Task-oriented incivility and its impact on nursing students' safety behaviors in intensive care units: A qualitative study.

Résumé

BACKGROUND: In high-acuity intensive care units (ICUs), production pressures often normalize incivility, prioritizing efficiency over education and compromising patient safety. While the psychological toll on students is well-documented, limited research explores how such environments shape safety decision-making and professional integrity.OBJECTIVES: To explore the underlying dynamics of ICU incivility, analyze its influence on professional identity across diverse student backgrounds, and examine the defensive strategies adopted and their implications for clinical safety behaviors.DESIGN: A qualitative descriptive design was employed, adhering to the Standards for Reporting Qualitative Research (SRQR) checklist.SETTINGS AND PARTICIPANTS: The study was conducted between November 2025 and January 2026 in the ICUs of three public teaching hospitals in xxx. Purposive sampling was used to recruit 26 participants, including 19 nursing interns and 7 clinical preceptors/administrators.METHODS: Data were collected through semi-structured in-depth interviews. Braun and Clarke's six-phase thematic analysis was utilized for coding and theme generation.RESULTS: The analysis identified "contextualized survival strategy" as the overarching theme, comprising four interrelated themes: (1) Professional marginalization and academic devaluation: Students experienced status incongruence and were frequently functionalized as labor supplements; (2) Prioritization of clinical production over educational needs: Instructors' efficiency imperatives contributed to pedagogical rationing and physical takeover of tasks; (3) Adoption of defensive coping strategies and performative compliance: Students navigated the hierarchy through strategic silence and regulating work pace; and (4) Influence of fear-based silence on patient safety: Fear of incivility prompted defensive simplifications, such as non-disclosure of errors and documentation workarounds.CONCLUSIONS: Task-oriented incivility appears to function as a latent structural force, prompting students to prioritize social survival over strict compliance. Addressing these adaptive deviations requires more than moral education; institutions must critically examine the efficiency imperative, establish non-punitive safety feedback channels, and provide structural support to rectify environmentally shaped behavioral deviations.