Disabling Disruptive Behavior Requires Effective Communication Skills

WASHINGTON, DC—Providing education in effective communication skills is key to addressing disruptive behaviors in the oncology environment, a study presented at the Oncology Nursing Society (ONS) 38th Annual Congress has found.

“Disruptive behaviors negatively impact job satisfaction, performance, cost of patient care, and incidence of medical errors,” noted Connie Green, RN, MSN, OCN®, of North Kansas City Hospital, Kansas City, MO. “The negative impact of disruptive behaviors in the workplace environment has been explored in many high stress acute care practice settings but not in oncology care.”

Noting that ongoing identification of such behaviors “is imperative in maintaining high-quality, safe patient care,” Green described a two-part intervention study using quantitative and qualitative survey methodologies to assess nursing staff perceptions of the presence of disruptive behaviors as well as “determine if an educational intervention would improve staff's self-efficacy when facing disruptive behavior on the inpatient oncology unit.”

She and her colleagues adapted Pearson, Anderson and Wegner's framework on workplace incivility as the conceptual model to apply to disruptive behaviors. In part one, 29 staff members anonymously completed a web-based Disruptive Behaviors Staff Survey that evaluated staff relationships, the types of disruptive behaviors they witnessed or experienced, the impact of the behaviors, and barriers to addressing disruptive behaviors.

In part two, 25 staff members voluntarily participated in a 4-hour adapted Crucial Conversation class, which was designed to improve communication skills for confronting disruptive behaviors and to build staff confidence. The class included a lecture, discussion, case studies, videos, and small group activities. Participants completed the Self-Efficacy to Address Disruptive Behaviors Scale (SADBS) immediately before, after, and at 6 months following the class and data from these three time points were analyzed using paired t-tests.

A staff survey analysis from part one “showed strong correlations between disruptive behaviors and decreased staff satisfaction, increased workplace stress, decreased staff collaboration, and increased staff perceptions of poor patient outcomes,” Green reported. “Participant narratives suggested improvement in communication skills would address the disruptive behaviors.”

In part two, staff perceptions of the SADBS increased significantly, from a mean of 49.08 to 70.67 (top score=100; P <0.05). At the 6-month follow-up, SADBS increased further, to a mean of 75.35.

“This small scale study found that while disruptive behaviors exist on the oncology unit, the adapted Crucial Conversations class in effective communication improved the staff's self-efficacy to address disruptive behaviors,” Green noted.

Continued monitoring of disruptive behaviors is imperative for quality patient care, and empowered communications may decrease the incidence of these behaviors, the researchers concluded.

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