Systems thinking and incivility in nursing practice: An integrative review

Area of Science:

• Healthcare Systems Science
• Nursing Practice
• Patient Safety

Background:

• Workplace incivility poses a significant threat to patient safety, contributing to an estimated one million avoidable deaths globally.
• Implementing systems thinking (ST) is crucial for fostering civil healthcare environments and improving patient-centered care.
• Addressing incivility requires a global, interprofessional approach within healthcare systems.

Purpose of the Study:

• To identify evidence-based systems thinking (ST) strategies that promote workplace civility in healthcare settings.
• To explore the impact of ST on mitigating incivility and its effects on patient quality and safety.

Main Methods:

• An integrative review methodology guided the study.
• Thirty-eight relevant studies were systematically reviewed.
• The quality of included articles was assessed using the Mixed Methods Assessment Tool.

Main Results:

• Themes identified incivility's antecedents and consequences within complex healthcare systems.
• Findings suggest that ST can improve civility and enhance nursing practice.
• The review highlighted the systemic nature of incivility in nursing.

Conclusions:

• This review offers insights into global nursing incivility from a systems perspective.
• Several models are proposed to promote civility and enhance patient safety and quality.
• Further research is recommended on incivility and its impact on patient outcomes.