Description and Background of Nursing Civility Study

Project Title: Identifying Strategies for Promoting a Culture of Civility

Study Purpose: The purpose of this study is to explore and discuss strategies for creating a culture of civility in academic nursing environments so that clear critical analyses of high stakes healthcare topics can occur.

Introduction: Scholars on nursing civility maintain that civility involves the allowance for and encouragement of respectful discourse, especially when differing opinions are present. This is especially important in today’s world of nursing, in which there is a growing presence of diversity among patients and a need for more diversity among practitioners. There is also an imperative to eliminate health disparities and discrimination which requires honest and difficult conversations. Without civility these conversations cannot occur safely and effectively and the profession cannot progress toward needed and positive change.

Background: This study developed out of a civility think tank that took place in 2017. Nurses got together weekly for several months to discuss the problem of incivility in nursing learning environments and how that could be turned around. The idea to study strategies to promote civility was raised during these meetings and two of the nurses, who serve as faculty in two different nursing programs, decided to pursue it further. Another nurse, who is a current doctoral student, also joined the project.

Rationale: An atmosphere that fosters inclusion, autonomy, value, and respect goes a long way toward creating a culture of civility. Woodworth (2016) describes civility in nursing education as complex and consisting of “a compilation of positive behaviors and attributes that influence communication, interpersonal relationships, learning, and patient outcomes” (p. 201). A variety of factors can influence the extent of civility in a particular environment, including observation of the conduct of others, prior encounters with civility and incivility, and baseline knowledge of what behaviors are acceptable versus unacceptable (Woodworth, 2016).  When opportunities for effective management are seized, a culture of civility is fostered; moreover, when faculty and students work together to resolve conflict, civility is enhanced, and a safer, more respectful learning environment is created (Clark & Springer, 2010).

In academia, incivility is more likely to occur when stress levels between faculty and students are high and when opportunities to resolve conflict are missed (Clark & Springer, 2010). Our work is focusing on what to do in the moment of a high-stakes conversation. Incivility, whether intended or not, is occurring, and given the caring mandate of nursing, the pervasive reality of incivility is especially disturbing. Perspectives of incivility on which we want to reflect include: (a) when we engage in incivility; (b) when we are the recipients of incivility; and (c) when we are the bystanders of incivility.

This study is guided by the Critical Caring Pedagogy model (Chinn & Falk-Rafael, in press). The model of Critical Caring Pedagogy (CCP) describes nurses’ ethical obligation to care. CCP is comprised of Modeling, Dialogue, Practice, and Confirmation (Chinn & Falk-Rafael, in press), all of which align with caring and civility in nursing education. CCP accounts for positions of power, which are typically assigned to faculty and not students. Chinn and Falk-Rafael (in press) suggest changing from “power over” to “power with,” so that every voice is heard and every individual valued (p.11). Because supportive, respectful learning environments foster students’ ability to flourish and reach their highest potential (p. 12), “teaching and learning grounded in nursing perspectives will prepare nurses to practice with a firm nursing theoretical foundation and advance the discipline of nursing as one that supports dignity, humanization, and human flourishing” (p.13). The purpose of this Critical Caring Pedagogy-guided study, therefore, is to explore and discuss strategies for creating a culture of civility in nursing learning environments.

Chinn, P.L., & Falk-Rafael, A. (In press). Critical Caring Pedagogy.

Clark, C.M., & Springer, P.J. (2010). Academic nurse leaders’ role in fostering a culture of civility in nursing education. Journal of Nursing Education, 49(6), 319-235.

Woodworth, J.A. (2016). Promotion of nursing student civility in nursing education: A concept analysis. Nursing Forum, 51(3), 196-203.

What the study entails: Participants are asked to complete a 9-question survey. Answers are anonymous and participation is voluntary. The survey takes approximately 10-15 minutes to complete. Completion of this survey constitutes consent to participate in this study.

Project team:

Jane K. Dickinson, RN, PhD, CDE, is the Program Director and faculty in the Master of Science in Diabetes Education and Management Program at Teachers College, Columbia University.


Piri Ackerman-Barger, PhD, RN, is an Assistant Clinical Professor and Co-Director of the Interprofessional Teaching Scholars Program at University of California Davis Betty Irene Moore School of Nursing.



Louisa Dasher Martin, MSNA, CRNA, practices full-time as a nurse anesthetist at University Health Care System in Augusta, Georgia, and is a part-time student in the PhD in Nursing program at Augusta University.



Note: This study was determined by the Institutional Review Board at the University of California Davis to be “not research involving human subjects and IRB review is not required”.

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