Disruptive behavior & clinical outcomes: Perceptions of nurses & physicians
Disruptive behavior & clinical outcomes: Perceptions of nurses & physicians
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DOI：
10.1097/00000446-200501000-00025
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发表时间：
2005-01-01
影响因子：
2.7
通讯作者：
O'Daniel, M
中科院分区：
文献类型：
--
作者：
Rosenstein, AH;O'Daniel, M
提供安全、无差错的护理是所有医疗保健专业人员的首要任务。良好的结果与程序效率、循证标准的实施以及旨在降低医疗错误可能性的工具（如计算机化药物医嘱和条形码患者身份识别）的使用相关。但是工作关系对临床结果的影响并没有得到很好的记录。目前的调查是作为之前VHA西海岸调查的后续调查而设计的，该调查研究了医生的破坏性行为对护士工作满意度和保留率的普遍性和影响（参见“护士-医生关系：对护士满意度和保留率的影响”，2002年6月）。根据该调查结果和后续评论，对医生和护士的破坏性行为，以及团体和管理者对其对提供者的影响和对临床结果的影响的看法进行了后续调查。调查分布在全国50家VHA医院，对1，500多名调查参与者的结果进行了评估。据报道，护士的扰乱行为几乎和医生一样频繁。大多数受访者认为破坏性行为具有负面或恶化的影响，在护士和医生，压力，挫折，浓度，沟通，协作，信息传递和工作场所的关系。更令人不安的是受访者对破坏性行为对不良事件、医疗差错、患者安全、患者死亡率、护理质量和患者满意度的负面或恶化影响的看法。这些研究结果表明，破坏性行为的后果远远超出护士的工作满意度和士气，影响临床医生之间的沟通和协作，这可能会反过来对临床结果产生负面影响。建议采取旨在减少破坏性行为的发生率和影响的策略。
Providing safe, error-free care is the number-one priority of all health care professionals. Excellent outcomes have been associated with procedural efficiency, the implementation of evidence-based standards, and the use of tools designed to reduce the likelihood of medical error (such as computerized medication orders and bar-coded patient identification). But the impact of work relationships on clinical outcomes isn't as well documented.The current survey was designed as a follow-up to a previous VHA West Coast survey that examined the prevalence and impact of physicians' disruptive behavior on the job satisfaction and retention of nurses (see ''Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention,'' June 2002). Based on the finding of that survey and subsequent comments on it, the follow-up survey examined the disruptive behavior of both physicians and nurses, as well as both groups' and administrators' perceptions of its effects on providers and its impact on clinical outcomes.Surveys were distributed to 50 VHA hospitals across the country, and results from more than 1,500 survey participants were evaluated. Nurses were reported to have behaved disruptively almost as frequently as physicians. Most respondents perceived disruptive behavior as having negative or worsening effects, in both nurses and physicians, on stress, frustration, concentration, communication, collaboration, information transfer, and workplace relationships. Even more disturbing was the respondents' perceptions of negative or worsening effects of disruptive behavior on adverse events, medical errors, patient safety, patient mortality, the quality of care, and patient satisfaction. These findings suggest that the consequences of disruptive behavior go far beyond nurses' job satisfaction and morale, affecting communication and collaboration among clinicians, which may well, in turn, have a negative impact on clinical outcomes. Strategies aimed at reducing the incidence and impact of disruptive behavior are recommended.