School of Nursing Jerusalem College of Technology, Head, Hadassah Research and Innovation Center in Nursing, Hadassah University Medical Center, Jerusalem, Israel.
Multi-Disciplinary Studies, Achva Academic College, Israel.
J Nurs Scholarsh. 2023 Jan;55(1):253-261. doi: 10.1111/jnu.12857.
BACKGROUND: Nurse managers and team co-workers' disruptive behaviors (DBs) are negatively associated with a perceived safe climate. Moreover, DBs are a risk factor for patients' safety. Yet, it remains unknown whether and to what extent these effects were prevalent in COVID-19 wards and among witnesses of DBs. DESIGN: A cross-sectional study. METHODS: A questionnaire was distributed on social networks and completed by nurses in various Israeli healthcare organizations using snowball sampling between October and December 2021. The questionnaire included seven previously published measures and a question checking whether the participants had worked in a COVID-19 ward. The minimal sample size for any analysis was 236. Hypotheses were tested with correlations and structural equation modeling. RESULTS: DBs of nurse managers and team co-workers toward nurses were higher in COVID-19 teams. As hypothesized, DBs were negatively correlated with a safe climate and positively with patient safety (fewer errors). The data were consistent with a model suggesting that a safe climate is related to fewer DBs and DBs largely mediate the effects of safe climate on errors. Surprisingly and importantly, the strongest predictor of errors, including preventable mortality, is witnessing DBs and not being a victim of DBs. CONCLUSIONS: DBs may impede open communication and collaboration among co-workers, particularly in COVID-19 teams. This study shows the links between nurse shaping of a safe climate, DBs toward nurses, and patient safety. CLINICAL RELEVANCE: Nurse managers who create a safe climate and show zero tolerance for DBs could reduce the risk of errors in care.
背景:护士长和团队同事的破坏性行为(DBs)与感知到的安全氛围呈负相关。此外,DBs 是患者安全的一个风险因素。然而,目前尚不清楚这些影响在 COVID-19 病房和 DBs 的目击者中是否普遍存在,以及存在的程度如何。
设计:一项横断面研究。
方法:在 2021 年 10 月至 12 月期间,通过社交网络分发问卷,并通过滚雪球抽样法由以色列各医疗机构的护士完成。问卷包括之前发表的七个量表和一个问题,询问参与者是否在 COVID-19 病房工作过。任何分析的最小样本量为 236。使用相关分析和结构方程模型检验假设。
结果:护士长和团队同事对护士的 DBs 在 COVID-19 团队中更高。正如假设的那样,DBs 与安全氛围呈负相关,与患者安全(错误减少)呈正相关。数据与一个模型一致,该模型表明安全氛围与 DBs 减少有关,DBs 在安全氛围对错误的影响中起主要中介作用。令人惊讶且重要的是,错误(包括可预防的死亡率)的最强预测因素是目睹 DBs 而不是成为 DBs 的受害者。
结论:DBs 可能会阻碍同事之间的公开沟通和协作,特别是在 COVID-19 团队中。本研究显示了护士营造安全氛围、对护士的 DBs 与患者安全之间的联系。
临床相关性:营造安全氛围且对 DBs 零容忍的护士长可以降低护理错误的风险。
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