目的:综合临床医生对防御实践的看法和经验的定性证据。
方法:系统评价定性数据。
方法:MEDLINE,Embase,PsycINFO,AMED,产妇和婴儿护理,CINAHL,ASSIA,社会学文摘,从2000年到2023年10月,搜索了Proquest论文和论文以及PROSPERO。
方法:我们纳入了临床医生的英语研究,报告了诉讼或投诉对临床实践影响的定性数据。
方法:我们使用接地理论方法逐行对发现数据进行编码。我们使用Hawker等人的工具评估质量,并按主题合成数据。
结果:纳入17项研究。参与者确定了一系列可能具有防御性动机的临床决策,关于诊断和文件以及治疗。防御性实践往往涉及一种分散的风险感,而不是诉讼的直接威胁,并且可能与其他动机重叠,例如患者的感知压力或避免伤害的愿望。防御实践在许多方面被认为是有害的,但同样,这些看法可能会从更广泛的不信任和剥夺权力的叙述中获得力量,与诉讼风险一样多。
结论:防守练习的想法,根据颁布,比一些理论解释所建议的更复杂,并且通常可能会表达对临床护理工作的更广泛关注。定性证据质疑防御性实践作为将诉讼风险与不当治疗和超额成本联系起来的关键调解人的观点。
OBJECTIVE: To synthesise qualitative evidence on clinicians\' views and experiences of defensive practice.
METHODS: Systematic review of qualitative data.
METHODS: MEDLINE, Embase, PsycINFO, AMED, Maternity and Infant Care, CINAHL, ASSIA, Sociological Abstracts, Proquest Dissertations & Theses and PROSPERO were searched from 2000 to October 2023.
METHODS: We included English-language studies of clinicians which reported qualitative data on the impact of litigation or complaints on clinical practice.
METHODS: We coded findings data line by line using a grounded theory approach. We assessed quality using Hawker et al\'s tool and synthesised data thematically.
RESULTS: 17 studies were included. Participants identify a range of clinical decisions which may be defensively motivated, relating to diagnosis and documentation as well as to treatment. Defensive practice often relates to a diffuse sense of risk rather than the direct threat of litigation and may overlap with other motivations, such as perceived pressure from patients or the desire to avoid harm. Defensive practice is seen to be harmful in many ways, but again, these perceptions may gain force from broader narratives of mistrust and disempowerment, as much as from the risk of litigation.
CONCLUSIONS: The idea of defensive practice, as enacted, is more complex than some theoretical accounts suggest and may often function to express broader concerns about the work of clinical care. The qualitative evidence calls into question the view of defensive practice as a key mediator linking litigation risk to inappropriate treatment and excess costs.