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    Disruptive behaviors in obstetric services diminished with action plan

    In a survey of more than 100 nurses, physicians, and administrators, participants were asked how often they witnessed or experienced disruptive behaviors ranging from verbal abuse to physical or sexual harassment and were questioned about the effects of these behaviors on psychologic factors that affect emotions and performance as well as on medical errors, adverse events, and compromises in patient safety and quality of care. The survey was conducted by Physician Wellness Services (San Francisco, California).

    Researchers found that disruptive behavior was extremely common among both nurses and physicians and occurred most frequently in high-stress areas, including the obstetrics department and in certain specialties.

    Whereas physician disruptive behaviors were usually direct and overt and generally subsided after the triggering event, disruptive behaviors among nurses were more passive-aggressive and occurred most often in nurse-to-nurse rather than nurse-to-physician encounters.

    Respondents' perceptions of the psychologic impact of disruptive behaviors and their effect on process and outcomes of care were striking. Disruptive behaviors that occurred "sometimes," "frequently," and "constantly" were strongly linked to stress, frustration, loss of concentration, reduced RN/MD collaboration, reduced information transfer, and reduced communication. These behaviors also were strongly associated with undesirable clinical outcomes: adverse events, errors, and negative effects on patient safety, quality of care, mortality, and patient satisfaction.

    In light of these findings, the authors recommended that physicians and nurses work together to gain a better understanding of each other's roles, responsibilities, and priorities and devise a mutually agreed-on process of care to ensure positive patient outcomes. Further, organizations must be committed to the process and provide the necessary education and resource support.

    The authors noted that addressing disruptive behaviors in a positive manner is particularly relevant in the obstetric setting, where care is delivered over time with many different members of the healthcare team playing a role.

    Rosenstein AH. Managing disruptive behaviors in the health care setting: focus on obstetrics services. Am J Obstet Gynecol. 2011;204(3):187-192.

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