COMM 1147 - De-escalating Patient Incivility in Nursing: Code White

This essay explores the critical role of effective communication in de-escalating incidents of incivility perpetrated by patients within healthcare facilities, specifically focusing on Code White emergencies. It discusses the rising prevalence of incivility and violence against care providers, highlighting findings from studies that reveal verbal, sexual, and racial harassment primarily perpetrated by patient's family members. The essay also addresses potential conflict triggers, including patient intoxication, restriction from habits, fatigue, tension, previous violent behavior, psychiatric conditions, language barriers, and inadequate support. A personal practicum experience illustrates how effective communication and cultural sensitivity can prevent conflict escalation. The essay concludes that patient-centered therapeutic relationships, family involvement, and collaborative planning, combined with self-reflection and improved communication skills, are essential for mitigating patient incivility. The paper references academic articles, and guidelines from nursing organizations to support its claims.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Hospitals generally use a set of colour coded indicators in order to alert the care
professionals within a healthcare setting about an emergency. The colour codes also present a
set of unique criteria that signifies the manner in which care professionals are expected to
respond during the emergency situation. It should be mentioned here that the emergency
situation can range from an incident of incivility, violence or a disaster such as fire breakout.
The most widely used colour codes include the codes red, yellow, white, orange, green, pink,
grey, black and brown. This essay would revolve around the central theme of the code white
emergencies within the healthcare facilities and throw light on the fact that whether effective
communication could help care professionals to deescalate problems related to incivility
caused by patients within a care unit.
Discussion:
Incivility can be defined as a behavioural trait of making an impolite or an offensive
remark. As stated by Oyeleye et al. (2013), incivility has been mentioned to be synonymous
to unsociable behaviour. Incidences of incivility are on the rise in care units, with patients
putting up a violent behaviour against the care providers. According to a study conducted by
Cheung, Lee and Yip (2017), it has been stated that the prevalence of violence and threats
from the patients and their family members are on the increase despite employing serious
efforts worldwide to control the scenario. The researchers in this case adapted a multiple
logistic regression model and collected data over five months from August till December to
estimate the prevalence of code white emergencies. The sample size comprised of 107
physicians and 613 nursing professionals. The findings revealed that 53.4% of the
participants has experienced verbal abuse. Further, it was also found that 16.1% of the
participants had experienced harassment with 14.2% having experienced sexual harassment

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and 2.5% having experienced racial harassment. The results critically revealed that violence
and aggression was majorly perpetrated by the family members of the patient. Another study
conducted by Campana and Hammound (2013), suggested that nursing care professionals
frequently experience incivility from the patients and their relatives which results in burnout.
The study clearly indicated that aggression and violence perpetuated a poor workplace
environment which led to increased burnout.
According to CNO, conflict arises during circumstances where the client and the care
professional differ in their perspective of effective care. The primary reasons where a conflict
could possibly rise between a client and a nurse includes situations where the client is either
intoxicated or withdrawing from substance abuse, is being constrained or restrained from a
habit such as smoking or drinking, is fatigued or is tensed. In addition to this, factors such as
previous medical history of violent behaviour, or being diagnosed with a psychiatric
condition, experiencing language barrier issue or not getting adequate support can also lead to
a condition of conflict (Cno.org, 2019). It is important to understand here that certain
behaviour on the part of the care professional could also lead to a conflict. These incidences
include, misunderstanding or judging a client, holding incorrect perception about the cultural
background of the client, misbehaves with the client or fails to adapt a family centred
approach for recovery and does not appropriately address the concern of the family members.
(Cno.org, 2019) Another important aspect that has been attributed to cause client-professional
conflict can be mentioned as the inability of the care professional to reflect upon their
behaviour and endeavour to improve the scope of practice (Cno.org, 2019).
In this regard, I would like to mention one incident from my practicum where I could
correctly identify a situation and take appropriate measures to avoid the possibility of a
conflict. Shahzin, a 19 year old Muslim female had been accompanied by her father to the
outpatient department. She complained of excessive abdominal pain and weakness. One of

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my colleagues, RN Mark was documenting the patient history and when the patient’s father
enquired about what had mentioned. RN Mark causally mentioned we would be able to find
that out after taking the vitals and performing the abdominal assessment. Shahzin’s father
seemed offended and stated in a loud voice, ‘are you going to assess her?’ I was casually
talking to a GN at that time but I could sense that something was wrong. I asked RN Mark
and he mentioned that, ‘He is not letting me take her vitals’. Considering the conservative
religious and social background of Shahzin it was clear to me that her father would definitely
like a male RN to touch his daughter even for the purpose of vital assessment.
I spoke to Shahzin’s father and assured him that the assessment would be performed
by a female RN and she would ensure that Shahzin is comfortable. I offered him a glass of
water and asked him if he would like a RN who belonged to the similar religious and cultural
background as his to perform the assessment. Her father relented and thanked me. I
apologized on behalf of RN Mark.
Therefore, from the above scenario, it is clear that effective communication can help
in avoiding the case of a conflict. In order to devise strategies to deescalate the problems
related to violence and incivility, it is extremely important to identify the instances that seem
problematic to patients and their family members and enrage them. Provision of client-
centred care can be explained as the best practice that could help in effectively dealing with
instances of violence and incivility. As mentioned by Blevins (2015), involving the family
members in the care process and decision making process can positively help in avoiding
instances of aggression and violence.
Conclusion:
Therefore, to conclude, it can be said that establishing a patient-centred therapeutic
relationship with the client along with the inclusion of a family-centred practice can help in

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avoiding conflicts. Also, reporting to supervisors in adverse situations or collaborative
planning with another colleague can help in avoiding conflict scenarios. Certain adverse
events could also be addressed by withdrawing services or leaving the patient for a while to
allow him gain composure. Overall, introspecting upon self-behaviour and effective
communication can help in deescalating problems related to patient incivility.

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References:
Blevins, S. (2015). Impact of incivility in nursing. MedSurg Nursing, 24(6), 379-381.
Campana, K. L., & Hammoud, S. (2015). Incivility from patients and their families: can
organisational justice protect nurses from burnout?. Journal of nursing
management, 23(6), 716-725.
Cheung, T., Lee, P., & Yip, P. (2017). Workplace violence toward physicians and nurses:
prevalence and correlates in Macau. International journal of environmental research
and public health, 14(8), 879.
Cno.org (2019). [online] Cno.org. Available at:
https://www.cno.org/globalassets/docs/prac/47004_conflict_prev.pdf [Accessed 19
Feb. 2019].
Oyeleye, O., Hanson, P., O’connor, N., & Dunn, D. (2013). Relationship of workplace
incivility, stress, and burnout on nurses’ turnover intentions and psychological
empowerment. Journal of Nursing Administration, 43(10), 536-542.