■医疗保健系统中的不专业行为会对员工的福祉产生负面影响,患者安全和组织成本。不专业的行为包括一系列行为,包括无礼,微侵略,骚扰和欺凌。尽管努力打击医疗机构中的不专业行为,它仍然很普遍。已经进行了减少医疗保健中不专业行为的干预措施-但尚不清楚它们如何以及为什么起作用。鉴于问题的复杂性,现实主义者的审查方法是检查医疗保健系统中不专业行为的理想方法。
■为了提高特定于上下文的理解,为什么以及在什么情况下,急性医疗保健环境中的员工之间会发生不专业的行为,以及实施缓解策略的证据,管理和预防。
■与现实主义和元叙事证据综合相一致的现实主义综合方法:不断发展的标准报告指南。
■从原始提案和各种网站的非正式搜索中确定了建立初始理论的文献来源。为了理论完善,我们在EMBASE等数据库上对同行评审的文献进行了系统和有目的的搜索,护理和相关健康文献和MEDLINE数据库以及灰色文献的累积指数。搜索从2021年11月到2022年12月进行了迭代。
■最初的理论构建借鉴了38个来源。搜索产生了2878个标题和摘要。总的来说,审查中包括148个来源。用于非专业行为的术语和定义不一致。在试图确定和解决非专业行为时,这可能会给政策和实践带来问题。不专业行为的贡献者可以分为四个方面:(1)工作场所失权,(2)组织的不确定性,困惑和压力,(3)(缺乏)社会凝聚力;(4)支持容忍非专业行为的有害文化。那些最有可能经历不专业行为的人是来自小规模背景的员工。我们在文献中确定了42种干预措施来解决非专业行为。这些跨越的五种类型:(1)单个会话(即一次性),(2)多个会话,(3)与其他行动相结合的单个或多个课程(例如培训课程加上行为准则),(4)专业问责制和报告干预措施,以及(5)结构化的文化变革干预措施。我们确定了42份干预报告,没有在英国进行。其中,评估了29种干预措施,大多数(n=23)报告了一些有效性衡量标准。干预措施借鉴了13种行为改变策略,例如:改变社会规范,提高对非专业行为的认识,或者重新设计工作场所。干预措施受到12个关键动态的影响,包括关注个人,缺乏对管理的信任和不存在的逻辑模型。
■工作场所的失权和组织障碍是导致非专业行为的主要因素。然而,干预措施主要侧重于个人教育或培训,而不涉及系统性,组织问题。改善工作人员福祉或患者安全的干预措施的有效性尚不确定。我们提供12个关键动态和15个实施原则来指导组织。
■干预措施需要:(1)在英国背景下进行测试,(2)借鉴行为科学原理,(3)目标系统,组织问题。
■本综述重点关注员工之间的不专业人际关系行为,仅适用于急性医疗机构,不包括英国以外或医疗保健以外的非干预文献。
■这项研究在PROSPEROCRD42021255490上进行了前瞻性注册。该记录可从www获得。crd.约克。AC.uk/prospro/display_record.php?ID=CRD42021255490。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:NIHR131606)资助,并在健康和社会护理提供研究中全文发表。12号25.有关更多奖项信息,请参阅NIHR资助和奖励网站。
对于这项研究,我们问:如何,为什么以及在什么情况下可以减少在急性护理(通常是医院)工作的医护人员之间的不专业行为,管理和预防?我们想研究人们如何理解不专业的行为,探索导致不专业行为的情况,并了解现有的解决不专业行为的方法如何在员工团体和急性医疗机构中起作用(或不起作用)。我们使用了一种称为“现实主义审查”的文献审查方法,这与其他审查方法不同。现实主义者的审查重点不仅在于理解干预措施是否有效,而且在于它们如何以及为什么有效,为谁。这使我们能够分析更广泛的相关国际文献,而不仅仅是学术论文。我们找到了148个来源,这两者之所以相关,要么是因为他们描述了不专业的行为,要么是因为他们提供了如何解决不专业行为的信息。对非专业行为的定义各不相同,很难确定一个描述。例如,不专业的行为可能涉及不礼貌,欺凌,骚扰和/或微攻击。我们研究了可能导致不专业行为的因素,并确定了包括工作环境不确定性在内的因素。我们没有发现基于英国的干预措施,只有美利坚合众国的干预措施试图减少对少数群体的非专业行为。策略经常试图鼓励员工大声疾呼,提供报告不专业行为或设定社会行为标准的方法。我们还确定了可能使组织成功选择,实施和评估干预措施,以解决非专业行为。我们建议采用全系统的方法来解决不专业的行为,包括评估上下文,然后在很长一段时间内(而不仅仅是一次)实施多种方法,因为它们可能对不断变化的文化产生更大的影响。我们正在制定实施指南来支持这一进程。干预措施需要增强员工在工作中感到安全的能力,有效地工作,并支持那些更有可能经历不专业行为的人。
UNASSIGNED: Unprofessional behaviour in healthcare systems can negatively impact staff well-being, patient safety and organisational costs. Unprofessional behaviour encompasses a range of behaviours, including incivility, microaggressions, harassment and bullying. Despite efforts to combat unprofessional behaviour in healthcare settings, it remains prevalent. Interventions to reduce unprofessional behaviour in health care have been conducted - but how and why they may work is unclear. Given the complexity of the issue, a realist
review methodology is an ideal approach to examining unprofessional behaviour in healthcare systems.
UNASSIGNED: To improve context-specific understanding of how, why and in what circumstances unprofessional behaviours between staff in acute healthcare settings occur and evidence of strategies implemented to mitigate, manage and prevent them.
UNASSIGNED: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards reporting guidelines.
UNASSIGNED: Literature sources for building initial theories were identified from the original proposal and from informal searches of various websites. For theory refinement, we conducted systematic and purposive searches for peer-reviewed literature on databases such as EMBASE, Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases as well as for grey literature. Searches were conducted iteratively from November 2021 to December 2022.
UNASSIGNED: Initial theory-building drew on 38 sources. Searches resulted in 2878 titles and abstracts. In total, 148 sources were included in the
review. Terminology and definitions used for unprofessional behaviours were inconsistent. This may present issues for policy and practice when trying to identify and address unprofessional behaviour. Contributors of unprofessional behaviour can be categorised into four areas: (1) workplace disempowerment, (2) organisational uncertainty, confusion and stress, (3) (lack of) social cohesion and (4) enablement of harmful cultures that tolerate unprofessional behaviours. Those at most risk of experiencing unprofessional behaviour are staff from a minoritised background. We identified 42 interventions in the literature to address unprofessional behaviour. These spanned five types: (1) single session (i.e. one-off), (2) multiple sessions, (3) single or multiple sessions combined with other actions (e.g. training session plus a code of conduct), (4) professional accountability and reporting interventions and (5) structured culture-change interventions. We identified 42 reports of interventions, with none conducted in the United Kingdom. Of these, 29 interventions were evaluated, with the majority (n = 23) reporting some measure of effectiveness. Interventions drew on 13 types of behaviour-change strategy designed to, for example: change social norms, improve awareness of unprofessional behaviour, or redesign the workplace. Interventions were impacted by 12 key dynamics, including focusing on individuals, lack of trust in management and non-existent logic models.
UNASSIGNED: Workplace disempowerment and organisational barriers are primary contributors to unprofessional behaviour. However, interventions predominantly focus on individual education or training without addressing systemic, organisational issues. Effectiveness of interventions to improve staff well-being or patient safety is uncertain. We provide 12 key dynamics and 15 implementation principles to guide organisations.
UNASSIGNED: Interventions need to: (1) be tested in a United Kingdom context, (2) draw on behavioural science principles and (3) target systemic, organisational issues.
UNASSIGNED: This
review focuses on interpersonal staff-to-staff unprofessional behaviour, in acute healthcare settings only and does not include non-intervention literature outside the United Kingdom or outside of health care.
UNASSIGNED: This study was prospectively registered on PROSPERO CRD42021255490. The record is available from: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131606) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 25. See the NIHR Funding and Awards website for further award information.
For this study, we asked: how, why and in what situations can unprofessional behaviour between healthcare staff working in acute care (usually hospitals) be reduced, managed and prevented? We wanted to research how people understand unprofessional behaviour, explore the circumstances leading to unprofessional behaviour and understand how existing approaches to addressing unprofessional behaviour worked (or did not work) across staff groups and acute healthcare organisations. We used a literature
review method called a ‘realist
review’, which differs from other
review methods. A realist
review focuses on understanding not only if interventions work but how and why they work, and for whom. This allowed us to analyse a wider range of relevant international literature – not only academic papers. We found 148 sources, which were relevant either because they described unprofessional behaviour or because they provided information on how to address unprofessional behaviour. Definitions of unprofessional behaviour varied, making it difficult to settle on one description. For example, unprofessional behaviour may involve incivility, bullying, harassment and/or microaggressions. We examined what might contribute to unprofessional behaviour and identified factors including uncertainty in the working environment. We found no United Kingdom-based interventions and only one from the United States of America that sought to reduce unprofessional behaviour towards minority groups. Strategies often tried to encourage staff to speak up, provide ways to report unprofessional behaviour or set social standards of behaviour. We also identified factors that may make it challenging for organisations to successfully select, implement and evaluate an intervention to address unprofessional behaviour. We recommend a system-wide approach to addressing unprofessional behaviour, including assessing the context and then implementing multiple approaches over a long time (rather than just once), because they are likely to have greater impact on changing culture. We are producing an implementation guide to support this process. Interventions need to enhance staff ability to feel safe at work, work effectively and support those more likely to experience unprofessional behaviour.