IJBA Volume 3, Issue 3, 2023

Exploring Patient Experience: A Phenomenological Qualitative Approach to Enhance Post-Operative Healing Environments in Healthcare Management
Jasdeep Singh, Mohd Roslan Ismail, Vijayesvaran Arumugam, Adlina Suleiman

The healing environments in healthcare establishments are crucial to facilitating natural healing processes. These environments are divided into four categories: internal, external, behavioural, and interpersonal. The study investigates the post-operative healing process by investigating physical environment elements and interpersonal relationships between care providers, family members, and patients. The participants in the study indicated that having a sense of control, positive distractions, and strong interpersonal relationships were essential for their healing. These findings are consistent with previous healing environment theories. However, the study also recognises that not all patient demands can be met, and the physical environment of hospital rooms can sometimes limit patients’ sense of control. For example, poorly designed controls and alarm buttons can cause stress and deter patients’ healing. The study also highlights the importance of positive distractions, such as encouraging patient mobility and providing healing spaces like libraries, healing gardens, or patient lounges. Finally, the study emphasises the importance of interpersonal relationships between patients, care providers, and family members in recovery. These relationships can significantly aid a patient’s healing by offering physical and emotional support.

Keywords : Healing environment, healthcare, MOH, IR4.0, Evidence Based Design (EBD), Post operative ward

List of references


Abbas, M. Y., & Ghazali, R. (2011). Physical Environment: The major determinant towards the creation of a healing environment? Procedia-Social and Behavioral Sciences, 30, pg. 1951-1958

Apfelbaum, J. L. (2003). Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesthesia and analgesia, 97(2), pg. 534– 540.

Aripin, S. (2006). Healing architecture: a study on the physical aspects of healing environment in hospital design . In Proceedings of the 40th Annual Conference of the Architectural Science Association (ANZAScA). Adelaide, South Australia.

Aripin, S., Othman, R., & Nawawi, N. M. (2015). The Relevance of Green Building in Creating a Healing Environment in Hospital Designs in Malaysia. Perspektif: Jurnal Sains Sosial dan Kemanusiaan, 7(3), pg. 39-46

Chez, R. A., & Jonas, W. B. (2005). Developing healing relationships: foreword from the organizers. Journal of Alternative & Complementary Medicine, 10 (Suppl. 1).

Chouchou, F. K. (2014). Postoperative sleep disruptions: a potential catalyst of acute pain? Sleep medicine reviews.

Dag, A. (1989). Patients’ Knowledge and Patients’ Work. Patient:Patient Interaction in General Hospitals. Acta Sociologica, 32(3), pg. 295-305.

Desborough, J. P. (2000). The stress response to trauma and surgery. British journal of anaesthesia, 85(1), pg.109-17.
Dijkstra, K. P. (2006). Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. Journal of advanced nursing, 56(2), pg.166-81.

Geraci C. (2017) Foreword. In Fazarro DE, Trybula W, Tate J, Hanks C, editors. Boston: De Gruyter. pp. V–VI.

Idris, M. M. (2018). Investigating Space Use Patterns in a Malaysian Hospital Courtyard Garden: Lessons from real-time observation of patients, staff and visitors. Environment-Behaviour Proceedings Journal, 3(8), pg. 32–45.

Kamali, N. J., & Abbas, M. Y. (2012). Healing environment: enhancing nurses’ performance through proper lighting design. Procedia-Social and Behavioral Sciences, 35, pg.205-212.

Maguire, M. &. (2017). Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland Journal of Higher.

Miller, W. L., & Crabtree, B. F. (2005). Healing landscapes: patients, relationships, and creating optimal healing places. Journal of alternative and complementary medicine, 11 Suppl 1, pg.S41–S49.

Oderda, G. M. (2007). Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Annals of Pharmacotherapy, 41(3), pg.400–406.

Oi-Zhen, S. W.-W.-T. (2015). Quality of Healing Environment in Healthcare Facilities. Jurnal Teknologi, 74(2), pg.101-108.

Rawal, N. (2016). Current issues in postoperative pain management. European Journal of Anaesthesiology, 33(3), pg.160-71.

Rosenberg-Adamsen, S. K. (1996). Postoperative sleep disturbances: mechanisms and clinical implications. British journal of anaesthesia, 76(4), pg. 552–559.

Said, I. M., & Bakar, M. S. (2005). Garden as environmental intervention in restoration process of hospitalized children. Universiti Teknologi Malaysia.
Sakallaris BR, M. L. (2015). Optimal healing environments. Glob Adv Health Med, 4(3), pg. 40 – 45.

Salkind, N. J. (2010). Encyclopedia of Research Design. Sage.

Samah, Z. A. (2013). Translating quality care factors to quality space: design criteria for outpatient facility. J. S. Procedia-Social and Behavioral Sciences, 105, pg. 265-272.

Sommer R, R. H. (1958). Social interaction on a geriatrics ward. IntJ Soc Psychiatry, Sommer,

R.F., & Ross, H. (1958). Social Interaction on a Geriatrics Ward. International Journal of Social Psychiatry, 4, pg. 128 – 133.

Stuckey HL. (2013) Three types of interviews: Qualitative research methods in social health.Journal of Social Health and Diabetes;pp. 056-059.

Ulrich R. S., Z. C. (2008). A review of the research literature on evidence-based healthcare design, 1(3), pg. 61-125

Ulrich, R. S. (2004). The role of the physical environment in the hospital of the 21st century.

Vaughn, F. W. (2007). Does preoperative anxiety level predict postoperative pain? AORN journal, 85(3), pg. 589-604

Wheeler, M. O. (2002). Adverse events associated with postoperative opioid analgesia: a systematic review. The Journal of Pain, 3(3), pg. 159-80

A Review and Conceptual Development of the Contributing Factors for Workplace Incivility in Healthcare Organisations in Malaysia

Baxter Ma Sian Tong, Vijayesvaran Arumugam, Adlina Suleiman
International Medical University

Workplace incivility is prevalent in many workplaces especially those with higher contact time such as healthcare organisations. Most research has focused on the framework for workplace incivility among nurses which showed certain predictors and triggers that can lead to an increase in prevalence of deviant behaviours at the workplace from milder incivilities to more serious aggression and violence which can negatively impact on staff performance, organisational goals as well as patient safety. Despite that, there are only a few academic studies conducted on the contributory factors of workplace incivility in healthcare organisations, especially in Malaysia. This conceptual paper is envisioned to establish the antecedents of predictors and triggers of workplace incivility from the Malaysian perspective. A total of eighteen studies related to workplace environment, culture, organisational factors, and managerial factors on the prevalence of workplace incivility were reviewed and analysed. A frequency analysis was used to determine the independent variables of the conceptual framework. The findings indicated that the following: workload/demands, healthy work environments, intolerance to incivility, workgroup cohesion/teamwork, policies, and procedures for addressing incivility, perceived leadership in ability to handle and respond to workplace incivility and supervisory/mentor support are significantly influencing the prevalence of workplace incivility.

Keywords: workplace incivility, predictors, triggers, Malaysia.

List of References


Alkaabi, O., & Wong, C. (2019). Relationships among authentic leadership, manager incivility and trust in the manager. Leadership in Health Services, 33(1), 27–42. https://doi.org/10.1108/lhs-06-2019-0030

Andersson, L. M., & Pearson, C. M. (1999). Tit for Tat? The Spiraling Effect of Incivility in the Workplace. Academy of Management Review, 24(3), 452–471. https://doi.org/10.5465/amr.1999.2202131

Armmer, F., & Ball, C. (2015). Perceptions of horizontal violence in staff nurses and intent to leave. Work, 51(1), 91–97. https://doi.org/10.3233/wor-152015

Armstrong, N. (2018). Management of Nursing Workplace Incivility in the Health Care Settings: A Systematic Review. Workplace Health & Safety, 66(8), 403–410. https://doi.org/10.1177/2165079918771106

Arslan Yürümezoğlu, H., & Kocaman, G. (2019). Structural empowerment, workplace incivility, nurses’ intentions to leave their organisation and profession: A path analysis. Journal of Nursing Management, 27(4), 732–739. https://doi.org/10.1111/jonm.12751

Bambi, S., Foà, C., Felippis, C., Lucchini, A., Guazzini, A., & Rasero, L. (2018). Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors. Acta Bio-Medica : Atenei Parmensis, 89(6-S), 51–79. https://doi.org/10.23750/abm.v89i6-S.7461

Bansal, A. S. (2014). Disruptive Behaviour Amongst Doctors, Myth Or Reality? Journal of Evolution of Medical and Dental Sciences, 3(2), 399–406. https://doi.org/10.14260/jemds/2014/1841

Birks, M., Cant, R. P., Budden, L. M., Russell-Westhead, M., Sinem ÜZar ÖZçetin, Y., & Tee, S. (2017). Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students’ experiences during clinical placement in Australia and the UK. Nurse Education in Practice, 25, 14–21. https://doi.org/10.1016/j.nepr.2017.04.011

Blackstock, S., Salami, B., & Cummings, G. G. (2018). Organisational antecedents, policy and horizontal violence among nurses: An integrative review. Journal of
Nursing Management, 26(8), 972–991. https://doi.org/10.1111/jonm.12623

Blaikie, N., & Priest, J. (2019). Designing Social Research: The Logic of Anticipation (3rd ed.). Polity.

Brewer, C. S., Kovner, C. T., Obeidat, R. F., & Budin, W. C. (2013). Positive work environments of early-career registered nurses and the correlation with physician verbal abuse. Nursing Outlook, 61(6), 408–416. https://doi.org/10.1016/j.outlook.2013.01.004

Budin, W. C., Brewer, C. S., Chao, Y. Y., & Kovner, C. (2013). Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing, 45(3), 308–316. https://doi.org/10.1111/jnu.12033

Ceravolo, D. J., Schwartz, D. G., Foltz-Ramos, K. M., & Castner, J. (2012). Strengthening communication to overcome lateral violence. Journal of Nursing Management, 20(5), 599–606. https://doi.org/10.1111/j.1365-2834.2012.01402.x

Chang, H. E., Park, M. Y., Jang, H., Ahn, S., & Yoon, H. J. (2019). Relationships among demands at work, aggression, and verbal abuse among registered nurses in South Korea. Nursing Outlook, 67(5), 567–577. https://doi.org/10.1016/j.outlook.2019.04.007

Coursey, J. H., Rodriguez, R. E., Dieckmann, L. S., & Austin, P. N. (2013). Successful Implementation of Policies Addressing Lateral Violence. AORN Journal, 97(1), 101–109. https://doi.org/10.1016/j.aorn.2012.09.010

Creswell, J. W., & Poth, C. N. (2017). Qualitative Inquiry and Research Design: Choosing Among Five Approaches (4th ed.). SAGE Publications, Inc.

Dehue, F., Bolman, C., Völlink, T., & Pouwelse, M. (2012). Coping with bullying at work and health related problems. International Journal of Stress Management, 19(3), 175–197. https://doi.org/10.1037/a0028969

Department of Labor, USA. (2021, July). American Time Use Survey – May to December 2019 and 2020 Results. Bureau of Labor Statistics, Department of Labor, USA. https://www.bls.gov/news.release/pdf/atus.pdf

Einarsen, S. (2005). The nature, causes and consequences of bullying at work: The Norwegian experience. Perspectives Interdisciplinaires Sur Le Travail et La Santé, 7–3. https://doi.org/10.4000/pistes.3156

Elhoseny, T. A., & Adel, A. (2016). Disruptive physician behaviors and their impact on patient care in a health insurance hospital in Alexandria, Egypt. Journal of the Egyptian Public Health Association, 91(2), 80–85. https://doi.org/10.1097/01.epx.0000482793.51 921.cb

Estes, B., & Wang, J. (2008). Integrative Literature Review: Workplace Incivility: Impacts on Individual and Organizational Performance. Human Resource Development Review, 7(2), 218–240. https://doi.org/10.1177/1534484308315565

Ferguson, M., & Barry, B. (2011). I know what you did: The effects of interpersonal deviance on bystanders. Journal of Occupational Health Psychology, 16(1), 80–94. https://doi.org/10.1037/a0021708

Flin, R. (2010). Rudeness at work. BMJ, 340(may19 2), c2480. https://doi.org/10.1136/bmj.c2480

Griffin, B. (2010). Multilevel relationships between organizational-level incivility, justice and intention to stay. Work & Stress, 24(4), 309–323. https://doi.org/10.1080/02678373.2010.531186

Hutchinson, M., Vickers, M., Jackson, D., & Wilkes, L. (2006). Workplace bullying in nursing: towards a more critical organisational perspective. Nursing Inquiry, 13(2), 118–126. https://doi.org/10.1111/j.1440-1800.2006.00314.x

Hutton, S., & Gates, D. (2008). Workplace Incivility and Productivity Losses among Direct Care Staff. AAOHN Journal, 56(4), 168–175. https://doi.org/10.3928/08910162-20080401-01

Ishmael, A. (1999). Harassment, Bullying and Violence at Work: A Practical Guide to Combating Employee Abuse in the Workplace (Employment Matters). Spiro Press.

Kaiser J. A. (2017). The relationship between leadership style and nurse-to-nurse incivility: turning the lens inward. Journal of nursing management, 25(2), 110–118. https://doi.org/10.1111/jonm.12447

Karasek, R., & Theorell, T. (1992). Healthy Work: Stress, Productivity, and the Reconstruction Of Working Life (Revised ed.). Basic Books.

Keller, R., Krainovich-Miller, B., Budin, W., & Djukic, M. (2018). Predictors of nurses’ experience of verbal abuse by nurse colleagues. Nursing Outlook, 66(2), 190–203. https://doi.org/10.1016/j.outlook.2017.10.006

Keller, S., Yule, S., Zagarese, V., & Henrickson Parker, S. (2020). Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open, 10(6), e035471. https://doi.org/10.1136/bmjopen-2019-035471

Kennedy, J. M., Nichols, A. A., Halamek, L. P., & Arafeh, J. M. R. (2012). Nursing Department Orientation. Journal for Nurses in Staff Development, 28(1), 24–26. https://doi.org/10.1097/nnd.0b013e318240a6f3

Leape, L. L., Shore, M. F., Dienstag, J. L., Mayer, R. J., Edgman-Levitan, S., Meyer, G. S., & Healy, G. B. (2012). Perspective. Academic Medicine, 87(7), 845–852. https://doi.org/10.1097/acm.0b013e318258338d

Leiter, M. P., Price, S. L., & Spence Laschinger, H. K. (2010). Generational differences in distress, attitudes and incivility among nurses. Journal of Nursing Management, 18(8), 970–980. https://doi.org/10.1111/j.1365-2834.2010.01168.x

Lewis, P. S., & Malecha, A. (2011). The Impact of Workplace Incivility on the Work Environment, Manager Skill, and Productivity. JONA: The Journal of Nursing Administration, 41(1), 41–47. https://doi.org/10.1097/nna.0b013e3182002a4c

Lim, S., Cortina, L. M., & Magley, V. J. (2008). Personal and workgroup incivility: Impact on work and health outcomes. Journal of Applied Psychology, 93(1), 95–107. https://doi.org/10.1037/0021-9010.93.1.95

McKenna, B. G., Smith, N. A., Poole, S. J., & Coverdale, J. H. (2003). Horizontal violence: experiences of Registered Nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90–96. https://doi.org/10.1046/j.1365-2648.2003.02583.x

Mikkelsen, E. G., & Einarsen, S. (2002). Basic assumptions and symptoms of post-traumatic stress among victims of bullying at work. European Journal of Work and Organizational Psychology, 11(1), 87–111. https://doi.org/10.1080/13594320143000861
Morecroft, J. D. W. (2015). Strategic Modelling and Business Dynamics: A feedback systems approach (2nd ed.). Wiley.

Nemeth, L. S., Stanley, K. M., Martin, M. M., Mueller, M., Layne, D., & Wallston, K. A. (2017). Lateral Violence in Nursing Survey: Instrument Development and Validation. Healthcare (Basel, Switzerland), 5(3), 33. https://doi.org/10.3390/healthcare 5030033
Notelaers, G., Baillien, E., De Witte, H., Einarsen, S., & Vermunt, J. K. (2013). Testing the strain hypothesis of the Demand Control Model to explain severe bullying at work. Economic and Industrial Democracy, 34(1), 69–87. https://doi.org/10.1177/0143831X12438742

Oyeleye, O., Hanson, P., O’Connor, N., & Dunn, D. (2013). Relationship of Workplace Incivility, Stress, and Burnout on Nurses’ Turnover Intentions and Psychological Empowerment. JONA: The Journal of Nursing Administration, 43(10), 536–542. https://doi.org/10.1097/nna.0b013e3182a3e8c9

Pattani, R., Ginsburg, S., Mascarenhas Johnson, A., Moore, J. E., Jassemi, S., & Straus, S. E. (2018). Organizational Factors Contributing to Incivility at an Academic Medical Center and Systems-Based Solutions. Academic Medicine, 93(10), 1569–1575. https://doi.org/10.1097/acm.0000000000002310

Pearson, C. (2010). The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What to Do about It. Human Resource Management International Digest, 18(6). https://doi.org/10.1108/hrmid.2010.04418fae.002

Pearson, C. M., & Porath, C. L. (2004). On incivility, its impact, and directions for future research. In R. W. Griffin & A. O’Leary-Kelly (Eds.), The Dark Side of Organizational Behavior (1st ed., pp. 403–425). JosseyBoss, San Francisco, CA.

Pearson, C. M., & Porath, C. L. (2005). On the nature, consequences and remedies of workplace incivility: No time for “nice”? Think again. Academy of Management Perspectives, 19(1), 7–18. https://doi.org/10.5465/ame.2005.15841946

Pearson, C. M., Andersson, L. M. & Porath, C. L. (2005). Workplace incivility. In S. Fox & P. E. Spector (Eds.), Counterproductive Work Behavior: Investigations Of Actors And Targets (1st ed., pp. 177–200). Amer Psychological Assn.

Pearson, C. M., Andersson, L. M., & Porath, C. L. (2000). Assessing and attacking workplace incivility. Organizational Dynamics, 29(2), 123–137. https://doi.org/10.1016/s0090-2616(00)00019-x

Pearson, C. M., Andersson, L. M., & Wegner, J. W. (2001). When Workers Flout Convention: A Study of Workplace Incivility. Human Relations, 54(11), 1387–1419. https://doi.org/10.1177/00187267015411001

Porath, C. L., Gerbasi, A., & Schorch, S. L. (2015). The effects of civility on advice, leadership, and performance. Journal of Applied Psychology, 100(5), 1527–1541. https://doi.org/10.1037/apl0000016

Quine, L. (2001). Workplace Bullying in Nurses. Journal of Health Psychology, 6(1), 73–84. https://doi.org/10.1177/135910530100600106

Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing, 43(4), 395–401. https://doi.org/10.1046/j.1365-2648.2003.02728.x

RCN. (2021, June 16). Working time and breaks | Advice guides | Royal College of Nursing. The Royal College of Nursing. https://www.rcn.org.uk/get-help/rcn-advice/working-time-rest-breaks-on-call-and-night-work

Rehder, K. J., Adair, K. C., Hadley, A., McKittrick, K., Frankel, A., Leonard, M.,
Frankel, T. C., & Sexton, J. B. (2020). Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression. Joint Commission journal on quality and patient safety, 46(1), 18–26. https://doi.org/10.1016/j.jcjq.2019.09.004

Riskin, A., Erez, A., Foulk, T. A., Kugelman, A., Gover, A., Shoris, I., Riskin, K. S., & Bamberger, P. A. (2015). The Impact of Rudeness on Medical Team Performance: A Randomized Trial. PEDIATRICS, 136(3), 487–495. https://doi.org/10.1542/peds.2015-1385

Rosenstein, A. H., & O’Daniel, M. (2006). Impact and Implications of Disruptive Behavior in the Perioperative Arena. Journal of the American College of Surgeons, 203(1), 96–105. https://doi.org/10.1016/j.jamcollsurg.2006.03.027

Saunders, M. N. K., Lewis, P., & Thornhill, A. (2021). Research Methods For Business Students (8th ed.). PEARSON.

Schilpzand, P., de Pater, I. E., & Erez, A. (2014). Workplace incivility: A review of the literature and agenda for future research. Journal of Organizational Behavior, 37, S57–S88. https://doi.org/10.1002/job.1976

Sellers K.F., Millenbach, L., Ward K., & Scribani, M. (2012). The Degree of Horizontal Violence in RNs Practicing in New York State. JONA: The Journal of Nursing Administration, 42(10). https://doi.org/10.1097/NNA.0b013e31826a208f

Shetty, A. L., Vaghasiya, M., Boddy, R., Byth, K., & Unwin, D. (2016). Perceived incivility during emergency department phone consultations. Emergency Medicine Australasia, 28(3), 256–261. https://doi.org/10.1111/1742-6723.12564

Sleem, W. F. (2017). Role of Workplace Civility Climate and Workgroup Norms on Incidence of Incivility Behaviour among Staff Nurses. International Journal of Nursing Didactics, 7(6). https://doi.org/10.15520/ijnd.2017.vol7.iss6.230.34-43

Small, C. R., Porterfield, S., & Gordon, G. (2015). Disruptive behavior within the workplace. Applied Nursing Research, 28(2), 67–71. https://doi.org/10.1016/j.apnr.2014.12.002

Smith, J. G., Morin, K. H., & Lake, E. T. (2017). Association of the nurse work environment with nurse incivility in hospitals. Journal of Nursing Management, 26(2), 219–226. https://doi.org/10.1111/jonm.12537

Smith, L. M., Andrusyszyn, M. A., & Spence Laschinger, H. K. (2010). Effects of workplace incivility and empowerment on newly-graduated nurses’ organizational commitment. Journal of Nursing Management, 18(8), 1004–1015. https://doi.org/10.1111/j.1365-2834.2010.01165.x

Laschinger, S., H. K., Leiter, M., Day, A., & Gilin, D. (2009). Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes. Journal of Nursing Management, 17(3), 302–311. https://doi.org/10.1111/j.1365-2834.2009.00999.x

Taylor, S. G., & Kluemper, D. H. (2012). Linking perceptions of role stress and incivility to workplace aggression: The moderating role of personality. Journal of Occupational Health Psychology, 17(3), 316–329. https://doi.org/10.1037/a0028211

Tikva, S. S., Kluger, A. N., & Lerman, Y. (2019). Disruptive behaviors among nurses in Israel – association with listening, wellbeing and feeling as a victim: a cross-sectional study. Israel Journal of Health Policy Research, 8(1). https://doi.org/10.1186/s13584-019-340-6

Vessey, J. A., Demarco, R., & Difazio, R. (2010). Bullying, Harassment, and Horizontal Violence in the Nursing Workforce The State of the Science. Annual Review of Nursing Research, 28(1), 133–157. https://doi.org/10.1891/0739-6686.28.133

Viotti, S., Converso, D., Hamblin, L. E., Guidetti, G., & Arnetz, J. E. (2018). Organisational efficiency and co-worker incivility: A cross-national study of nurses in the USA and Italy. Journal of nursing management, 26(5), 597–604. https://doi.org/10.1111/jonm.12587

Zia-ud-Din, M., Arif, A., & Shabbir, M. A. (2017). The Impact of Workplace Incivility on Employee Absenteeism and Organization Commitment. International Journal of Academic Research in Business and Social Sciences, 7(5). https://doi.org/10.6007/ijarbss/v7-i5/2893