Demographics (n = 236).

Background
There is a well-established relationship between the quality of workplace interactions among nurses, physicians, their managers, and nurse colleagues, and the subsequent improvement in patient outcomes. However, despite the growing body of research on this topic in developed countries, there remains a notable paucity of literature exploring these dynamics in developing countries.
Aim
To investigate the impact of workplace relationships on nurse-reported quality of care and patient safety.
Design
This study applied a cross-sectional survey design
Method
A multiphase sampling method was applied. Purposive sampling was used to select the province, health sector and hospitals (n = 3). All-inclusive sampling was applied to in-patient units of the selected hospitals and nursing staff in those units (n = 236). Data was collected in April 2021, using validated instruments.
Results
Nurse manager ability, leadership, and support was not experienced as positively contributing to the practice environment and had the most impact on quality of care and patient safety. Collegial nurse-physician relationships were experienced as contributing positively to the practice environment, and had the most impact on adverse events, namely medication errors, patient falls after admission and healthcare-associated infections. Increased exposure to COVID-19 patients resulted in more positive perceptions of nurses regarding collegial nurse-physician relationships. The most common perpetrators of workplace violence were supervisors/managers, followed by nursing colleagues. On average participants experience more personal workplace violence than physical workplace violence. Personal workplace violence had more effect on quality of care, patient safety, and adverse events than physical workplace violence.
Conclusion
Positive workplace relationships or collegiality, especially nurse-manager relationships, appear to have the most impact on nurse-perceived quality of care and patient safety, followed by nurse-physician relationships, and then workplace violence.
Relevance to clinical practice
The focus of education interventions should be on developing leadership, and recruiting and retaining relationship-focused leaders since leaders have the greatest impact on nurse-reported quality of care and patient safety.

背景
目前已有充分研究证实，护士、医师、其管理者以及护士同事之间的职场互动质量，与患者结局的后续改善存在明确关联。尽管发达国家针对该主题的研究日益增多，但目前仍显著缺乏探究发展中国家此类互动动态的相关文献。

研究目的
本研究旨在探讨职场关系对护士报告的护理质量与患者安全的影响。

研究设计
本研究采用横断面调查设计。

研究方法
本研究采用多阶段抽样方案：首先通过目的抽样法选取省份、卫生部门及医院（共3家）；随后对入选医院的住院病区及该病区内的护理人员实施全面抽样，最终纳入236名研究对象。研究于2021年4月采用经过信效度验证的调研工具收集数据。

研究结果
护士管理者的能力、领导力与支持未被护士感知为对实践环境存在积极贡献，但其对护理质量与患者安全的影响最为显著。医护同事间的协作关系则被护士感知为对实践环境存在积极贡献，且对不良事件（即用药错误、入院后患者跌倒及医疗相关感染）的影响最为显著。接触新冠患者越多的护士，对医护协作关系的感知越积极。职场暴力最常见的施暴者为管理者/督导人员，其次为护士同事。研究对象平均遭遇的非肢体职场暴力多于肢体职场暴力；且非肢体职场暴力对护理质量、患者安全及不良事件的影响程度高于肢体职场暴力。

研究结论
积极的职场关系或同事协作，尤其是护-管理者关系，对护士感知的护理质量与患者安全的影响最为显著，其次为医护协作关系，最后为职场暴力。

临床实践意义
临床教育干预的核心应聚焦于培养领导力，以及招聘并留住注重关系建设的管理者——鉴于管理者对护士报告的护理质量与患者安全影响最为显著。