Background: Although there is a sizeable body of evidence regarding the nature of hostile behaviours among\r\nclinicians in the nursing workplace, what is less clear is the nature of the relationship between these behaviours\r\nand patient care. To inform the development of appropriate intervention strategies we examine the level of\r\nevidence detailing the relationships between hostile clinician behaviours and patient care.\r\nMethods: Published qualitative and quantitative studies that examined hostile clinician behaviours and patient care\r\nwere included. Quality assessment, data extraction and analysis were undertaken on all included studies. The search\r\nstrategy was undertaken in July and August 2011 and comprised eight electronic databases (CINAHL, Health\r\nCollection (Informit), Medline (Ovid), Ovid Nursing Full Text, Proquest Health and Medicine, PsycInfo, Pubmed and\r\nCochrane library) as well as hand searching of reference lists.\r\nResults: The search strategy yielded 30 appropriate publications. Employing content analysis four themes were\r\nrefined: physician-nurse relations and patient care, nurse-nurse bullying, intimidation and patient care, reduced nurse\r\nperformance related to exposure to hostile clinician behaviours, and nurses and physicians directly implicating patients\r\nin hostile clinician behaviours.\r\nConclusions: Our results document evidence of various forms of hostile clinician behaviours which implicate\r\nnursing care and patient care. By identifying the place of nurse-nurse hostility in undermining patient care, we\r\nfocus attention upon the limitations of policy and intervention strategies that have to date largely focused upon\r\nthe disruptive behaviour of physicians. We conclude that the paucity of robustly designed studies indicates the\r\nproblem is a comparatively under researched area warranting further examination.
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