Clinical Question
Nurse incivility or horizontal violence remains a serious issue in nursing practice. It embodies a diversity of workplace behaviors, including bullying, scapegoating, sabotage, undermining activities, verbal affront, and physical violence (Lasater, Mood, Buchwach, & Dieckmann, 2015). Thousands of nurses in the U.S. face verbal abuse and physical violence on an everyday basis. Due to the sensitivity and complexity of the issue, data on the prevalence and incidence of horizontal violence in nursing varies considerably. Lasater et al. (2015) suggest that the rates of bullying among the nursing staff in the U.S. range between 18 and 31 percent.

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Accordingly, 88 percent of nurses confess they could identify at least one colleague who regularly engages in at least one form of lateral violence (Lasater et al., 2015). Apart from the heavy statistics on the incidence of violence in nursing settings, its implications for stakeholders also should not be ignored. Griffin and Clark (2014) say that “workplace incivility can negatively impact employee physical and mental health, job satisfaction, productivity, and commitment to the work environment” (p. 535). Horizontal violence has profound financial implications, resulting in costs as high as $12,000 per nurse practitioner (Griffin & Clark, 2014). These costs come in the form of lost productivity due to physical and emotional harm, low motivation, and reluctance to function beyond one’s capacity in the workplace (Griffin & Clark, 2014). Despite the implementation of numerous policies and mechanisms of action, workplace incivility remains a pervasive problem affecting all aspects of nursing care provision.

One of the principal questions is whether any programs could help stop horizontal violence or at least minimize the scope of incivility in nursing practice. This being said, the PICOT question to be answered as part of this group project is “In nurses aged 35-45 years (P) can educational and cognitive interventions (I) reduce the number of reported cases of violence compared with the nurses who do not participate in such programs (C) (O), within 6 months following the intervention (T)?” The purpose of the present work is to analyze the effects educational and cognitive interventions have on nurses in terms of preventing horizontal violence in the workplace.

Levels of Evidence
Speaking of the types of evidence, the best evidence to inform the future conclusions was found at Levels 2 (Cohort studies) and 4 (Case reports). The PICOT question proposed above is of the intervention/therapy type. Such questions refer to or propose a treatment. In the present discussion, nurse incivility is the issue of choice, whereas educational and cognitive interventions are intended to act as therapy to reduce the incidence of violence in nursing. Randomized controlled trials represent the most valuable source of data to answer the PICOT question above. Although the two articles selected for the review do not represent the best evidence, they are still based on the results of primary studies and incorporate rich primary and secondary evidence to support authors’ conclusions.

Search Strategy
The search strategy was based on the realization that only the most recent articles and sources present an interest and can offer a new insight into the nature of the problem and possible ways to solve it. Therefore, the search procedure was focused on the online scholarly databases, which provide easy access to medical and nursing literature, including CINAHL, MEDLINE, EBSCOHost, Ovid, PubMed, and Google Scholar. The following search terms were used: “nurse incivility”, “horizontal violence”, “horizontal violence nursing”, “prevention horizontal violence”, “prevention nurse incivility”, “nurse incivility effects”, and “interventions nurse incivility”. The initial search uncovered thousands of articles related to the topic. To make the search strategy more systematic and effective, a number of refinements were made. First, the search was limited to peer-reviewed journal articles. Other sources were excluded, including newspapers and trade publications. Second, only full-text articles were included in the search. Third, the scope of the search strategy was limited to the studies published between 2012 and 2015. Ultimately, the focus was made on studies published in professional nursing journals.

As a result, two articles were selected for the group project. First, in an article published by Lasater et al. (2015) and titled “Reducing Incivility in the Workplace: Results of a Three-Part Educational Intervention”, the researchers report the results of their mixed-methods analysis of the effectiveness of a complex educational intervention to stop horizontal violence among nurses. The results confirmed that, following the intervention, perceived acts of nurse incivility reduced significantly, coupled with a substantial rise in nurse self-efficacy (Lasater et al., 2015). Second, in their peer-reviewed article, Griffin and Clark (2014) revisit the effectiveness of cognitive rehearsal as presented in an earlier study 10 years ago. The researchers present the results of their literature review to confirm that cognitive rehearsal has the potential to reduce horizontal violence in nursing settings (Griffin & Clark, 2014). Both studies can be used to answer the PICOT question presented above.

Overall, nurse incivility is a recognized problem in nursing practice. Unfortunately, despite the growing body of empirical research, most healthcare facilities have been largely unsuccessful eliminating problem at its core. The two studies used in the present paper can help create a better picture of horizontal violence in nursing and inform the development of future strategies to minimize the risks of violence in the workplace. Simultaneously, any empirical evidence provided should be critically evaluated to ensure that it displays high levels of reliability, validity, generalizability, transferability, and credibility. Evidence generated as part of well-organized systematic reviews, meta-analyses, and randomized controlled studies should become a preferred option in developing evidence-based strategies to prevent horizontal violence.

  • Griffin, M., & Clark, C.M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542. DOI: 10.3928/00220124-20141122-02.
  • Lasater, K., Mood, L., Buchwach, D., & Dieckmann, N.F. (2015). Reducing incivility in the workplace: Results of a three-part educational intervention. Journal of Continuing Education in Nursing, 46(1), 15-24. DOI: 10.3928/00220124-20141224-01.