From the Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Psychological & Brain Sciences, Washington University St. Louis, St. Louis, Missouri.
J Patient Saf. 2021 Oct 1;17(7):e607-e614. doi: 10.1097/PTS.0000000000000423.
Disruptive intraoperative behavior has detrimental effects to clinicians, institutions, and patients. How clinicians respond to this behavior can either exacerbate or attenuate its effects. Previous investigations of disruptive behavior have used survey scales with significant limitations. The study objective was to develop appropriate scales to measure exposure and responses to disruptive behavior.
We obtained ethics approval. The scales were developed in a sequence of steps. They were pretested using expert reviews, computational linguistic analysis, and cognitive interviews. The scales were then piloted on Canadian operating room clinicians. Factor analysis was applied to half of the data set for question reduction and grouping. Item response analysis and theoretical reviews ensured that important questions were not eliminated. Internal consistency was evaluated using Cronbach α. Model fit was examined on the second half of the data set using confirmatory factor analysis. Content validity of the final scales was re-evaluated. Consistency between observed relationships and theoretical predictions was assessed. Temporal stability was evaluated on a subsample of 38 respondents.
A total of 1433 and 746 clinicians completed the exposure and response scales, respectively. Content validity indices were excellent (exposure = 0.96, responses = 1.0). Internal consistency was good (exposure = 0.93, responses = 0.87). Correlations between the exposure scale and secondary measures were consistent with expectations based on theory. Temporal stability was acceptable (exposure = 0.77, responses = 0.73).
We have developed scales measuring exposure and responses to disruptive behavior. They generate valid and reliable scores when surveying operating room clinicians, and they overcome the limitations of previous tools. These survey scales are freely available.
术中干扰行为对临床医生、医疗机构和患者都有不利影响。临床医生对此类行为的反应可能会加剧或减轻其影响。先前对干扰行为的研究使用了具有显著局限性的调查量表。本研究旨在开发适当的量表来测量对干扰行为的暴露和反应。
我们获得了伦理批准。量表的开发遵循一系列步骤。通过专家评审、计算语言学分析和认知访谈对量表进行了预测试。然后在加拿大手术室临床医生中进行了试点研究。对一半数据集进行因子分析，以减少问题并进行分组。项目反应分析和理论综述确保了重要问题不会被删除。采用 Cronbach α 评估内部一致性。在数据集的另一半上进行验证性因子分析以检查模型拟合。最后重新评估了最终量表的内容效度。评估了观察到的关系与理论预测之间的一致性。对 38 名受访者的子样本进行了时间稳定性评估。
共有 1433 名和 746 名临床医生分别完成了暴露和反应量表。内容效度指数非常好（暴露=0.96，反应=1.0）。内部一致性良好（暴露=0.93，反应=0.87）。暴露量表与次要测量指标之间的相关性与基于理论的预期一致。时间稳定性可接受（暴露=0.77，反应=0.73）。
我们开发了测量对干扰行为的暴露和反应的量表。当调查手术室临床医生时，这些量表可产生有效和可靠的分数，并且克服了先前工具的局限性。这些调查量表是免费提供的。
