Document Type : Original Article


1 Department of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran

2 Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran

3 Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran


BACKGROUND: Incivility has been raised as a growing concern and a hot topic in nursing education.
The aim of this study was to determine the effect of a context‑based educational intervention on the
nursing students’ civility index and their perception of uncivil behaviors.
MATERIALS AND METHODS: This quasi‑experimental study was done from 2019 to 2020 in
Khorramabad, Iran. A context‑based educational intervention focusing on problem‑based scenarios
was conducted for 4 weeks. Clark Civility Index for Students and Classmates (2017) and Clark
Incivility Scale in the University Environment (2014) were used. Data were analyzed using Stata,
descriptive statistics, and paired t‑test.
RESULTS: There was a significant difference between the mean score of students’ civility index
before and after the intervention (8.31 points increase, P = 0.004). However, there was no significant
difference between the mean score of the civility index for classmates before and after the intervention.
Furthermore, the mean score of students’ perception of incivility after the intervention increased by 5.88
points, which confirmed the significant effect of the intervention in improving students’ understanding
of uncivil behaviors (P = 0.018).
CONCLUSIONS: Considering the effectiveness of the problem‑based scenario along with other
strategies such as journal club and self‑learning in increasing the awareness of civility and improving
the civility index, the use of these strategies is recommended in order to reduce incivility.


1. Clark CM, Ahten SM, Macy R. Using problem‑based learning
scenarios to prepare nursing students to address incivility. Clin
Simulat Nurs 2013;9:e75‑83.
2. Hasanvand S, Pour MM, Goudarzi F, Rasouli M, Baharvand P,
Zarei M. The incidence and importance of uncivil behaviors of
nursing students: Comparing the perception of educators and
students. Future Med Educ J 2019;9:16‑25.
3. Clark CM, Barbosa‑Leiker C, Gill LM, Nguyen D. Revision and
psychometric testing of the Incivility in Nursing Education (INE)
survey: Introducing the INE‑R. J Nurs Educ 2015;54:306‑15.
4. Clark  CM, Springer  PJ. Incivility in nursing education:
A descriptive study of definitions and prevalence. J Nurs Educ
5. Sprunk EA, LaSala KB, Wilson VL. Student incivility: Nursing
faculty lived experience. J Nurs Educ and Pract 2014;4:4‑7.
6. Narimani A, Akbarzadeh M, Hamzeh M. Evaluation of general
health in medical students of AJA University of medical sciences,
2009. Ann Mil Health Sci Res 2010;8:49‑55.
7. Irajpour A, Farzi S, Saghaei M, Ravaghi H. Effect of interprofessional
education of medication safety program on the medication error
of physicians and nurses in the intensive care units. J Educ Health
Promot 2019;8:196.
8. Clark  CM. An evidence‑based approach to integrate civility,
professionalism, and ethical practice into nursing curricula. Nurse
Educ 2017;42:120‑6.
9. Rad M, Karimi Moonaghi H. Strategies for managing nursing
students’ incivility as experienced by nursing educators:
A qualitative study. J Caring Sci 2016;5:23‑32.
10. Rad M, Ildarabadi EH, Moharreri F, Karimi Moonaghi H. Causes
of incivility in Iranian nursing students: A qualitative study. Int
J Community Based Nurs Midwifery 2016;4:47‑56.
11. Joibari L, Mohammadi Z, Sanagoo A. A glance at students and
faculty fembers perceptions of incivil behavior in educational
settings. Strides Develop Med Educ 2011;7:127‑33.
12. Rafiee Vardanjani  L, Parvin  N, Shafiei  Z, Dehcheshmeh  SF.
Incivility behavior training of teachers and students in nursing
and midwifery department of shahrekord. J Develop Strateg in
Med Educ 2016;2:25‑37.
13. Amada G. Coping with the disruptive college student: A practical
model. J Am Coll Health 1992;40:203‑15.
14. Luparell S. Critical Incidents of Incivility by Nursing Students:
How Uncivil Encounters with Students Affect Nursing
Faculty [dissertation]. Lincoln: University of Nebraska; 2003. p. 24.
15. Woith WM, Jenkins SH, Kerber CH. The impact of a journal club
intervention on student perceptions and behaviours regarding
academic dishonesty. J Nurs Educ Pract 2012;3:27.
16. Kerber C, Jenkins S, Woith W, Kim M. Journal clubs: A strategy
to teach civility to nursing students. J Nurs Educ 2012;51:277‑82.
17. Jenkins  SD, Kerber  CS, Woith  WM. An intervention to
promote civility among nursing students. Nurs Educ Perspect
18. Abedini  Z, Parvizy  S. The effects of group discussion and
self‑learning on nursing students’ civility. Iran J Nurs Midwifery
Res 2019;24:268‑73.
19. Clark CM. Creating and Sustaining Civility in Nursing Education.
2nd ed. Indianapolis, IN: Sigma Theta Tau Int Publishing; 2017.
20. Mohammadipour M, Hasanvand S, Goudarzi F, Ebrahimzadeh F,
Pournia  Y. The level and frequency of faculty incivility as
perceived by nursing students of Lorestan University of medical
sciences. J Med Life 2018;11:334‑42.
21. Sebold LF, Boell JE, Fermo VC, Girondi JB, Santos JL. Role‑playing:
Teaching strategy that encourages reflections on nursing care. Rev
Bras Enferm 2018;71:2706‑12.
22. Gillespie GL, Brown K, Grubb P, Shay A, Montoya K. Qualitative
evaluation of a role play bullying simulation. J Nurs Educ Pract
23. Xu JH. Toolbox of teaching strategies in nurse education. Chin
Nurs Res 2016;3:54‑7.
24. Jenkins  SH, Woith  WM, Stenger  DA, Kerber  CS. Using an
innovative journal club strategy to teach civility to nursing
students: Lessons learned. J Nurs Educ Pract 2014;4:161.
25. Hogan  R, Orr  F, Fox  D, Cummins  A, Foureur  M. Developing
nursing and midwifery students’ capacity for coping with
bullying and aggression in clinical settings: Students’ evaluation
of a learning resource. Nurse Educ Pract 2018;29:89‑94.
26. Abedini Z, Parvizy S. Student’s perceptions of using scenario‑based
education to improve civility: A mixed method study. J Adv Med
Educ Prof 2019;7:165‑74.
27. Rutherford  DE, Gillespie  GL, Smith  CR. Interventions against
bullying of prelicensure students and nursing professionals: An
integrative review. Nurs Forum 2019;54:84‑90.