| Disruptive behavior among health care providers has an undisputed link to negative patient outcomes. High-stress areas, including the perioperative setting, are especially prone to this behavior. In July 2008, The Joint Commission (TJC) issued a Sentinel Event Alert, Behaviors that Undermine a Culture of Safety, and introduced a new leadership standard mandating that all accredited organizations develop processes for managing disruptive behavior, including a surveillance of the problem and training in communication skills and conflict resolution. To address this standard, the overall purpose of this study was to develop, implement and evaluate an educational communication skills intervention, Nurses Addressing Disruptive Behavior (NADB) , aimed at increasing the self-efficacy of perioperative nurses to address disruptive physician behavior. To achieve this overall purpose, three studies were conducted. The first study determined that the incidence of disruptive physician behavior in the perioperative setting of a midwestem medical center was alarmingly high. Ninety-five percent of the perioperative nurses surveyed reported having witnessed and/or experienced disruptive behavior. The second study developed the communication skills intervention based on the Crucial ConversationsRTM Training Healthcare Track, the pattern of interaction component of Humanizing Nursing Communication Theory, and the self-efficacy component of Social Cognitive Theory. To evaluate the effectiveness of the intervention, a 10 item Likert-type instrument, the Self-Efficacy to Address Disruptive Behavior Scale (SADBS), was developed, tested, and determined to be a valid, reliable and sensitive instrument to measure nurse self-efficacy to address disruptive physician behavior. The third study implemented and evaluated the intervention. Seventeen perioperative nurses participated in a two-day communication skills program presented by a certified Crucial ConversationsRTM trainer. The SADBS was used to collect study data. Using paired t-test analysis, there was a statistically significant increase in total mean self-efficacy scores immediately after the intervention and four weeks following the intervention. In addition, participants were able to address disruptive physician behavior 71% of the time, four weeks after the intervention. The results of these studies strongly suggest that one possible intervention strategy to address the serious threat of disruptive physician behavior to patient safety is to educate nurses in communication skills. |
