Incivility in Indonesian Nursing Education: A Qualitative Survey

Ni Gusti Ayu Eka

and Derek Chambers

Faculty of Nursing, Universitas Pelita Harapan, Tangerang Indonesia

Faculty of Medicine & Health Sciences, The University of Nottingham, U.K.

Keywords: Incivility, Nursing Education, Indonesia.

Abstract: Incivility has been increasingly acknowledged as a growing problem in nursing education. A number of

studies have investigated the issue, but these have predominately been conducted from a Western

perspective, whilst studies in Asian countries, such as Indonesia are limited. This study aimed to explore

incivility experienced by nursing students and faculty members in Indonesia. A multiple-case study design

was conducted using purposive sampling of students and faculty members from two faculties of nursing

(FoN) in Indonesia. A total of 306 respondents participated in the study. Data was collected using self-

reported survey (open-ended questions in an adapted Incivility Nursing Education/INE questionnaire). A

cross-case analysis was conducted using three steps, which were establishing word-tables, examining

disparities and similarities and integrating-interpreting the outcomes. The results identified three themes

including the nature of incivility, the underlying factors that led to an act of incivility and the setting in

which it took place. It is noted that incivility has occurred in Indonesia nursing education. Thus, there is a

need for further research to include management of incivility and the promotion of civility in nursing

education, especially in the Indonesian context, considering contextual factors such as the importance of

individuals’ backgrounds.

1 INTRODUCTION

Incivility is defined as any disrespectful behaviour,

which happens when students or teachers break rules

of conduct (Berger, 2000; Ferriss, 2002; Galbraith,

2008). Incivility is also socially and culturally

determined, and as such will vary from setting to

setting and could manifest in the social process

(Alexander-Snow, 2004; Connelly, 2009; Holm,

2014; Moffat, 2001). This also means that people

can perceive it differently according to their social

groups, social collaborations and settings.

Some aspects might be related to instances of

incivility. Knepp classifies three contributing aspects

of incivility: students, institution and faculty staff

aspects (Knepp, 2012). The student aspects include

great students’ expectations and a feeling of

entitlement. In regard to expectations, Alberts,

Hazen, & Theobald, identified a new students’

generation called the ‘Millennial Generation’

students (born from 1997 onward) (Alberts, Hazen

& Theobald, 2010). These students challenge their

faculty because of their immediate gratification

experiences, which has allowed them to possess a

lack of attention span and capability to multiple

tasks, thus they are difficult to engage in the

duration of learning.

A feeling of entitlement held by the ‘Millennial

Generation’ students is believed to be able to

influence students when working on their courses in

minimum effort (Knepp, 2012). Meanwhile, faculty

members perceive themselves as being responsible

for the students’ learning; students become passive

in their learning process (Clark, 2008; Cynthia M.

Clark & Springer, 2010; Eka, Chambers, &

Narayanasamy, 2016; Natarajan, Muliira, & van der

Colff, 2017). This passivity is against current

andragogic approaches of education.

The institutional aspects have been related to a

paradigm change in the last 20 years within general

and higher education. To that effect, it is argued that

many institutions of higher education and nursing

education have been growing into the development

of diverse students (Bednarz, Schim, & Doorenbos,

2010). This diversity leads to display students’

attitudes and expectations of education and the

educational atmosphere in a particular way. In

addition, lots of students have not been

knowledgeable of the good manners expected at the

Eka, N. and Chambers, D.

Incivility in Indonesian Nursing Education: A Qualitative Survey.

DOI: 10.5220/0008201200490056

In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 49-56

ISBN: 978-989-758-406-0

university in some portions of the learning system;

consequently, they might be ignorant to their deeds

that might be perceived as incivility instances

(Knepp, 2012).

The third aspect, as identified by Knepp,

emphasizes on faculty members as the perpetrator of

uncivil behaviour (Knepp, 2012). Though some

faculty members were susceptible to the students’

uncivil behaviour (impoliteness to physical attack),

it is unexpected that they could play a major role in

the incivility instance. However, according to Knepp

(Knepp, 2012), this is the result of: (i) inexperienced

teachers who are employed increasingly, such as

graduate teaching assistants, and (ii) a number of

demographic or individual characteristics of the

faculty members including ethnicity, age, gender,

and status of the faculty members (Clark, 2008;

Clark & Springer, 2010; Eka et al., 2016; Muliira,

Natarajan, & Van Der Colff, 2017).

A survey of the Indonesian nursing education

institutions concluded that incivility in nursing

education is a problem that has to be managed (Eka

et al., 2016). The study provides a new

understanding that incivility may be perceived

differently according to people's social context. The

study also shows that incivility was perceived

differently based on people's faiths.

The aim of this study was to examine perceived

incivility of nursing students and faculty members

within the Indonesian context.

2 METHODS

2.1 Design

This paper revealed the findings of the open-ended

questions of Eka’s study (Eka et al., 2016). The

study, which was conducted as a small portion of a

graduate program, included a multiple-case study

design (Yin, 2014). This also means that this study

also used an embedded design which combined

quantitative and qualitative data derived from two

different groups of respondents: faculty members

and nursing students at two faculties of

nursing/FoNs.

2.2 Ethical Considerations

The university's Institutional Review Board issued

the study ethical clearance. In addition, the faculties

of nursing (private and public) and clinical settings

in which the study took place provided permissions

for implementing this study.

2.3 Sample

A purposive sampling method was applied for

recruiting the sample. The inclusion criteria for

academic staff respondents were a lecturer who had

been teaching in the FoN for at least one year (in

the classroom, skills laboratory and in clinical

settings). For students, the inclusion criteria were an

undergraduate student in the FoN in year three or

four of the academic program, and students in their

professional program.

A total of 306 respondents from two FoNs

participated in the study. The respondents consisted

of 102 people at a private faculty of nursing

(students 96, academic staff 6) and 204 people at a

public faculty of nursing (students 185, academic

staff 19).

2.4 Instrument

The questionnaire used in the study was an adapted

version of Incivility in Nursing Education/INE

questionnaire (Clark, C.M., Farnworth, J. and

Landrum, 2009; Eka & Chambers, 2017; Eka et al.,

2016). The questions comprised four open-ended

questions related to incivility experiences including

examples and reasons of incivility instances and how

to address them (see appendix). The INE

questionnaire has been tested for its validity,

reliability (Cronbach Alpha > 0.8) and readability

from 20 students (Eka & Chambers, 2017). Based on

the validity results, some of the questions in the

questionnaire were reworded again. The rewording

of the questionnaire was also to facilitate easy

comprehension for Indonesians.

2.5 Procedure

Data collection started in the first FoN and finished

in the second FoN in 2013. The process for

collecting the data in each of the two FoNs was

using a similar procedure as well as from varied

resources. The researchers came to the class, skills

laboratory and hospital to recruit the students. For

recruiting the academic staff, the researchers came

personally to the academic staff working room at

nursing school.

The qualitative results of the open-ended

questions were analysed using thematic analysis

(Braun, V. & Clarke, 2006) of the result from the

faculty members and student nurses at each FoN.

The thematic analysis steps included data reading,

coding, themes development and reporting.

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

From the thematic analysis results, a cross-case

analysis (Eisenhardt, K, 1989; Stake, 2006; Yin,

2014) was applied using three steps including: first,

establishing word-tables based on the two data

sources (one for each FoN used in the study).

Second, these data sources were then analysed by

comparing and contrasting the two sources. The

third or last step included integrating and

interpreting the results in regard to the study

questions.

3 RESULTS

3.1 Characteristics of Respondents

Characteristics of the faculty respondents at the

private FoN were mostly female (83%), with age

range of 31-35 years old (33%) and above 40 (33%),

Christian (83%), Indo Malay ethnic group (83%),

half of them had working experience between 6 to

10 years, and two-thirds (67%) had a monthly

income above 6,000,000 rupiahs (500 USD). Most

students were female (78%), with age range of 20-25

years old (68%), Christian (65%) and more than half

(58%) Indo Malay (Bataknese) ethnic background.

Most of the faculty members at the public FoN

were female (79%), half (53%) with age range of

36-40 years old, Islam (89%), one hundred percent

were Indo Malay, more than half (53%) have

worked as lecturers with work experience range of

11 to 15 years, and had monthly income above

6,000,000 rupiahs/500 USD (42%). Most students

were female (88.65%), one hundred percent with age

range of 20-25 years old, half of them (51.35%)

consisted of Christian believers, and Indo Malay

(89.72%) with Bataknese ethnic background.

3.2 Perceptions of Incivility

The perceptions of the respondents in regard with

incivility in this study including: (i) the form and the

causes of incidences of incivility, (ii) the

dissimilarities between the locations in which the

incivility occurred and (iii) recommendations for

addressing the incivility instance. The results of the

cross-case analysis are presented in Table 1.

3.2.1 The Form and Causes of Incivility

Instances

In regard to the types of the uncivil behaviour, four

categories emerged which included: unprofessional

behaviour, ineffective communication and

relationship as well as teaching-learning process

issues. Unprofessional behaviours were conducted

by faculty members, student nurses and clinical

nurses in nursing education settings. For example,

faculty members were said to undermine students

within the classroom, given unjustified grade and

dishonoured other faculty members. The students

came late, unprepared for class and engaged in acts

of dominance to other students. The nurses’

unprofessional behaviour was manifested by:

neglecting patients, rejecting to work with students

and inaccurate patient recordings.

Table 1 also reports the emerging themes

regarding the causes of incidences of incivility

including: issues related to professionalism,

ineffective communication, inconsistency of rules

application as well as individual and contextual

influences. In regard to professionalism, one of the

reasons, faculty members at the private FoN referred

to was the overwhelming responsibilities of their

roles as a cause factor to incivility. For example, one

faculty respondent commented that incivility

frequently occurred “Because of the demanding

tasks … that must be finished by the faculty

members and students” (Student #004). In addition,

only respondents at the private FoN declared

ineffective communication as one of the causes of

incivility.

In contrast, only respondents at the public FoN

stated the implementation of ineffective rules as one

of the causes of the instances of incivility. It seems

that there were minor differences in opinions between

the two FoNs regarding the causes of incivility. The

individual conditions and background issues were

also identified as some of the causes for the incivility

instances. The faculty members at the private FoN

reported personal stress and ineffective coping, as two

reasons in regard to individual factors that might

cause incivility instances. Author(s) name(s) should

be aligned to the center with line space exactly at 13-

point. The text must be set to 11-point.

3.2.2 The Dissimilarities between the

Locations in Which the Incivility

Occurred

The respondents also reported that there were

differences in the instances of incivility concerning

the classroom, skills laboratories and clinical

practice settings. These differences were related to

(1) the type of the incivility, (2) the individuals

involved, (3) the areas and scope of the incivility.

It is noted that most of the respondents supported the

three themes. A student at the public university

Incivility in Indonesian Nursing Education: A Qualitative Survey

Table 1: Cross-case analysis of open-ended questions findings.

Questions

Themes

Private FON

Public FON

Faculty members

Students

Faculty members

Students

Forms of incivility

Communication issues

√

Interaction issues

√

Educational issues

√

Professionalism issues

√

Misuse of technology

√

Causes of incivility

Ineffective communication

√

Professionalism issues

√

Individual and contextual

factors

√

Ineffective rules

implementation

√

Dissimilarities between

the locations in which

the incivility occurred

Form of the incivility

instances

√

Person involved in

Incivility instances

√

Areas or scopes of

incivility

√

Recommendations for

addressing the incivility

Effective communication

and relationships

√

Effective rules

implementation

√

Role Modelling

√

mentioned that “…in the classroom, and it

emphasises more on students’ tardiness and schedule

alterations; whereas in the skills laboratory it was

more about harassing comments, such as students

being called stupid” (Student #105).

The same student also stated, “In the wards, it

[uncivil behaviour] is often demonstrated by using

harsh words or high intonation. In the clinical unit,

“…insulting words, underestimating education

institution and hitting or pinching” (Student #105).

From faculty members perspective, a faculty

mentioned some students’ uncivil behaviour

including: “In the classroom: students were

noisy [disturbing noise]. In the skills laboratory:

students did not attempt to practice [their] skills

[passive] and improper students’ attire. In the

clinics: ineffective communication between students

and patients (Faculty member #006)”. Another

faculty member said: “Actually, it is similar, the

only difference is the people involved. In the

laboratory, it happens between students and faculty

members. In the clinics, it is uncivil behaviour

towards patients” (Faculty member #007).

3.2.3 Recommendations for Addressing the

Incivility Instances

This current study further identified three main

strategies for addressing incivility in nurse education

including: role modelling, effective rule

implementation, and effective communication and

relationships. The provision of positive role

modelling was by members of faculty as well as

clinically based. For example, a faculty member

said, “A role model is needed from the upper

position [supervisor]/leaders/academics” (Faculty

member #004). Indeed, positive role modelling was

also expected by students, as one respondent went

on to identify that in order for role modelling to be

effective, it is imperative to “…appreciate

dissimilarities in culture…the distinctiveness of

every person that leads to a sense of respect”

(Student #003).

Effective rule implementation is also required for

promoting civility in the settings of nursing

education. This was supported by one faculty

respondent when he/she said: “All persons have to

follow the rules in academic settings” (Faculty

member #005). A student respondent further uttered

their view that in addition to the implementation of

effective rules, strong religious values were also

important in maintaining civility. The student

supported: “… strong faith [is also needed], not only

[due to] the existing regulation...” (Student #111).

Effective communication and relationships are

also essential in managing (including preventing and

addressing) incivility in nursing school. One of the

examples that relates to effective communication is

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

that nursing education should establish their ground

rules within the institution’s context, as a faculty

member suggested: “The faculty staff members

manage the class while teaching [effectively] and

establish agreements with students in regard to class

ground rules” (Faculty member #001). A number of

illustrations related to effective relationships are

encouraging, honouring others and self-reflection. A

student also mentioned a need for “directness,

honour and repute for each other, as well as

necessity for [written] assessment for self-

refinement” (Student #089).

4 DISCUSSION

This study explored perceptions of both faculty and

students of incivility at two FoNs in the Western part

of Indonesia. The findings revealed that incivility

could be perceived differently by different people.

The reason is a person’s perception of incivility is

determined by some reasons such as their social

context, individual experiences, values and beliefs

(Clark, 2013; Robertson, 2012). The doer could

recognise it to be normal, meanwhile the receivers or

those witnessing it could recognise it to be uncivil.

Hence, the concept and perception of incivility is

socially generated and can be an issue to discuss

further (Moffat, 2001).

The respondents at both faculties of nursing

showed some similar themes. These themes are

related to the nature of the acts of incivility

including communication and professional issues.

What was interesting was the differences between

the private and public schools with the former

expressing more concerns about ineffective

communication, whereas respondents at the public

school were more concerned about the

implementation of ineffective rules.

Effective communication and collaborations are

vital in nursing (McCabe and Timmins, 2013).

Nevertheless, the respondents at both FoNs showed

that individuals involved in nursing education

communicated and interconnected ineffectively,

which led to anger, distress and frustration. These

conditions may lead to withdrawal of the people

involved (Budden, Birks, Cant, 2015; Luparell, 2007).

Faculty members and students in this study also

perceived that incivility occurred differently based

on the settings: classroom, skills laboratory and

clinical settings. The differences included forms of

the behaviour, the people involved, and extend of

the behaviour. For instance, in the classroom, the

uncivil behaviour included chatting (during lectures)

and unpunctuality to attend classes or to complete

tasks by students. In the skills laboratory, the

incivility instances included harsh comments by

faculty members. Last but not least, in the clinical

practice, nurses performed superiority attitudes; the

concerns of this deprived relationship of health-care

workers could involve patient safety issues

(Rosenstein, A.H. & O’Daniel, 2008; Woith,

Jenkins, & Kerber, 2012) and decreased standards of

care (Budden, Birks, Cant, 2015).

Regarding the area and scope of the behaviour,

the results of this study are in line with previous

studies (Beck, 2009; Budden, Birks, Cant, 2015).

The students suggested that incivility probably

occurred more in the classroom; in contrast, the final

year students felt that incivility happened more

frequently in clinical settings (Beck, 2009). This

finding may be associated with the students’

conditions that the last year students spent more time

in clinical settings than in the classroom. Moreover,

the third-year students were in a position comparing

what they described as professional or

unprofessional behaviours, in the terms of civility, as

they have become knowledgeable pupils who have

learned better understanding of professionalism

(Beck, 2009).

The characteristics of individuals involved in

nursing school are also vital, and it is readily

understood that there is a need for having better self-

awareness and value interpretation for the purpose of

understanding the influence of individual traits in

cross-cultural relations. The present-day students’

characteristics such as dearth of social interaction

abilities and kind-heartedness as well as discourteous

and self-centred behaviours may be the reasons for

incivility instances (Hernandez & Fister, 2001).

Moreover, there are very diverse ethnicities,

religions and SES backgrounds in Indonesia

(Mandryk, 2010) and those backgrounds might be

integrated in people’s day-to-day lives (Kutieleh,

2011). Thus, a person’s background could affect the

acts of incivility, especially in the Indonesian setting.

In regard to the implementation of rules, faculty

members at the two FoNs applied inconsistent rules,

such as in conducting the unpunctuality policy and

in rewarding and punishing behaviour. These

differences may lead students to disregard rules and

tolerate uncivil behaviour. Former studies showed

that students’ incivility perseveres when incivility is

addressed poorly (Clark, 2008; Luparell, 2005).

Moreover, this current study provided new insights

into the strength that religious beliefs play in

promoting and demonstrating civility in nursing

education.

Incivility in Indonesian Nursing Education: A Qualitative Survey

The respondents recommended role modelling,

effective rules’ application and effective

communication and interactions to manage incivility

instances in nursing education. The respondents

offered some examples in regard to behaving

appropriately, including honouring and

understanding others, and role modelling that

performs decent behavioural examples to others as

approaches for decreasing incivility in nursing

education (Cynthia M. Clark & Springer, 2010; de

Swardt, van Rensburg, & Oosthuizen, 2017).

This current study’s findings are similar to the

former research in that it is important to generate

effective guidelines, procedures and code of conduct

to prevent and address incivility instances (Longo,

2010; Suplee, Lachman, Siebert, & Anselmi, 2008).

Longo also recommended that particular policies

and rules are required to manage the incivility

instances effectively, for example, establishing

ground rules to describe and manage the civility or

incivility instances (Longo, 2010).

The finding of this study showed that effective

communication is central to the promotion of civility

in which it is also supported by previous studies.

Effective communication between nursing students

and clinical educators, and supportive climate

amongst nurses, nurse educators and students(Decker

& Shellenbarger, 2012) are required for promoting

civility in nursing education. Not only previously

mentioned strategies, providing clear discussions and

positive activities that include “counselling, coaching

and mentoring” in the nursing education setting could

further manage incivility effectively (Clark &

Springer, 2010; p.324).

This study could not be generalised due to the

challenges of truly representing various backgrounds

in Indonesia. Therefore, further study should be

conducted in other settings of nursing schools in

Indonesia.

5 CONCLUSIONS

Incivility has been identified as an actual and

growing problem in Indonesian nursing schools.

Faculty members and students had experienced or

observed incivility in the academic environment. In

addition, the data exposed differences as well as

some similarities in the ways the two groups

perceived incivility, which appeared to have been

based on: the nature of incivility, the underlying

factors that led to an act of incivility and the setting

in which it took place. The results of this study

suggest that if incivility in the Indonesian context is

to be addressed, there is a need to consider

contextual factors such as individuals’ background.

The study also identifies a need for further research

to include management of incivility and the

promotion of civility in nursing education, especially

in Indonesia.

ACKNOWLEDGEMENTS

Directorate General of Higher Education Indonesia

(DIKTI) is supported the study. The authors would

further like to express gratitude for people at

faculties of nursing and two hospitals in Indonesia

for their permission and involvement in the study.

REFERENCES

Alberts, & Hazen & Theobald. (2010). Classroom

incivilities: The challenge of interactions between

college students and instructors in the US. Journal of

Geography in Higher Education, 34(3), 439–462.

https://doi.org/10.1080/03098260903502679

Alexander-Snow. (2004). Dynamics of gender, ethnicity,

and race in understanding classroom incivility. New

Directions for Teaching and Learning, 2004(99), 21–

31. https://doi.org/10.1002/tl.155

Beck, J. W. (2009). Deconstructing student perceptions of

incivility in the nursing education triad. Retrieved

from http://citeseerx.ist.psu.edu/viewdoc/download?

doi=10.1.1.469.9558&rep=rep1&type=pdf

Bednarz, H., Schim, S., & Doorenbos, A. (2010). Cultural

Diversity in Nursing Education: Perils, Pitfalls, and

Pearls. Journal of Nursing Education, 49(5), 253–260.

https://doi.org/10.3928/01484834-20100115-02

Berger, B. A. (2000). Incivility. American Journal of

Pharmaceutical Education, 64(December).

Braun, V. & Clarke, V. (2006). Using thematic analysis in

psychology. Qualitative Research in Psychology, 3(2),

77–101. https://doi.org/http://dx.doi.org/10.1191/

1478088706qp063oa

Budden, Birks, Cant, B. & P. (2015). Australian nursing

students’ experience of bullying and/or harassment

during clinical placement. Collegian, 24(2), 125–133.

https://doi.org/10.1016/j.colegn.2015.11.004

Clark, C.M., Farnworth, J. and Landrum, R. E. (2009).

Development and description of the incivility in

nursing education (INE) survey. The Journal of

Theory Construction and Testing, 13(1), 7–15.

Clark. (2008). Faculty and Student Assessment of and

Experience with Incivility in Nursing Education.

Journal of Nursing Education, 47(10), 458–465.

https://doi.org/10.3928/01484834-20081001-03

Clark, C.M. (2013). Creating and sustaining civility in

nursing education. Retrieved from

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

https://www.amazon.com/Creating-Sustaining-

Civility-Nursing-Education/dp/1937554546

Clark, Cynthia M., & Springer, P. J. (2010). Academic

Nurse Leaders’ Role in Fostering a Culture of Civility

in Nursing Education. Journal of Nursing Education,

49(6), 319–325. https://doi.org/10.3928/01484834-

20100224-01

Connelly. (2009). Introducing a Culture of Civility in

First-Year College Classes. The Journal of General

Education, 58(1), 47–64. https://doi.org/10.1353/jge.

0.0029

de Swardt, H. C. (Rina), van Rensburg, G. H., &

Oosthuizen, M. J. (2017). Supporting students in

professional socialisation: Guidelines for professional

nurses and educators. International Journal of Africa

Nursing Sciences, 6, 1–7. https://doi.org/10.1016/j.

ijans.2016.11.002

Decker, J. L., & Shellenbarger, T. (2012). Strategies for

nursing faculty to promote a healthy work

environment for nursing students. Teaching and

Learning in Nursing, 7(2), 56–61.

https://doi.org/10.1016/j.teln.2010.12.001

Eisenhardt, K, M. (1989). Building Theories from Case

Study Research. The Academy of Management

Review, 14(4), 532. https://doi.org/10.2307/258557

Eka, Ni Gusti Ayu Eka & Chambers, D. (2017). Incivility

in nursing education: a case study in Indonesia.

Retrieved from http://eprints.nottingham.ac.uk/41224/

1/Thesis_4146288_Ni Gusti Ayu

Eka.pdf%0Ahttp://eprints.nottingham.ac.uk/41224/1/T

hesis_4146288_Ni Gusti Ayu Eka.pdf

Eka, N. G. A., Chambers, D., & Narayanasamy, A. (2016).

Perceived uncivil behaviour in Indonesian nursing

education. Nurse Education in Practice, 20.

https://doi.org/10.1016/j.nepr.2016.07.007

Ferriss, A. L. (2002). Studying and measuring civility: A

framework, trends, and scale. Sociological Inquiry,

72(3), 376–392. https://doi.org/10.1111/1475-

682X.t01-1-00023

Galbraith, M. W. (2008). College teaching: Developing

perspective through dialogue. Malabar, FL: Krieger

Publishing Co.

Hernandez, T. J. &, & Fister, D. L. (2001). Dealing With

Disruptive and Emotional College Students: A

Systems Model. Journal of College Counseling, 4, 49–

62.

Holm, K. (2014). Workplace incivility as a social process:

how witnessing incivility relates to uncivil conduct,

well-being, job satisfaction and stress.

Knepp, K. A. (2012). Understanding student and faculty

incivility in higher education. The Journal of Effective

Teaching, 12(1), 32–45.

Kutieleh, A. &. (2011). How different are we?

Understanding and managing plagiarism between East

and West. Journal of Academic Language & Learning,

5(2), 88–98. Retrieved from http://journal.aall.org.au/

index.php/jall/article/viewArticle/159

Longo, J. (2010). Combating Disruptive Behaviors:

Strategies to Promote a Healthy Work Environment

Letter to the Editor. OJIN: The Online Journal of

Issues in Nursing, 15(1), 1–11.

https://doi.org/10.3912/OJIN.Vol15No01Man05

Luparell, S. (2005). Why and How We Should Address

Student Incivility in Nursing Programs. Annual

Review of Nursing Education, Vol 3, 2005, (October

2002), 23–36.

Luparell, S. (2007). The effects of student incivility on

nursing faculty. Journal of Nursing Education, 46(1),

15–19.

Mandryk, J. (2010). Operation world: The definitive

prayer guide to every nation. Retrieved from

https://www.amazon.com/Operation-World-

Definitive-Prayer-Nation/dp/0830857249

McCabe, C. and Timmins, F. (2013). Communication

skills for nursing practice. Retrieved from

https://www.macmillanihe.com/page/detail/communic

ation-skills-for-nursing-practice-catherine-

mccabe/?sf1=barcode&st1=9780230369207#

Moffat, R. C. L. (2001). Incivility as a barometer of

societal decay. Florida Philosophical Review. 1 (1), p.

63-75.

Muliira, J. K., Natarajan, J., & Van Der Colff, J. (2017).

Nursing faculty academic incivility: Perceptions of

nursing students and faculty. BMC Medical

Education, 17(1), 1–10. https://doi.org/10.1186/

s12909-017-1096-8

Natarajan, J., Muliira, J. K., & van der Colff, J. (2017).

Incidence and perception of nursing students’

academic incivility in Oman. BMC Nursing, 16(1), 1–

10. https://doi.org/10.1186/s12912-017-0213-7

Robertson, J. (2012). Can’t we all just get along? A primer

on student incivility in nursing education. Nursing

Education Perspective, 33(1), 21–26.

Rosenstein, A. H. & O’Daniel, M. (2008). A survey of the

impact of disruptive behaviors and communication

defects on patient safety. The Joint Commission

Journal on Quality and Patient Safety, 34(8), 464–471.

Stake, R. E. (2006). Multiple case study analysis. The

Guilford press, New York.

Suplee, P. D., Lachman, V. D., Siebert, B., & Anselmi, K.

K. (2008). Managing nursing student incivility in the

classroom, clinical setting, and on-line. Journal of

Nursing Law, 12(2), 68–77. https://doi.org/10.1891/

1073-7472.12.2.68

Woith, W., Jenkins, S. D., & Kerber, C. (2012).

Perceptions of Academic Integrity Among. Nursing

Forum, 47(4), 253–260. https://doi.org/10.1111/j.

1744-6198.2012.00274.x

Yin, R. K. (2014). Case study research: Design and

methods (5th ed.). SAGE Publication, Inc.

APPENDIX

Open-ended questions in the survey:

1. Give examples of uncivil behaviours that occurs

in academic environment (classroom, skills

laboratory and clinical practice).

Incivility in Indonesian Nursing Education: A Qualitative Survey

2. In your opinion, why (reasons) do you think

incivility occurs in academic environment?

3. Please describe how students, faculty members,

nurses and the university/college should address

incivility in the academic environment.

4. What are the differences in the uncivil

behaviours seen in the traditional classroom,

skills laboratory and the clinical unit?

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association