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to collaborate with their colleagues in their health care agencies to create and implement disaster preparedness plans. Nurse educa- tors serve as a pivotal force in preparing cur- rent and future nurses to participate fully in the disaster preparedness cycle.
American Red Cross (ARC). (2014). Retrieved from www.redcross.org
Centers for Disease Control and Prevention.
Retrieved from www.cdc.gov
Disaster Health and Sheltering for Nursing Students. (2014). Retrieved from www .disasterhealthandsheltering.org
Federal Emergency Management Agency (FEMA). (2008). National response framework (2008), glossary section. Retrieved from www .fe m a.gov/e merge nc y/n r f/g lo s s a r y .htm#R
Goodwin-Veenema, T. (2013). Disaster nursing and emergency preparedness for chemical, bio- logical, and radiological terrorism and other hazards (3rd ed.). New York, NY: Springer Publishing.
Sigma Theta Tau International. (2014).
Disaster preparedness and response—Online course. Retrieved from www.nursingsoci- ety.org
Cheryl K. Schmidt
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ISRUPTIVEB
EHAVIORDEFINITION
Disruptive behavior is any inappropriate behavior, confrontation, or confl ict, rang- ing from verbal abuse to physical or sexual harassment (Rosenstein, 2013). Disruptive behaviors include overt and covert actions that are displayed by any health care worker that threaten the performance of the health care team (Joint Commission, 2008).
Disruptive behavior includes profane or dis- courteous language, demeaning behavior, sexual comments or overtone, racial/ethnic jokes, outbursts of anger, throwing objects, community organizations described in the
plan. Waiting until an actual disaster may be too late to determine major fl aws in the steps of disaster preparedness.
SYNOPSIS
Nursing faculty has free, immediate access to educational materials that can be used for in- class lectures or self-study by students. FEMA and the ARC provide several resources to guide professionals in the phases of disaster education. FEMA provides free online train- ing about the NIMS, described previously.
The ARC provides printed and online mate- rials designed for individuals, families, and organizations to assist them in preparing for disasters. For nurses who volunteer with the ARC, free educational modules (ReadyRN) were donated by Goodwin-Veenema (2013), an international nurse expert in disaster pre- paredness. The U.S. Government provides similar resources for individual, family, and community preparedness. The Centers for Disease Control and Prevention provide information about potential biological, chem- ical, and nuclear/radiological hazards.
A task force of ARC volunteer nurses created a free course for pre-licensure nurs- ing students to prepare to serve as Red Cross volunteers under registered nurse (RN) supervision in Red Cross disaster shelters.
Educators may consider adding this course to their Community Health Nursing or Leadership and Management course. Sigma Theta Tau International offers an inexpen- sive online continuing nursing education (CNE) course to prepare staff nurses and others for disasters.
RECOMMENDATIONS
As citizens and health care professionals, nurses should set an example for their com- munities by demonstrating personal, family, and professional preparedness. This includes the steps described in the preparedness stages related to the self and family. Once those resources are in place, nurses need
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Collaborative Partnerships Between Academia and Service
A collaborative vision and partnership between academia and the practice setting can successfully translate to increased pro- fessionalism, effective communication, opti- mal patient care, and substantive working relationships.
Zero Tolerance for Behaviors Undermining a Culture of Safety
Based on the Sentinel Event Alert (Joint Commission, 2008), the Joint Commission began requiring health care facilities to imple- ment zero-tolerance policies that defi ned intimidating and disruptive behaviors. Zero tolerance includes, but is not limited to, intimidating and/or disruptive behaviors, especially the most egregious instances of disruptive behavior such as assault and other criminal acts (Joint Commission, 2008). It is essential to provide information and educa- tion to students, as well as to the staff of all disciplines, concerning the phenomenon of disruptive behavior: defi ning characteris- tics, understanding the effects toward indi- viduals and an organization, identifying the system for reporting and monitoring, and the responsibility that all stakeholders hold in eliminating disruptive behavior and adhering to the organization’s zero-tolerance policy. Education about zero tolerance can be offered by formal or informal means, such as coaching, mentoring, or precepting. An emphasis on individual accountability at all organizational levels, as well as organiza- tional adoption of a culture of civility, would be required for policies to be effective (Clark, Olender, Cardoni, & Kenski, 2011).
Addressing Disruptive Behavior
Careful attention must be given to implement- ing effective strategies to empower newly registered nurses or experienced nurses to confront, defuse, and resist disruptive behaviors in their professional nursing prac- tice. Griffi n (2004) has delineated cognitive–
behavioral techniques addressing negative criticism in front of patients or staff, com-
ments that undermine a patient’s trust, and comments that undermine a caregiver’s self- confi dence (Porto & Lauve, 2006).
APPLICATION
Health care workers are often exposed and desensitized to behaviors that support a non- conducive and disrespectful work environ- ment. Nurses, as well as other health care providers, must support, establish, and main- tain working environments that are safe and conducive to the provision of quality health care. Disruptive behaviors not only threaten patient safety but also the ability for health care workers to perform their job compe- tently. Hickson (2012) identifi ed four signifi - cant implications to decrease the incidents of disruptive behaviors: orientation/resi- dency programs, collaborative partnerships between academia and service, zero tolerance for behaviors that undermine a culture of safety, and addressing negative behaviors.
Orientation/Residency Programs
These orientation/residency programs are intended to provide positive mentorship and preceptorship to support and promote a culture of professionalism and collegial- ity. According to the Quality and Safety Education for Nurses (QSEN, 2014), compe- tency nurses, physicians, and other health care professionals are expected to function effectively within interprofessional teams, foster open communication, employ mutual respect, and share decision making to achieve quality patient care. Nurse residencies and internships further indicate a relationship between the quality and quantity of nurses’
orientation and the satisfaction and reten- tion of novice professionals (Scott, Keehner- Engelke, & Swanson, 2008). The Institute of Medicine (2010) suggested that the collabora- tion of state boards of nursing and accredit- ing bodies should support the completion of a nursing residency program upon licensure or advanced practice degree program, or the transition to new clinical practice areas.
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how to confront disruptive behavior before entering their profession. New graduates must leave nursing programs equipped with well-developed professional communication skills.
Dellasega (2011) identifi ed a three-step process for decreasing the incidents of dis- ruptive behavior in the workplace, which can be affected by nursing educators to support the transition of students to newly graduated nurses. The three steps are: edu- cating nurses who are the victims of disrup- tive behavior about disruptive behavior in order to improve their understanding of the phenomenon, teaching interactive strategies to help nurses relate and reframe disruptive behaviors, and using role modeling to inte- grate appropriate behaviors.
RECOMMENDATIONS
Disruptive behavior can have deleteri- ous effects on a personal or organizational level, which can no longer be ignored.
Accreditation of health care facilities now depends on an organization’s ability to effectively address disruptive behaviors.
Organizations who operationalize and rein- force zero-tolerance policies demonstrate to their employees the promotion of a healthy work environment (Hickson, 2013). A strong commitment on the part of health care agen- cies to eliminate disruptive behaviors, along with cooperation from everyone in the orga- nization, is imperative. Longo (2010) identi- fi ed approaches for addressing disruptive behaviors which include the following:
adopt a zero-tolerance stance, develop a code of conduct that defi nes acceptable and unacceptable behaviors, provide education regarding communication skills, provide coaching and mentoring, provide mediation services to resolve disputes between parties, and take disciplinary action. Rosenstein (2009) echoed similar topics as a call to action for health care environments to address disruptive behavior: strong organizational leadership, awareness and accountability, communication and team collaboration training, identifying clinical champion/
behaviors, emphasizing educational aware- ness and cognitive rehearsal as specifi c inter- ventions that new nurses can use to confront their hostile offender. Strategies identifi ed by the Center for American Nurses (2008) include nurses adopting and modeling professional ethical behavior, recognizing and address- ing bullying and disruptive behaviors in the workplace, refl ecting on one’s own behavior and communicating respectfully, participat- ing in collaborative interprofessional initia- tive to prevent abuse, and working to ensure the mission, vision, and values of their work- places are refl ective of the Code of Ethics for Nurses and standards set by the profession in order to eliminate disruptive behavior.
The burden of responsibility for decreas- ing and/or eliminating disruptive behavior does not fall solely on an individual or a group, but the organization as a whole. Organizational leaders should use their constitutive capacity of persuasive infl uence to foster healthy and nondisruptive work environments, which ulti- mately create the ethical practice desired by the stakeholders of the nursing profession. It is not enough for the leaders to use their infl u- ence to reinforce a nondisruptive environment but also to commit to a role-modeling change in the preexisting culture. If organizational leaders continue to overlook the urgency of the domino effect that disruptive behavior has within health care, they steadfastly default on their vow of providing a culture of safety and promoting the standards of professionalism (Hickson, 2012).
SYNOPSIS
Eliminating disruptive behavior in the nurs- ing profession is necessary in order to sup- port an environment conducive to a healthy workplace. If it is to be achieved, nursing education and health care organizations must develop educational and mentorship programs that foster a healthy work envi- ronment and change the culture of nursing to one of valuing self, peers, and nursing practice (Lux, Hutcheson, & Peden, 2014).
Lux et al. (2014) stressed that nurse educa- tors must educate nursing students about
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Lux, K. M., Hutcheson, J. B., & Peden, A. R.
(2014). Ending disruptive behavior: Staff nurse recommendations to nurse edu- cators. Nurse Education in Practice, 14(1), 37–42. doi:org/10.1016/j.nepr.2013.06.014 Porto, G., & Lauve, R. (2006). Disruptive cli-
nician behaviors: A persistent threat to patient safety [Electronic version]. Patient Safety & Quality Health Care, July/August, 1–11. Retrieved from http://www.psqh .com/julaug06/disruptive.html
Quality and Safety Education for Nurses.
(2014). Pre-licensure KSAs: Teamwork and collaboration. Retrieved from http://
qsen.org/competencies/pre-licensure- ksas/#teamwork_collaboration
Rosenstein, A. H. (2009). Managing disrup- tive behaviors in the health care setting:
Process, policy, prevention, and interven- tion. Advances in Psychology Research, 72, 1–14.
Rosenstein, A. H. (2013). Bad medicine:
Managing the risks of disruptive behaviors in health care settings. Retrieved from http://
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Scott, E. S., Keehner-Engelke, M., & Swanson, M. (2008). New graduate nurse transition- ing: Necessary or nice? Applied Nursing Research, 21(2), 75–83. doi:10.1016/j.
apnr.2006.12.002
Josiane Hickson