الفهرس 
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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.