Journal of Medical Ethics and History of Medicine 

 

                                  
 

 

 

 

Original Article 

 

Nursing students' perceptions of teachers' uncivil behaviors:  

a qualitative research 
 

 

Anahita Masoumpoor1, Fariba Borhani2*, Abbas Abbaszadeh3, Maryam Rassouli4 

 
1Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 

Iran.  
2Associate Professor, Medical Ethics and Law Research Center, Department of Medical-Surgical Nursing, School of Nursing 

and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.  
3Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical 

Sciences, Tehran, Iran.  
4Associate Professor, Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of 

Medical Sciences, Tehran, Iran. 

 

 
Corresponding Author: Fariba Borhani 

Address: Vali Asr Ave., Hashemi Rafsanjani Cross Road, Niayesh Complex, School of Nursing and Midwifery, Shahid 

Beheshti University of Medical Sciences, Tehran, Iran.  

Email: faribaborhani@msn.com 

Tel: +98913-3439254 

 
Received: 29 Apr 2017 

Accepted: 17 Oct 2017 
Published: 5 Nov 2017 
 

 
J Med Ethics Hist Med, 2017, 10:10 
© 2017 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved. 
 

 
Abstract 
One of the main issues in nursing education that teachers and students frequently encounter is uncivil behaviors. This type of 

behavior is destructive for the teaching and learning environment. As teachers play an important role in nursing students' 

education and are ultimately their role models, the identification of these behaviors in nursing teachers appears to be essential. 

This study was conducted to determine nursing students' perceptions of their teachers' uncivil behaviors.  

The present study was conducted using a qualitative approach and content analysis. A total of 13 nursing students were selected 

through purposive sampling, and deep and semi-structured interviews were conducted with them. Content analysis was 

performed using an inductive approach. 

Three main categories were obtained through data analysis; disruptive behaviors affecting communication climate (subthemes: 

humiliation, the lack of supportiveness, and distrust), disruptive behaviors affecting ethical climate (subthemes: self-

centeredness, coercion and aggression, and harassment), and disruptive behaviors affecting learning climate (subthemes: poor 

teaching skills, poor time management, and indiscipline). Given that human dignity takes precedence over education, any action 

causing humiliation and embarrassment can have inverse effects on the students and may harm them. These behaviors taint the 

educational role. Since students select their teachers as their role models, the impact of teachers' uncivil behaviors on students 

cannot be neglected. Neglecting these behaviors might lead to their persistence in the clinical setting and irreparable damage to 

patients, who are the ultimate recipients of care. 

 
Keywords:  Uncivil behavior, Student perception, Nursing teachers, Qualitative research 

  



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Introduction  
There has been a dramatic increase in the incidence 

of uncivil behaviors in nursing education compared 

to the past (1-3). The majority of students and 

teachers consider uncivil behaviors in nursing 

education as a serious threat (4, 5). Destructive 

uncivil behaviors are serious problems in nursing 

education that require constant attention and 

assessment. These behaviors jeopardize the 

peacefulness of the teachers, students, and the 

academia (6), have destructive effects on the 

students and the teachers, and hurt teaching and 

learning environment and the student-teacher 

relationship to a degree that might lead to the 

violation of the rights of all students (3, 7). However, 

civil behavior is respect for others in the face of 

disagreement, dispute, and debate (8). These uncivil 

behaviors cause psychological and physical 

disturbances for those involved, and might turn into 

threatening situations if neglected (9).  

Previous studies have reported teachers' uncivil 

behaviors to manifest themselves in the form of 

canceling classes without prior notice, coming to 

class unprepared for teaching, not allowing free 

discussion in the classroom, acting cold and 

indifferent, humiliating and scolding the students, 

rushing through the topics, humiliation, unfairness, 

imposing their own will, indifference toward the 

students (3, 10), and being unavailable (4). Amanda 

has reported that behaviors such as late arrival, 

coming into the class unprepared, giving dirty looks 

to impolite students, and disrespecting students 

provoke retaliation in the students (10). Teachers' 

uncivil behaviors are not limited to the examples 

mentioned and also include teaching incompetence 

(10), immodesty, poor teaching skills (11), and poor 

communication skills (12, 13). Students have 

reported experiences of vulnerability (14), 

helplessness, stress, sleep disorders (15), and 

depression (16) when exposed to teachers' uncivil 

behaviors (17-19) and have the notion that teachers 

wish to get rid of them (8). Teachers may 

inadvertently provoke retaliation in the students by 

such uncivil behaviors as late arrival, coming to the 

class unprepared for learning, giving dirty looks to 

impolite students, and disrespecting students (20, 

21). Some teachers commit uncivil behaviors 

knowingly or unknowingly, which is proof that it is 

possible for teachers to cause uncivil behaviors in 

their colleagues in the academic setting (12). 

Teachers' manner of responding to the students can 

exacerbate or abate the tensions (7). Occasionally, 

they do not realize that the act of humiliating and 

embarrassing students may unintentionally cause 

conflict and hostility (22). The conflicts between the 

teachers and the students disconnect the students 

from learning process (3), and can deteriorate the 

learning environment and lead to poor performance 

and violations in the workplace (23). It is not 

surprising that people who commit uncivil behaviors 

in academic settings continue this behavior in the 

workplace (24).  

Previous studies indicate that teachers are concerned 

about the growing frequency of these behaviors in 

nursing education settings (14). These behaviors can 

disturb those involved, jeopardize the teaching and 

learning environment, and cause hostility (25). 

Considering the humanitarian objectives of nursing 

as a profession, the need for focusing on the ultimate 

beneficiaries (i.e., the patients), and the importance 

of developing civility in all communities, especially 

in nursing education settings, it seems that 

identifying these behaviors in various societies 

(including Iran) can provide invaluable information 

on this topic. To diminish uncivil behaviors, creation 

of a safe and dependable environment should be 

given priority (24). The first step is identification of 

these behaviors, reduction of the conflicts caused by 

them, understanding of the feelings and perspectives 

of the students, and hearing their views. Identifying 

these behaviors and taking measures to reduce them 

are therefore necessary steps for creating a standard 

educational setting. The present study was designed 

to determine students' perceptions of teachers' 

uncivil behaviors. 

 

Method 
The present study used directed qualitative content 

analysis and purposive sampling to investigate the 

perception of nursing students regarding teachers' 

uncivil behaviors. In this qualitative approach, the 

phenomena must be investigated in their natural 

context. The nursing schools of Tehran University of 

Medical Sciences, Iran University of Medical 

Sciences, Shahid Beheshti University of Medical 

Sciences, Islamic Azad University, and Shahed 

University (Tehran, Iran) were selected. Participants 

were selected through purposive sampling. The 

interviews were held in a quiet room in the nursing 

schools or hospitals. Sampling continued until data 

saturation, which occurred in the 11th interview, 

when no further new data could be obtained and 

previous codes were being repeated. The students 

had completed at least two semesters of their studies, 

entered the clinical setting, and received clinical 

training in nursing schools of the selected medical 

universities in Tehran. The data extracted from each 

interview guided the subsequent interviews. After 

ethical approval and obtaining written informed 

consent from the participants, in-depth and semi-

structured interviews were conducted to collect the 

data. The researcher first briefed participants on the 

study objectives, and then, introduced herself at the 

beginning of each interview and asked participants to 

fill out and sign informed consent forms for 

participation in the study and the recording of their 

voices. Participants were also briefed on the study 

objectives, the reason for recording the interviews, 



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the voluntary nature of their participation, and the 

confidentiality of their data and identities. For 

greater assurance, two more interviews were 

conducted, which resulted in no new data. Interviews 

were begun with the questions "Have you witnessed 

abnormal and disrespectful behaviors from your 

teachers during your education?", "How did these 

behaviors affect you?", "On what occasions did you 

experience these behaviors?" and "Could you 

describe one of these experiences." In order to obtain 

more data and clarify certain issues, some probing 

questions were also asked, and continued with more 

specific questions. Field notes were taken during the 

interviews. Each interview lasted between 30 and 60 

minutes. All interviews were recorded on tape and 

the transcripts were typed, reviewed, and coded at 

the end of each interview. To observe the principle 

of confidentiality, participants’ names were not 

revealed. Instead, each of them was given a specific 

number and their important characteristics such as 

age, sex, and level of education were recorded, and 

promptly transcribed verbatim and typed. To 

immerse in the data, the researcher reviewed the 

interviews several times and coded them. Data were 

analyzed simultaneously and continuously by 

collecting information. Semantic units were 

extracted in the form of initial codes or open codes 

from the interviews. The codes were reread several 

times and placed in subcategories on the basis of 

similarity and proportion of the participant 

expressing the same topic. Next, the subcategories 

were compared with each other and those with 

similar characteristics were combined to create wider 

categories, which were presented once more.  

Some of the measures taken to enhance data 

accuracy included prolonged engrossment in the 

topic, confirmation of findings by the participants, 

and observer reviews. To ensure dependability of the 

data, in addition to the members of the research 

team, three experts, who were members of the 

research team, were asked to evaluate the interviews, 

coding, and categories. To enhance transferability, 

the entire process of the research and all the work 

done in the course of the study were prepared in 

clear and accurate written form to enable others to 

track and study the population characteristics. 

The qualitative content analysis method used in the 

study included 8 stages proposed by Wildemuth 

(26). To ensure the confirmability of the data, parts 

of the interviews were checked along with the 

extracted codes and subthemes both externally and 

by 4 postgraduate nursing students familiar with 

qualitative studies. To allow for future references to 

the study, the stages and processes of the research 

were carefully recorded and reported.  

 

Results 
A total of 13 (10 female and 3 male) students were 

interviewed. To obtain a wider variety of 

experiences, maximum variation sampling was used 

in the selection of participants in terms of their year 

of study (3rd to 8th semester), age (19-25 years old), 

and gender. 

Participants' rich, in-depth descriptions yielded 

extraction of 384 initial codes, which were then 

reduced to 70 after eliminations and integrations at 

different stages. Finally the 70 codes were converted 

to 3 themes and 9 subthemes (table 1). Each theme 

will be explained with its relevant subthemes in the 

following.  

 

Table 1: The themes and subthemes extracted from the interviews 

Theme Subtheme 

Disruptive behaviors affecting communication climate  
 

Humiliation  

Lack of supportiveness 

Distrust  

Disruptive behaviors affecting ethical climate 

Self-centeredness  

Coercion and aggression 

Harassment  

Disruptive behaviors affecting learning climate 

Poor teaching skills  

Poor time management  

Indiscipline  

 

Theme 1: 

The first main theme extracted was disruptive 

behaviors affecting communication climate, which 

included behaviors that cause the break-up of 

communication, and the subthemes of humiliation, 

lack of supportiveness, and distrust. 

Humiliation signifies the belittling and disrespecting 

of others. In the experience of the majority of the 

students, calling others unpleasant names or 

attributes taints their self-esteem. Participants 

emphasized the need for teachers to respect their 

students. One participant said: 

[During the training, some instructors argued with 

us in the presence of the patients, and scolded us, 

and so, the patients would not allow us to care for 

them, and would tell us that we did not know how to 

do our job, and humiliated us this way. But the 

instructor could have simply pulled us aside and told 

us about our mistake in private.] (Participant No.1)  

Another participant said: [One time, one of the 

students was having difficulty understanding what 

the teacher was trying to convey, and so, the teacher 

called him a dumbass, and the student turned 

beetroot. Is it okay for a teacher to embarrass a 



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student by calling him a dumbass?] (Participant No. 

2) 

The next subtheme was lack of supportiveness. The 

best way for establishing a good relationship with 

the students is for the teachers to give them 

emotional support. Participants' experiences showed 

that teachers' supportiveness enhances the students' 

self-esteem and motivation for learning; the effect of 

factors such as pleasantness, openness to criticism, 

flexibility, fairness, modesty, understanding, and 

empathy should not be neglected on learning, the 

communication of knowledge, and the overall 

development of the student and the university. They 

considered the teachers' lack of supportiveness and 

their disregard for the students' wishes as 

disheartening. One participant asserted: [The 

teachers never support us when we need them to, 

and ignore our problems.] (Participant No. 5)  

Another subtheme was distrust. Distrust signifies the 

lack of a strong belief in a person's credibility, 

honesty, and capability. In the experience of some 

students, some teachers doubt their students and do 

not believe their words. One participant said: [The 

teachers believe only themselves, and never trust in 

what their students have to say.] (Participant No. 4)  

The second main theme extracted was disruptive 

behavior affecting the ethical climate, which 

included the subthemes of self-centeredness, 

coercion and aggression, and harassment. 

Self-centeredness is an inimical behavior in which a 

person considers only his own interest and wishes 

and never feels accountable toward others. In the 

experience of some participants, the teachers are 

unfair and act according to their own impulses. One 

participant said: [Some teachers give good grades to 

the students they like and low grades to those they do 

not, just to trouble them.] (Participant No. 1)  

Coercion and aggression was another subtheme of 

this theme. Coercion signifies forcing others into a 

situation against their will. In the experience of 

participants, coercion and aggression lead to poor 

communication and distanced the students from the 

teachers out of fear. On the contrary, an amicable 

and respectful relationship can hearten the students 

to make greater efforts to resolve their mistakes. One 

participant said: [One of the teachers used to literally 

throw the book at us and shout if we could not give a 

satisfactory answer to her questions. Of course, we 

do not know everything; we are here to learn.] 

(Participant No. 8) 

Harassment was another subtheme, which signifies 

behaviors that harass others and deprive them of 

their right to peacefulness. Some participants 

discussed being harassed by their teachers, which 

made the girl students particularly uncomfortable. 

One participant revealed: [One of our man teachers 

would give away his phone number, so we would 

become friends with him.] (Participant No. 7) 

Another participant said: [One of the teachers in our 

second semester used to get on my nerves with his 

roving eyes.] (Participant No. 9)  

The third main theme was disruptive behavior 

affecting the learning climate, which tends to 

interfere with appropriate teaching and effective 

learning, and included the three subthemes of poor 

teaching skills, poor time management, and 

indiscipline. One of the subthemes of this theme was 

poor teaching skills, which signifies the teachers' 

lack of efforts for promotion of knowledge and skills 

in others. In the experience of the participants, the 

teachers' knowledge and teaching techniques are 

what count in increasing students’ interest in 

learning. They also asserted that uncreative teaching 

methods, especially simple lectures, make the class 

boring and do not motivate the students. One 

participant argued: [Some teachers only read the 

slides out loud, and do not expand on the subject or 

use modern teaching techniques, which make 

lectures super boring for us.] (Participant No. 2) 

Poor time management was another subtheme of this 

theme. In the experience of the participants, some 

teachers do not plan their classes ahead of time and 

often run out of time by wasting it, and then, request 

additional sessions. One participant said: [Teachers 

spend a great deal of time telling us anecdotes, and 

so, they run out of time. So, the students get tired and 

can no longer concentrate. Some teachers keep us 

longer to finish a topic, and if they cannot, they ask 

for additional sessions.] (Participant No. 6)  

The last subtheme of this theme was indiscipline. In 

the experience of participants, teachers are 

considered as role models by the students. How can 

an undisciplined teacher expect discipline from his 

students? One participant remarked: [Some teachers 

arrive late to the classroom.] (Participant No. 3)  

 

Discussion 
The results of the present study showed that nursing 

students experience uncivil behaviors from their 

teachers in three themes, namely disruptive 

behaviors affecting communication climate, ethical 

climate, and learning climate. A study conducted by 

Clark et al., however, revealed two themes, including 

destructive behaviors and threatening behaviors (9). 

A number of the subthemes extracted in the present 

study show clear differences and similarities with the 

themes extracted in previous studies, which will be 

addressed in detail. Humiliation was a subtheme of 

non-supportive behaviors that was frequently 

referred to in different forms by the majority of the 

students interviewed. The students described the 

major part of being humiliated to have occurred in 

the form of the teacher ignoring their identity and 

character or feeling superior to the students and 

explained that it included becoming the target of the 

teacher's ridicule, insult, and sarcasm, and not 

getting responses to their questions. The results of 

other studies have shown that students consider 

humiliating behaviors the same as uncivil behaviors 

and communication as a means of committing civil 



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behaviors (27). Studies conducted in the US by 

Tantleff-Dunn et al. (7) and Luparell (3) showed that 

students experienced humiliation as a result of the 

teacher not responding to their questions and 

neglecting them. The lack of supportiveness was 

another subtheme that was experienced in the form 

of the teacher's general indifference and the lack of 

attention to the students' requests. Clark and Springer 

referred to this subtheme as the teacher's refusal to 

respond to the students' requests (4). Distrust was 

another subtheme frequently referred to by the 

students. Although other studies have not directly 

addressed this subtheme, teachers' inflexibility and 

bullheadedness were noted several times (28, 29), 

which may have been due to the teachers' distrust in 

the students caused by their lying, trickery, and 

cheating in the exams. In the present study, the 

teachers' distrust in the students was attributed to the 

students' dishonesty.  

Self-centeredness was another subtheme discussed 

by the majority of the students. According to Victor 

and Cullen, in moral theory, self-centeredness is in 

line with egoism, which indicates an inconsideration 

for others (30). In the present study, self-

centeredness was manifested as grading the students 

according to one’s own preferences or presumptions, 

and in some cases as humiliating the students and 

making them apologize, which might be due to the 

teachers' sense of superiority over the students. 

Coercion and aggression comprised another 

subtheme of inimical behaviors, which were said to 

be manifested in the form of imposing one’s own 

beliefs, throwing books and arguing with the 

students. Clark and Carnosso confirm some teachers' 

tendency to use coercion and aggression on their 

students (8). 

Harassment was another subtheme of inimical 

behaviors. The students described this behavior as 

manifesting in the form of the teacher giving his 

phone number to students of the opposite sex and 

having roving eyes directed at them. Gallo 

confirmed some teachers' tendency to harass their 

students by the cellphone or through emails (11). In 

the Islamic culture of Iran, interaction between sexes 

is clearly defined according to the four principles of 

Ashram and non-Ashram and halal (allowed) and 

harm (forbidden); observing these principles is a 

duty of every Iranian Muslim. On another note, the 

main reason for attending university is to acquire 

knowledge, and interaction with the other sex in the 

academia is solely for educational purposes, and any 

friendships that may develop should be toward an 

educational goal or else be the prelude to achieving 

educational goals (31). Any behavior or relationship 

that distances the student from this goal is 

considered a diversion from the path of 

communication for the purpose of education (32). 

Poor teaching skills of the teacher was a subtheme of 

threatening behaviors; students referred to the 

teachers' lack of knowledge, not using different 

teaching techniques, and reading tedious slides out 

loud, and also the use of inexperienced teachers. The 

students believed that teacher's high scientific 

capabilities and their use of modern teaching 

techniques creates enthusiasm in them for learning 

and encourages them to acquire knowledge and 

skills. Clark also confirms the manifestation of the 

poor teaching skills of some teachers in the form of 

using ineffective methods and diversion from the 

topic of class (33). 

Poor time management was another subtheme, which 

was frequently expressed by the students to take 

place in the form of wasting time by irrelevant 

chatter, having no teaching plans, and requests for 

additional sessions. It is worth noting that no studies 

were found on this issue, which might be due to the 

limited number of studies conducted on the topic. 

The cause may also be that the need for time 

management is so deeply felt in other countries, that 

it has become an integral part of their life along with 

respect for others' rights (34), and the lack of time 

management has been considered an act of 

indiscipline (35,36). 

Indiscipline was a subtheme of tainting behaviors, 

which was manifested as late arrival to class, early 

dismissal of class, taking care of personal chores 

inside the class, and not coming to class prepared for 

teaching. As teachers are role models for their 

students, their disciplinary conduct makes students 

observe discipline as a duty and a norm in 

educational settings. Clark confirmed indiscipline to 

manifest itself in the form of late arrival to class, 

early dismissal of the class, and coming to the class 

unprepared to teach (13). 

The results of the present study cannot be taken as 

fully reflecting the perceptions of the entire 

community of nursing students in Iran. However, 

since the university admission system in Iran is 

centralized rather than localized, and since the 

education system is also centralized, the same 

perceptions can be assumed to exist in other parts of 

the country. The findings of the present study can 

therefore be indicative of the perceptions of the 

majority of nursing students across the country. 

 

Conclusion 
The results of the present study indicate that uncivil 

behaviors in nursing education and their destructive 

consequences are not issues that can be ignored. 

Neglecting these abnormal behaviors may lead to 

aggressive and hostile behaviors. These behaviors 

might become the norm and form part of the culture 

of the society over time. Given that teachers play a 

guiding role for students in addition to their 

educational role, their contribution to the formation 

of these behaviors cannot be overlooked. Since the 

educational environment, and especially teachers, 

play a major role in fostering committed, ethical, and 

devoted nurses, and since patients are the ultimate 

group that benefit from these improvements, it is 



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upon the authorities of the healthcare system to take 

every necessary measure for promoting civil 

behaviors and ending the growing trend of uncivil 

behaviors in nursing education settings for the 

ultimate purpose of fostering committed and 

efficient nurses and ensuring patient safety and 

health.  

 

Acknowledgements 
The present study is part of a PhD dissertation, with 

the code SBMU.Rec.1393.638, approved by the 

Research Council and Ethics Committee of Shahid 

Beheshti University of Medical Sciences (Code of 

ethics: IRSBMU.RETECH.REC.1395.587). 

The present study is the result of the generous 

guidance and the sincere endeavors of professors 

who helped in carrying out the research. The authors 

would like to express their gratitude to all the 

students and officials of the Nursing and Midwifery 

Schools of Shahid Beheshti University of Medical 

Sciences, Tehran University of Medical Sciences, 

Iran University of Medical Sciences, Islamic Azad 

University, and Shahed University.  

 

Conflicting Interests 
There were no potential conflicts of interest with 

respect to the research, authorship, and article 

publication. 

 

 

  



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