and maintain safe work environment for patients and staff to minimize incidence of WPI in working unit in form of: - Provide alerts, monitoring systems, and emergency signalling. - Installing security equipment, like metal detectors, can stop armed individuals from entering the hospital. - Design waiting areas that can accommodate and provide resources for patients and visitors who may experience delays in services - Provide a mechanism to notify security staff when rudeness is in jeopardy. - Make sure that a culture of safety and respect is closely aligned with the organization’s mission, vision, philosophy, and shared values. Develope a program for teaching civility as one of the organizational staff development initiatives. Create a respectful and encouraging workplace environment where management and coworkers value nurses by implementing conflict resolution strategies to assist staff members in resolving their conflicts. B. Managers/leaders In your capacity as manager, serve as an exemplar in your interactions with nurses. Take steps to determine the kind and severity of rudeness and create plans of action to address issues and lighten workloads. Encourage nurses to report incivility incidents as soon as possible and offer suggestions for reducing or eliminating risks. Encourage kindness among nurses by teaching them conflict resolution and courteous communication skills, as well as by including them in team-building activities. Implement measures that incentivize There were statistically significant positive correlations between all dimensions of WPI and each other namely; General incivility, Nurse Incivility, Supervisor, Physician and Patient, and total WPI. The nurses perceived a moderate level of overall WPI with a mean score and standard deviation of (90.97±26.79). In this context, the highest perceived dimension was ―nurse incivility‖ and ranked first with a mean score of (22.47±6.871) followed by patient incivility, General incivility, and Physician incivility with a mean score of (21.75±8.218, 18.56±6.118, 14.71±5.933) respectively, while; ―Supervisor incivility‖ ranked as the least perceived dimension of WPI by nurses with a mean score of (13.48±6.064). The nurses perceived a moderate level of PR with a mean score and SD. of (80.21±7.247), and a Mean Percent Score of (66. 84%). The subjects’ perception of the variables composites of their PR, which was perceived as a moderate level of PR with a mean score and SD of (80.21±7.247). Based on the study findings the following recommendations are suggested for: A. Hospital administrator • Create a clear policy for preventing WPI and make sure that managers, supervisors, nurses, patients, and vistores are all aware of it. Additionally, support WPI’s zero tolerance policy in order to protect hospital standards and encourage courteous discussion as the norm. Stablish and maintain safe work environment for patients and staff to minimize incidence of WPI in working unit in form of: - Provide alerts, monitoring systems, and emergency signalling. - Installing security equipment, like metal detectors, can stop armed individuals from entering the hospital. - Design waiting areas that can accommodate and provide resources for patients and visitors who may experience delays in services - Provide a mechanism to notify security staff when rudeness is in jeopardy. - Make sure that a culture of safety and respect is closely aligned with the organization’s mission, vision, philosophy, and shared values. Develope a program for teaching civility as one of the organizational staff development initiatives. Create a respectful and encouraging workplace environment where management and coworkers value nurses by implementing conflict resolution strategies to assist staff members in resolving their conflicts. B. Managers/leaders In your capacity as manager, serve as an exemplar in your interactions with nurses. Take steps to determine the kind and severity of rudeness and create plans of action to address issues and lighten workloads. Encourage nurses to report incivility incidents as soon as possible and offer suggestions for reducing or eliminating risks. Encourage kindness among nurses by teaching them conflict resolution and courteous communication skills, as well as by including them in team-building activities. Implement measures that incentivize nurses to exercise outside of work in order to reduce fatigue and the ensuing incivility. Foster good interpersonal relationships and social interaction between nurses and managers. These are all important factors in creating a work environment where employees feel at ease. Engage in active learning activities to practice responding to incivility, and pay close attention to the issues raised by team members and nurses. Communicate with staff the acceptable code of conduct which can be helpful in creating a list of what is acceptable conduct and what is not. Establish a committee to oversee WPI, preserve a safe workplace by encouraging nurse participation, and grant flexibility in the workday. Educate new hires on the policies and guidelines regarding appropriate conduct within the hospital setting. Create training programs for nurses to help them overcome WPI and advance their expertise. Provide a mechanism for nurses to ask for help if they feel threatened. B. for nurses All nurses within the workplace must improve spirits of team which improving cooperation and coordination between nurses. Establish productive communication connections and problem-solving techniques. All nurses should be trained in verbal de-escalation techniques, stress management, conflict resolution, and communication skills in order to handle difficult patients. These strategies will increase the probability of favorable outcomes. Nurses should respond to patients’ demands and solve their problems as soon as possible to improve patient satisfaction and lessen the likelihood of aggressive behavior. D. Recommendations for further study: Need more researches to investigate, focus and analyze PR in the field of nursing with other different variables such as work engagement, moral, distress and healthy work environment. |