Monitoring
Melissa Stevens
NUR/598
Patricia Dehof
April 47, 2015

Monitoring When using research methods to monitor solution implementation there is one that is commonly used in incivility research. In general, “the operational method” is commonly used to measure exposure to workplace bullying through surveys: participants indicate how frequently they are exposed to different bullying behaviors or negative acts that neither refer to the concept of bullying nor ask for bullying recognition (Giorgi, 2012). Having the ability to use different operations on one conceptual variable gives a researcher the ability to key in on the conceptual variable of interest. Using conceptual and measured variables will show the relationship between the two variables. Measured variables can be divided into two types: nominal and quantitative variables. A nominal variable is used to name a particular characteristic i.e. if a person is a male or a female. Quantitative variables use numbers to show how a person has a distinguishing effect. In the operational method two measurement scales are used, the first is the interval scale where there are equal distances between scores on a measure that are comparable to the changes in the conceptual model. Interval scales have a true zero point. A ratio scale allows for the division and multiplication of values. In an ordinal scale, numbers represent if there is more or less of a conceptual variable but, there is not an exact indication of the interval between individuals with the conceptual variable. The findings of this study are also in line with the premises of several theoretical frameworks that suggest a reversed linkage between climate and bullying, rather than a linear causation (Giorgi and Majer, 2009). The interval scale was used as “yes or no” questions were asked with no zero point. Conceptual and measurable variables were used in a proposed structural equation model to show the divides with workplace bullying, health, and organizational climate.

Evaluation Validation and reliability were methods used to evaluate the solution. A variable is simply a dimension or factor that changes. Validity has to do with the truthfulness degree and it actually measures the intended aspect. Even though validity may seem like a basic concept, it is not always the easiest to accomplish. The measurement of reliability deals with consistency, and there can be several different types of reliability. As an example, when researchers agree about an element of a study it is then considered reliable. Dimensions are almost always reliable if they are constant over a period of time. Researchers want to use validity and reliability measures in their studies to show truthfulness and consistency. Good studies will write about validity and reliability elements in the methods section of their article.
Outcome Measures Using the data collected from the Nursing Incivility Scale (NIS) validity and reliability were established through the use of internal consistency and by showing convergent and discriminant validity through the gathering of evidence. Evidence of validity was gathered by examining correlations between the NIS and other previously validated measures (Guidroz et al., 2010). There was a pattern that resulted in reliability estimates in the Nurse Incivility subscale that consisted of three incivility factors and the General Incivility subscale that consisted of two incivility factors. The average item-total correlation for all items was .76 indicating that the items demonstrate good internal consistency (Guidroz et al., 2010). Measurements are sensitive to change, an unexpected finding that can be further researched and possibly change the results are nurses who feel that they are not being compensated enough for the amount of social stress that they must deal with while at work. In the proposed incivility project when uncivil language comes from co-workers, managers, or physicians this is most upsetting to workers. This was validated in the NIS study.
Evaluation Data Collection The NIS was administered by paper and pencil or by an electric survey machine. Instructions were given to the participants to consider acts of incivility and respond to 10 questions using a 5-point Likert-type scale that ranged from 1-Strongly Disagree to 5-Stongly Agree. Before the survey was administered, advertisements were sent out a week before the survey collection to nurse managers to make an announcement to staff. During the survey collection, posters were put up throughout the hospital. Nursing staff were encouraged to stop in at the survey site to complete a survey. At the end of survey collection, the remaining survey packets were placed in the break rooms on the nursing units. The researchers chose this hospital as it was the hospital where the Managers Incivility scale was surveyed 6 months prior. Using the 5 question survey gave a cross-sectional design that allowed for interventions that can improve relationships between hospital workers. Relationally focused leadership styles are associated with positive work environments that promote employee engagement and result in greater work satisfaction and productivity (Uhi-Bien, 2006). Leaders that work under the relational leadership theory are administrators, human resource workers, nurse managers, and nurse leaders, working under this theory these leaders work as a team with their employees. Motivating employees with the possibility to create a powerful team that is effective at problem-solving and completing whatever task may challenge them. These leaders are those that work with their employees and the organization to accomplish organizational goals. Resonant leadership theory is another dominant leadership style to help create connected relationships with their employees. These leaders encourage their employees to produce their best possible work. These styles of leadership were associated with improved conflict management, job security, staff nurse health, and job satisfaction, as well as lower levels of anxiety, emotional exhaustion, and stress (Cowden et al., 2011). It is critical to involve individuals from the organization to create a cohesive planning team. These individuals include a nurse, a physician, and a physician advocate. With all of these resources included there can be a change in behavior by misbehaving staff members of incivility. On an organizational platform, there are two accomplishments that must be met: the first is the enactment of specific behavior values that discuss professionalism, courteousness, and behavior that is respectful between staff and when caring for patients; secondly, integrating defined specific values into procedure behaviors and performance appraisals. It is critical that values be identified and defined using a “ground-up” strategy that brings together representative stakeholders from the organization (Holloway and Kusy, 2010). We have heard stories of values being created and reinforced by executive personnel with any involvement of those that are expected to adhere to them (Holloway and Kusy, 2010). Without commitment by staff, there will be a lack of compliance and knowledge base. With staff involvement, there will be greater commitment, ownership, and results. When the values of incivility are written down, and employees must sign documentation to make a commitment to be respectful and courteous, employees will make a concentrated, committed act to change their behavior. When this is done values are established behavior and performance appraisal procedures can be set into place. The Joint Commission’s mandate should not simply be a mandate to monitor and reprimand, but a real opportunity to reward interpersonally effective behaviors that uphold codes of professional conduct and positive relational work (Holloway and Kusy, 2010). In taking successful steps to make changes within the organization stakeholders must participate and become part of the process for change; having employees sign the document of ethical behavior; incorporate the behaviors into procedures and performance appraisals; involve the change into the management system; and educate administrators, managers, and leaders regarding enforcing the values for minor and major infractions.

Appendix | NIS | NIS & NSS | | NURSING INCIVILITY | | | | Supervisor Factor | r=.19 | | p<.05 | Nurse Conflict | | r=.53 | p<01 | Nurse Supervisor | | r=.44 | p<.01 | Physician | | r=.64 | p<.01 | Patient/Nurse | | r=.24 | p<.01 | Patient/Supervisor | | r=.27 | p<.01 | WORK STRESS | | | | Nurse-specific Stress/Physician incivility | r=35 | | p<.01 | INCIVILITY and WORK STRESS | | | | Nurse Incivility | r=-.23 | | p<.01 | Supervisor Incivility | r=-.65 | | p<.01 | Physician Incivility | r=-.19 | | p<.05 | PAY SATISFACTION and INCIVILITY | | | | Physician Incivility | r=-.19 | | p<.05 | Supervisor Incivility | r=-.28 | | p<.01 | Patient Incivility | r=-.23 | | p<.01 |
References
Cowden, T., Cummings, G.G., & Profetto-McGrath, J. (2011). Leadership practices and staff nurses’ intent to stay: A systematic review. Journal of Nursing Management, 19(4), 461-477.
Giorgi, G. (2012). Workplace Bullying in Academia Creates a Negative Work Environment. An Italian Study. Employ Respons Rights Journal, 24, 261-275
Giorgi, G., & Majer, V. (2009). Mobbing virus organizzativo. [Mobbing organizational virus] Firenze: Giunti os organizzazioni speciali.
Guidroz, A.M., Burnfield-Geimer, J.L., Clark, O., Schwetschenau, H.M., & Jex, S.M. (2010). The Nursing Incivility Scale: Development and Validation of an Occupation – Specific Measure. Journal of Nursing Measurement, 18(3), 176-200
Holloway, E.L., & Kusy, M.E. (2010). Disruptive and Toxic Behaviors in Healthcare: Zero Tolerance, the Bottom Line, and What to Do About It. The Journal of Medical Practice Management: MPM, 25(6), 235-40
Uhi-Bien, M. (2006). Relational leadership theory: Exploring the social processes of leadership and organizing. The Leadership Quarterly, 17(6), 654-676.