Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility

Nurse Educ. 2019 Mar/Apr;44(2):64-68. doi: 10.1097/NNE.0000000000000563.


Background: Nurses have a professional and ethical obligation to foster civility and healthy work environments to protect patient safety. Evidence-based teaching strategies are needed to prepare nursing students to address acts of incivility that threaten patient safety.

Problem: Incivility in health care must be effectively addressed because the delivery of safe patient care may depend on these vital skills.

Approach: Cognitive rehearsal (CR) is an evidence-based technique where learners practice addressing workplace incivility in a nonthreatening environment with a skilled facilitator. The author describes the unique combination of CR, simulation, evidence-based scripting, deliberate practice, and debriefing to prepare nursing students to address uncivil encounters.

Outcomes: Learners who participated in CR identified benefits using this approach.

Conclusions: Combining CR with simulation, evidence-based scripting, repeated dosing through deliberate practice, and skillful debriefing is an effective method to provide nursing students with the skills needed to address incivility, thereby increasing the likelihood of protecting patient safety.

MeSH terms

  • Cognition
  • Evidence-Based Practice
  • Humans
  • Incivility / prevention & control*
  • Interprofessional Relations*
  • Learning
  • Nursing Education Research
  • Nursing Evaluation Research
  • Patient Simulation
  • Students, Nursing / psychology*