背景:医护人员之间的非专业行为(UB)在全球医疗保健系统中普遍存在,对员工福利产生负面影响,患者安全和护理质量。UB的驱动因素包括组织,情境,团队,和领导力问题以复杂的方式相互作用。对这些因素及其相互作用的更好理解将使未来的干预措施能够更好地针对UB的这些驱动因素。
方法:在利益相关者的投入下,按照RAMESES指南进行了一项现实性审查。最初的理论是根据研究小组已知的报告和范围搜索制定的。包括Embase在内的数据库的系统搜索,CINAHL,进行MEDLINE和HMIC以鉴定用于理论完善的文献。从这些报告中提取数据,合成,和最初的理论测试,产生精致的节目理论。
结果:我们从2,977个去重复的灰色和学术报告记录中纳入了81个报告(论文),和28通过谷歌,利益相关者,和团队成员,共收到109份报告。制定了五类贡献者:(1)工作场所剥夺权力;(2)有害的工作场所过程和文化;(3)抑制社会凝聚力;(4)说话能力降低;(5)缺乏经理意识和紧迫性。这些导致UB的直接增加,员工应对能力下降,报告能力下降,挑战或解决UB。开发了23种理论来解释这些贡献者是如何工作和互动的,以及他们的结果在不同的员工群体中如何不同。UB风险最大的工作人员包括女性,新员工,残疾工作人员,和来自少数群体的工作人员。UB通过损害浓度对患者安全产生负面影响,通信,学习能力,信心,人际信任。
结论:现有研究主要集中在个体特征上,但是这些是不一致的,很难解决,并可用于转移组织责任。我们提出了一个全面的程序理论,进一步理解UB的贡献者,它们是如何工作的,为什么,它们如何相互作用,他们影响了谁,以及如何影响患者的安全。需要更多的研究来了解如何以及为什么缩编员工受到UB的影响不成比例。
背景:本研究已在健康和社会护理前瞻性注册系统评价国际数据库(PROSPERO)中注册:https://www。crd.约克。AC.uk/prospro/display_record.php?ID=CRD42021255490。
BACKGROUND: Unprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB.
METHODS: A realist
review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories.
RESULTS: We included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust.
CONCLUSIONS: Existing research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB.
BACKGROUND: This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .