Manifestations of Uncivil Behaviors in Clinical Settings: Perspectives of Students, Faculty Members, Nurses, and Clinical Managers

Abstract

Background: The increasing incidence of uncivil behaviors in nursing education has become a major global concern, particularly in clinical learning environments where professional interactions are essential. Although previous studies have documented various forms of incivility, less attention has been given to distinguishing incivility from related phenomena, such as stress responses, role ambiguity, and structural challenges. Objectives: This study aimed to explore and clarify manifestations of uncivil behavior in clinical nursing education. Methods: A qualitative exploratory design was used. Participants comprised nursing students, faculty members, administrators, and healthcare staff at Shahid Beheshti University of Medical Sciences in Tehran, Iran. Purposive and snowball sampling techniques were used to ensure diverse perspectives. Data were collected over 5 months through semistructured interviews with 27 participants, and sampling continued until data saturation was reached. Conventional content analysis, supported by MAXQDA 2020 software, guided the analysis. Reflexivity was maintained throughout data collection and analysis. Results: Uncivil behaviors were categorized into 4 main groups: student-related, faculty-related, healthcare staff-related, and organizational behaviors. The findings indicated that incivility is a multidimensional phenomenon shaped by interactions across these groups. Importantly, not all identified behaviors constituted incivility in a strict sense; some reflected stress responses, role ambiguity, or organizational constraints. Incivility was characterized by violations of professional respect and interpersonal norms, whereas contextual factors were interpreted as underlying conditions influencing these behaviors. Conclusions: Uncivil behaviors in clinical nursing education arise from complex interactions among students, faculty members, healthcare staff, and organizational systems. The findings distinguish incivility from related phenomena, such as stress responses, role ambiguity, and structural constraints, clarifying that not all negative behaviors constitute incivility per se. Incivility was specifically characterized by violations of professional respect and interpersonal norms, whereas contextual factors served as underlying conditions. Addressing incivility therefore requires multilevel interventions that target both interpersonal behaviors and systemic organizational factors to promote respectful and effective clinical learning environments.