Lateral incivility, nursing students, and the academic environment: A modified epidemiological triangle

The traditional epidemiological triangle identifies an infectious disease causing agent, a susceptible host to house the agent, and an environment conducive to the agent's proliferation and sustenance. Social epidemiology expands this basic triangle to address health determinants, social inequities, and heath disparities related to and encountered by vulnerable populations. A group is considered vulnerable if it is susceptible to poor physical, psychological, spiritual, social, or emotional health, attack, and censure or criticism. Nursing students fulfill these criteria for vulnerability. Lateral student-to-student incivility as the disease causing agent, nursing students as the susceptible hosts, and the academic and clinical learning environments reflect a modified epidemiological triangle. Nursing students experience physical, social, and emotional problems from experiencing and witnessing incivility. Students replicate modeled incivility behaviors. Learning may be negatively compromised. Oppressed group behavior is presented as one cause of lateral incivility. The transmission of incivility behaviors as the disease causing agent can be interrupted through civility education offered to nursing student hosts and a no tolerance stance against incivility in the academic learning environment. Cognitive Rehearsal is an evidencebased strategy to teach nursing students how to confront incivility victimization.