How Deal With Disruptive Behaviors In Nursing Education
What Is Disruptive Behavior
Disruptive behavior is any
inappropriate behavior, confrontation, or conflict ranging from verbal abuse to
physical or sexual harassment (Rosenstein, 2013). Disruptive behaviors include
overt and covert actions that are displayed by any health care worker that
threaten the performance of the health care team (Joint Commission, 2008)
Disruptive behavior includes profane or dis courteous language, demeaning
behavior, sexual comments or overtone, racial/ethnic jokes, outbursts of anger,
throwing objects, criticism in front of patients or staff, comments that
undermine a patient's trust, and comments that undermine a caregiver's
self-confidence (Porto & Lauve , 2006 )
Impact of Disruptive Behavior on Educational Environment
Health care workers are often exposed and desensitized to behaviors that support a non-conducive and disrespectful work environment . Nurses, as well as other health care providers, must support, establish, and maintain working environments that are safe and conducive to the provision of quality health care. Disruptive behaviors not only threaten patient safety but also the ability for health care workers to perform their job competently. Hickson (2012) identified four significant implications to decrease the incidents of disruptive behaviors: orientation/residency programs, collaborative partnerships between academia and service, zero tolerance for behaviors that undermine a culture of safety, and addressing negative behaviors.
Nursing Orientation/Residency Programs In Educational Systems
These orientation/residency programs are intended to provide positive mentorship and preceptorship to support and promote a culture of professionalism and collegiality. According to the Quality and Safety Education for Nurses (QSEN, 2014), competency nurses, physicians, and other health care professionals are expected to function effectively within inter-professional teams, foster open communication, employ mutual respect, and share decision making to achieve quality patient care.
Nurse residencies and internships further indicate a relationship between the quality and quantity of nurse's orientation and the satisfaction and retention of novice professionals (Scott, Keehner Engelke , & Swanson, 2008). The Institute of Medicine (2010) suggested that the collaboration of state boards of nursing and accrediting bodies should support the completion of a nursing residency program upon license or advanced practice degree program, or the transition to new clinical practice areas.
Collaborative
Partnerships Between Academia and Service. A collaborative vision and
partnership between academia and the practice setting can successfully
translate to increased professionalism, effective communication, optimal
patient care, and substantive working relationships.
Zero Tolerance for Behaviors Undermining a Culture of Safety
Based on the Sentinel Event Alert (Joint Commission, 2008), the Joint Commission began requiring health care facilities to implement zero-tolerance policies that defined intimidating and disruptive behaviors. Zero tolerance includes, but is not limited to, intimidating and/or disruptive behaviors, especially the most egregious instances of disruptive behavior such as assault and other criminal acts (Joint Commission, 2008).
It is essential to provide information and education to students, as well as to the staff of all disciplines, concerning the phenomenon of disruptive behavior: defining characteristics, understanding the effects toward individuals and an organization, identifying the system for reporting and monitoring, and the responsibility that all stakeholders hold in eliminating disruptive behavior and adhering to the organization's zero tolerance policy.
Education about zero tolerance can be offered by formal or informal means, such
as coaching, mentoring, or precepting . An emphasis on individual
accountability at all organizational levels, as well as organizational adoption
of a culture of civility, would be required for policies to be effective
(Clark, Olender , Cardoni , & Kenski , 2011).
How Do Addressing Disruptive Behavior
Careful attention must be given to implementing effective strategies to empower newly registered nurses or experienced nurses to confront, defuse, and resist disruptive behaviors in their professional nursing practice Griffin (2004) has delineated cognitive behavioral techniques addressing negative behaviors, emphasizing educational awareness and cognitive rehearsal as specific interventions that new nurses can use to confront their hostile offender.
Strategies identified by the Center for
American Nurses (2008) include nurses adopting and modeling professional ethical
behavior, recognizing and addressing bullying and disruptive behaviors in the
workplace, reflecting on one's own behavior and communicating respectfully,
participating in collaborative inter-professional initiative to prevent abuse ,
and working to ensure the mission, vision, and values of their work places are
reflective of the Code of Ethics for Nurses and standards set by the profession
in order to eliminate disruptive behavior.
The burden of responsibility for decreasing and/or eliminating disruptive behavior does not fall solely on an individual or a group, but the organization as a whole organizational leader should use their constitutive capacity of persuasive influence to foster healthy and non-disruptive work environments, which ultimately create the ethical practice desired by the stakeholders of the nursing profession. It is not enough for the leaders to use their influence to reinforce a non-disruptive environment but also to commit to a role-modeling change in the pre-existing culture.
If organizational leaders continue to overlook the urgency of the
domino effect that disruptive behavior has within health care, they steadfastly
default on their vow of providing a culture of safety and promoting the
standards of professionalism (Hickson, 2012 ) .
Necessity of Dealing with Disruptive Behavior
Eliminating disruptive behavior in
the nursing profession is necessary in order to support an environment
conducive to a healthy workplace. If it is to be achieved, nursing education
and health care must develop educational and mentorship programs that foster a
healthy work environment and change the culture of nursing to one of valuing
self, peers, and nursing practice organizations (Lux, Hutcheson, & Peden ,
2014) Lux et al. (2014) stressed that nurse educators must educate nursing students
about how to confront disruptive behavior before entering their profession. New
graduates must leave nursing programs equipped with well-developed professional
communication skills.
Della Sega (2011) identified a
three-step process for decreasing the incidents of disruptive behavior in the
workplace, which can be affected by nursing educators to support the transition
of students to newly graduated nurses. The three steps are educating nurses who
are the victims of disruptive behavior about disruptive behavior in order to
improve their understanding of the phenomenon, teaching interactive strategies
to help nurses relate and re-frame disruptive behaviors, and using role modeling
to integrate appropriate behaviors.
Outcomes of Dealing With Disruptive Behaviors
Disruptive behavior can have deleterious effects on a personal or organizational level, which can no longer be ignored. Accreditation of health care facilities now depends on an organization's ability to effectively address disruptive behaviors. Organizations that operation and purely force zero-tolerance policies demonstrate to their employees the promotion of a healthy work environment ( Hickson , 2013).
A strong commitment on the part of health care agencies to eliminate disruptive behaviors, along with cooperation from everyone in the organization, is imperative. Longo (2010) identified approaches for addressing disruptive behaviors which include the following: adopt a zero-tolerance stance, develop a code of conduct that defines acceptable and unacceptable behaviors, provide education regarding communication skills, provide coaching and mentoring, provide mediation services to resolve disputes between parties, and take disciplinary action.
Rosenstein (2009) echoed similar topics as a call to action for health care environments to address disruptive behavior: strong organizational leadership, awareness and accountability, communication and team collaboration training, identifying clinical champion/clinical champions, enforcing policies and procedures, and reporting an intervention process.
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