Answer

Work Environment Assessment

Based on the Work Environment Assessment I conducted on my workplace, the conclusion was that my workplace was mildly civil. This conclusion was based on a number of observations and practical circumstances and interactions that I either observed or took part in. One of the characteristics demonstrated by members of my workplace is the exemplary way in which they demonstrate shared mission and vision, which is founded on the virtues of trust, respect and collegiality. The manner in which the nurses and supervisors in the field interact and handle patient care was admirable. It was refreshing to see how the physicians, nurses and supervisors handle the patients, other employees and the patient families in a respectful manner. It demonstrated the respect and dignity that a workplace ought to demonstrate. The manner in which the employees in the workplace are valued and respected makes it civil. The provision of health insurance to all workers, the offer of free uniforms and bonuses prove that the organization values and cares for the workers. The communication strategies used to communicate desired results and resolve conflicts amicably also prove civility.

I was surprised by what civility and respect can achieve to the provision of quality care. Healthcare is a sector that is characterised by extreme stress and psychological burden both on the patients, due to their conditions, and on the healthcare workers based on the amount of work they have to do (Adams & Maykut, 2015). When the patients and their families were talked to with respect, despite their occasional outbursts, they calmed down and the quality provided was guaranteed. Second, I was surprised by the way in which the superior supervisors interacted with nurses and how this interaction boosted the confidence of workers. I believed that effective communication is important in conflict resolution, and this was confirmed when the conflict I had with my supervisor was effectively resolved.

The evidence gathered from the Assessment suggests that my workplace has realized the positive impacts of civility and health in the workplace. The implementation of evidence-based research in terms of the interventions and problem solving prove that my workplace values the attainment of quality care as well as employee safety and satisfaction. In addition, the importance of adopting respectful and clear communication strategies was also evident and important.

PART 2: Literature Review

In her article, (Clark, 2015) explores the ways in which incivility at the healthcare environment can lead to a number of psychological and mental problems, such as lack of proper judgement and compromised critical thinking skills. It is also certain to be a chief cause of esteem problems within the workplace, causing workers to suffer uncertainty and self-doubt. When this happens, Clark is convinced that it would inevitably lead to life-threatening mistakes, harm or even death of the patient. She, therefore, proposes a technique known as Cognitive Rehearsal (CR) that is meant to create healthy working environments and promote acts of civility. This technique is meant to improve the confidence of those who work as nurses so that they can be able to not only confront instances of incivility with respectful language and demeanour, but also equip them with the skills they need to address stressful situations in ways that are non-threatening both to themselves and to the patients. Her theory then involves the respectful diffusion of stress or conflicts using evidence-based mental and psychological strategies. 

Besides this theoretical perspective, Clark et al. (2011) discuss in their article the ways in which stressful environments contribute to the inevitable adoption of incivility as a form of organizational culture. They observe that the healthcare environment is rife with stressful circumstances, exacerbated by an increasingly complex patient population and the overwhelming demands of the nurse workload. It is true, according to them, that when interpersonal relationships break down following these pressures, the spiral to uncivil behaviour has begun. The solution, for them, is to develop both a model for effective communication and a conceptual model in which stressors are identified and practical interventions that can help relieve these stressors such as education, policy and procedure, self-care initiatives, are implemented to reduce them. To support the development of a civil culture despite the stressors, the research suggests that aspects, such as positive role modelling, professionalism, collaboration, teamwork and ethical conduct, should be adopted within the framework.

The first theory that involves cognitive rehearsal is important by the manner in which it puts the quality of care and the patient’s well-being at the core of its strategy. In my organization, the findings of the assessment conducted indicated that one of the reasons why civility is favoured, and respectful discourse between nurses and their supervisors encouraged is because they are central to the patient’s well-being. The article asserts that the core problem for the cultivation of uncivil cultures within the workplace is the failure to resolve some of the mental problems and psychological toll that is bred within the work environment. When this happens, there can be mistakes and judgement errors that may put the life of the patient in danger. In my organization, such errors that are directly related to uncivility have been reduced due to the adoption of interventions that help improve communication and interaction between the healthcare workers themselves and also with the patients together with their families.

The second idea is from the conclusion that stressors are the chief cause of uncivil behaviour at the workplace; and so, a solution resides in developing an elaborate communication strategy and a conceptual framework that can identify stressors and suggest solutions. In my workplace too, the demands of work and the nature of patients makes the environment rife with depression and stress. Often, these can manifest themselves in violent outbursts and disagreements that do not adhere to the idea of civility (Clark, 2019). Capital Caring too has robust mechanisms of peacefully resolving conflicts and policies that encourage respectful communication and tolerant attitudes.  In these ways, the theory developed in this research relates to my own findings.

My organization, Capital Caring, can adopt the ideas of the framework developed by Clark and her colleagues to solve issues that emerge from the workplace and foster the culture of civility within the workplace. In the organization, a number of things can be said to be stressors. Because of the few number of nurses within the facility, for instance, they have adopted mandatory shifts for various healthcare workers. Even when all the physicians and nurses are on duty, the number is still below sufficient. Work overload is, therefore a chief stressor. Most of the nurses too are limited by guidelines that prevent them from practicing within the full extent of their training. Notably, they are limited by gagging State regulations and hospital policy. This demotivates and kills their esteem. What my organization can do then is to hire more staff to solve the problem of understaffing, and eliminate the mandatory shifts. In addition, they ought to facilitate and encourage nurses to train further so that as APRNs, they can climb above some of the restrictions to their practice that the system favours. Added to their communication channel that they have extensively developed, this would be a big leap towards the provision of quality care.

PART 3: Evidence-Based Strategies

The first strategy that can be implemented to address the shortcomings in my Assessment is to implement the aspect of cognitive rehearsal that addresses the challenge of unpreparedness for stressful situations in future (Clark, 2015). Cognitive rehearsal is about creating simulations of stressful situations that may spring out of healthcare practice in future and finding solutions to them in a systematic way. When the nurses engage in such situations, their anxiety is reduced, their confidence increases, and they get to learn a lot about impulse control whenever they engage in practicing new and effective ways of handling stressful situations. In addition, rehearsing these potential stressful situations prepares the nurses for the challenges by creating an opportunity to communicate what would be the expected civil behaviours. Secondly, this cognitive rehearsal can be followed up by another closely related strategy—debriefing. This is where there are safe spaces created for the nurses to reflect on and explore effective ways of addressing future challenges. The debriefing sessions we have within our organization are not structured in the organized formal sense but applied haphazardly. This is so even when it should be the duty of these debriefing sessions to help individuals in identifying the varied aspects of individual and team performance that failed to meet expectations and those that did.

One of the successful strategies identified during my assessment was the adoption of a sound communication channel that helped to clarify positions, communicate expectations and resolve conflicts. The strategy that can bolster it was suggested by Clark and colleagues when they advocated for the modelling and adoption of an effective communication strategy. They did affirm that such a model would improve the confidence of employees and boost their self-esteem (Clark et al. 2011). When this happens, the employees are less likely to get stressed and make mistakes that may prove fatal to the patient under care. The other strategy that can bolster my successful practices would be to identify stressors (factors that contribute to the stress experienced by nurses) and respond to them effectively. Even while I did identify some of the things that my organization does to the employees, including the provision of healthcare insurance and new attire, it cannot be assumed that these alone are enough to make the workers satisfied. The organization still needs to identify stressors that may prove to be the causes of tension, irritability and uncivil behaviour.

In conclusion, the Assessment of the Workplace can reveal facts about whether or not the organization adopts civility or encourages uncivil behaviour. My organization is only mildly civil, and it has made the use of effective communication strategies to improve interaction and promote civility. However, there are other strategies too that promote the identification of stressors and the utilization of cognitive rehearsal to help develop civil behaviour. These aspects have to be integrated into the organizational structure if civility is to be attained.