School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore 2780, Australia.
BMC Nurs. 2013 Oct 4;12(1):25. doi: 10.1186/1472-6955-12-25.
Although there is a sizeable body of evidence regarding the nature of hostile behaviours among clinicians in the nursing workplace, what is less clear is the nature of the relationship between these behaviours and patient care. To inform the development of appropriate intervention strategies we examine the level of evidence detailing the relationships between hostile clinician behaviours and patient care.
Published qualitative and quantitative studies that examined hostile clinician behaviours and patient care were included. Quality assessment, data extraction and analysis were undertaken on all included studies. The search strategy was undertaken in July and August 2011 and comprised eight electronic databases (CINAHL, Health Collection (Informit), Medline (Ovid), Ovid Nursing Full Text, Proquest Health and Medicine, PsycInfo, Pubmed and Cochrane library) as well as hand searching of reference lists.
The search strategy yielded 30 appropriate publications. Employing content analysis four themes were refined: physician-nurse relations and patient care, nurse-nurse bullying, intimidation and patient care, reduced nurse performance related to exposure to hostile clinician behaviours, and nurses and physicians directly implicating patients in hostile clinician behaviours.
Our results document evidence of various forms of hostile clinician behaviours which implicate nursing care and patient care. By identifying the place of nurse-nurse hostility in undermining patient care, we focus attention upon the limitations of policy and intervention strategies that have to date largely focused upon the disruptive behaviour of physicians. We conclude that the paucity of robustly designed studies indicates the problem is a comparatively under researched area warranting further examination.
尽管有大量证据表明护理工作场所的临床医生之间存在敌对行为，但这些行为与患者护理之间的关系性质尚不清楚。为了为制定适当的干预策略提供信息，我们研究了详细描述敌对临床医生行为与患者护理之间关系的证据水平。
纳入了研究敌对临床医生行为和患者护理的已发表定性和定量研究。对所有纳入的研究都进行了质量评估、数据提取和分析。该搜索策略于 2011 年 7 月至 8 月进行，包括八个电子数据库（CINAHL、Health Collection（Informit）、Medline（Ovid）、Ovid Nursing Full Text、Proquest Health and Medicine、PsycInfo、Pubmed 和 Cochrane library）以及对参考文献的手工搜索。
搜索策略产生了 30 篇合适的出版物。通过内容分析，提炼出四个主题：医生-护士关系与患者护理、护士-护士欺凌、恐吓与患者护理、暴露于敌对临床医生行为与护士绩效下降，以及护士和医生直接将患者牵连到敌对临床医生行为中。
我们的研究结果记录了各种形式的敌对临床医生行为的证据，这些行为涉及护理和患者护理。通过确定护士之间敌对行为破坏患者护理的地方，我们关注政策和干预策略的局限性，这些策略迄今为止主要集中在医生的破坏性行为上。我们的结论是，缺乏稳健设计的研究表明，这是一个相对研究不足的领域，值得进一步研究。
