Psychological safety and infection prevention practices: Results from a national survey

Patient safety competency and it associated with teamwork and psychological safety among emergency nurses in Iran

Patient safety competence, teamwork, and psychological safety are fundamental components in emergency patient care, as these elements can affect the quality of nursing care and patient safety. Therefore, the present study aimed to assess the level of patient safety competence and explore its correlations with teamwork and psychological safety among emergency department nurses in Iran. This cross-sectional descriptive-analytical study was conducted using stratified sampling proportional to the research community, involving 472 nurses from public hospitals affiliated with Mashhad University of Medical Sciences, Iran, in 2023. Data were collected using questionnaires on patient safety, teamwork, and psychological safety and analyzed with independent the Mann-Whitney U test, Pearson correlation, and linear regression analysis in SPSS-26 at a significance level of 0.05. Patient safety competence and teamwork among nurses were at a high level, while their psychological safety was at a moderate level. There was a significant inverse relationship between nurses' age and patient safety competence (p = 0.04). Patient safety competence varied significantly among nurses from different hospitals (p < 0.001). A direct and significant relationship existed between teamwork and psychological safety with patient safety competence, as well as between teamwork and psychological safety among nurses (p < 0.001). A multiple linear regression with teamwork, psychological safety, work experience and hospital type as independent variables explained 43.1% of the variance in patient safety competency (R2 = 0.431). Regression analysis revealed that teamwork (B = 0.169, 95% CI 0.139, 0.199, p < 0.001) and psychological safety (B = 0.252, 95% CI 0.205, 0.299, p < 0.001) were significant positive predictors for patient safety competency. Patient safety competency in teaching hospitals was more than not-teaching hospitals (B = 0.773, 95% CI 0.052, 1.494, p = 0.036). Work experience did not have a significant association with patient safety competency (p = 0.294). The model explained 43.1% of the variance in patient safety competency (R2 = 0.431). While nurses demonstrated high levels of patient safety and teamwork competence, their psychological safety was moderate, indicating the need to create a supportive work environment. So, increased teamwork and psychological safety can influence patient safety competence.

Influence of Psychological Safety and Safety Climate Perceptions on Nurses' Infection Prevention and Occupational Safety Practices and Environment

Background/Objectives: The aim of this study was to describe and examine the relationships among elements of infection prevention practices, the care environment, psychological safety, and safety climate in adult medical surgical units in the wake of the COVID-19 pandemic. Methods: Nurses in adult inpatient medical surgical units in the northeast were surveyed electronically. Each self-rated their infection prevention practices and elements of the care environment in their primary work unit. They were also asked to rate a series of questions regarding how psychologically safe they felt on their units as well as the overall patient safety climate. Results: A total of 259 nurses responded (52% response rate) to the survey. Overall psychological safety was rated neutrally among respondents, with a rating of 3.5 (1 being the lowest and 5 being the highest). Respondents reported better ratings of the safety climate on their unit (4.0) but also identified areas for improvement. Eight of twelve infection prevention practices were correlated with higher safety climate scores and ten were correlated with higher psychological safety scores. Nine of ten environmental factors were correlated with higher safety climate and higher psychological safety scores. Conclusions: Both psychological safety and patient safety climate are related to nurse self-ratings of performance of infection prevention practices. Similarly, the care environment nurses work in has important implications for psychological safety and patient safety. It is essential for nursing leadership to act as a steward in these areas to build a higher quality care environment for nurses and patients alike.

Psychological Safety in Medical Education, Another Challenge to Tackle?

Psychological safety is the feeling that one can take interpersonal risks without fear of negative consequences including retaliation, intimidation, or rejection. The literature base on psychological safety in medical education is increasing. Despite increasing recognition in the medical literature, many medical practitioners and educators are uncertain about the background and effects of psychological safety on medical education. For learners (students and residents), having an environment with high psychological safety means being able to admit knowledge gaps and skill deficits. Psychological safety is recognized as an essential attribute for a positive learning environment and is associated with several positive behaviors. To benefit medical educators, we contextualize the benefits of improved psychological safety in medical education and highlight the limited data substantiating what interventions are known to enhance psychological safety in graduate medical education. While it is recognized that higher psychological safety is important, creating better psychological safety is a complex challenge analogous to patient safety, well-being, and healthcare disparity. The challenges for environments with lower psychological safety are understanding what to fix and how to fix it, and recognition that quick fixes are elusive. Moving forward, medical educators must have a better understanding of how to enhance psychological safety.

Development and effectiveness of an educational program to foster psychological safety: A randomized controlled trial focusing on care workers in geriatric care facilities

This study aimed to examine the effectiveness of a program for improving interpersonal relationships to foster psychological safety among geriatric care workers. A randomized controlled trial was conducted with 192 care workers in seven geriatric care facilities. Participants were divided into intervention or control groups; intervention groups attended a 60-minute program twice. Participants completed questionnaires addressing psychological safety, work environment, and intention to leave three times in six months. A linear multiple regression analysis was performed for each score at Time 1 or Time 2 as the dependent variable, with the score at baseline as the covariate. The psychological safety score increased (p < .05), and the "exclusive workplace climate" score decreased (p < .10) between the baseline and second survey. However, the significance became nonexistent between the second and third surveys. Although the program effectively fostered psychological safety, further ingenuity should be provided for continued effectiveness.

Leadership Strategies to Increase Psychological Safety of Nurses: A Longitudinal Study

BACKGROUND AND OBJECTIVES

A work environment where employees feel comfortable taking chances without fear and with sufficient protection from retaliation is psychologically safe. The objective of this study was to investigate the effects of leader training for nurse managers on psychological safety of clinical registered nurses.

METHODS

The study was designed a longitudinal outcomes approach to assess nurse leader intervention (classes on leadership methods and psychological safety) with pre- and post-intervention measurement of nurse psychological safety at each time point.

RESULTS

The intervention and nurse leader rounding were shown to increase individual psychological safety climate scores of clinical nurses.

CONCLUSION

Psychological safety is an important component to consider in a nursing leadership role. Leadership interventions that focus on the tenets of psychological safety and include methods of being present, such as nurse leader rounding, can foster a sense of a psychologically safe environment for clinical registered nurses.

Urinary Catheter-Associated Infections

Catheter-associated urinary tract infections (CAUTIs) are common and costly hospital-acquired infections, yet they are largely preventable. The greatest modifiable risk factor for developing a CAUTI is duration of catheterization, including initial indwelling catheter placement when it may not otherwise be necessary. Alternatives to indwelling urinary catheters, including intermittent straight catheterization and the use of external catheters, should be considered in applicable patients. If an indwelling urinary catheter is required, aseptic insertion technique and maintenance should be performed. Through the use of collaborative, multidisciplinary intervention efforts, CAUTI rates can be successfully reduced.

Psychological Safety: What It Is, Why Teams Need It, and How to Make It Flourish

In health care, transforming individuals with diverse skills into an effective, cohesive team is fundamental to delivering and advancing patient care. All teams, however, are not created the same. Psychological safety has emerged as a critical feature of high-performing teams across many industries, including health care. It facilitates patient safety, quality improvement, learning, and innovation. This review presents an overview of psychological safety in medicine, describing its impact on learning, patient safety, and quality improvement. The review also explores interventions and essential leadership behaviors that foster psychological safety in teams.

The influence of hospital leadership support on burnout, psychological safety, and safety climate for US infection preventionists during the coronavirus disease 2019 (COVID-19) pandemic

OBJECTIVE

To explore infection preventionists' perceptions of hospital leadership support for infection prevention and control programs during the coronavirus disease 2019 (COVID-19) pandemic and relationships with individual perceptions of burnout, psychological safety, and safety climate.

DESIGN

Cross-sectional survey, administered April through December 2021.

SETTING

Random sample of non-federal acute-care hospitals in the United States.

PARTICIPANTS

Lead infection preventionists.

RESULTS

We received responses from 415 of 881 infection preventionists, representing a response rate of 47%. Among respondents, 64% reported very good to excellent hospital leadership support for their infection prevention and control program. However, 49% reported feeling burned out from their work. Also, ∼30% responded positively for all 7 psychological safety questions and were deemed to have "high psychological safety," and 76% responded positively to the 2 safety climate questions and were deemed to have a "high safety climate." Our results indicate an association between strong hospital leadership support and lower burnout (IRR, 0.61; 95% CI, 0.50-0.74), higher perceptions of psychological safety (IRR, 3.20; 95% CI, 2.00-5.10), and a corresponding 1.2 increase in safety climate on an ascending Likert scale from 1 to 10 (β, 1.21; 95% CI, 0.93-1.49).

CONCLUSIONS

Our national survey provides evidence that hospital leadership support may have helped infection preventionists avoid burnout and increase perceptions of psychological safety and safety climate during the COVID-19 pandemic. These findings aid in identifying factors that promote the well-being of infection preventionists and enhance the quality and safety of patient care.

Perceptions of organizational culture among infection preventionists in Israel, the United States, and Thailand: Results from national infection prevention surveys

In national surveys of infection preventionists in Israel (n = 15), the United States (n = 415), and Thailand (n = 100), we found that views of organizational culture track well with these countries' cultural dimension scores of power distance and individualism. Our findings highlight the importance of considering cultural dimensions when implementing infection prevention efforts.

Integrating infection control and environmental management work systems to prevent Clostridioides difficile infection

Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite their shared goals. We provide results from a qualitative study of Clostridioides difficile infection prevention in Veterans Affairs facilities regarding challenges in coordination between these teams and opportunities to improve coordination and maximize infection prevention activities.

Interactive Interventions Can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care-Experience From the "Safe Hands" Project

PURPOSE

This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation.

DESIGN

This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention.

METHODS

The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017.

FINDINGS

The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department.

CONCLUSIONS

This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.

Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small-Medium-Sized Hospitals: A Cross-Sectional Study

Perceived safety culture and nursing work environment are considered important prerequisites for a patient safety activity. Patient safety is also associated with person-centered care; however, few studies apply the person-centered care framework which includes staff attributes and care environment. This study aimed to examine the canonical correlations of person-centered care factors, including professional self-concept, patient safety culture, nursing work environment, and patient safety activities of nurses working in small-medium-sized hospitals. A cross-sectional survey was used. Participants included 171 nurses from seven small-medium-sized hospitals in Busan metropolitan city, in Korea. Data were analyzed using descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation coefficients, and canonical correlations. Two significant canonical variates were found. First, better professional self-concept, a positive patient safety culture, and better nursing work environment were associated with better patient safety care activities. Second, a negative patient safety culture and healthy nursing work environment were associated with a lack of communication between medical staff. Person-centered framework factors such as staff attributes and care environment were positively associated with patient safety activities. Based on the results, nurses in small-medium-sized hospitals should be highly aware of their professional self-concept. Moreover, nurses should be equipped with psychological safety and a healthy work environment to enhance patient safety activities.

The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings

OBJECTIVES

The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) exploring whether PS differs by healthcare worker demographic factors, and (4) exploring whether PS differs by participation in 2 institutional programs, which encourage PS and speaking-up with patient safety concerns (i.e., Safety WalkRounds and Positive Leadership WalkRounds).

METHODS

Of 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate, 81%) completed the 6-item PS scale, demographics, safety culture scales, and questions on exposure to institutional initiatives. Psychometric analyses, correlations, analyses of variance, and t tests were used to test the properties of the PS scale and how it differs by demographic factors and exposure to PS-enhancing initiatives.

RESULTS

The PS scale exhibited strong psychometric properties, and a 1-factor model fit the data well (Cronbach α = 0.80; root mean square error approximation = 0.08; Confirmatory Fit Index = 0.97; Tucker-Lewis Fit Index = 0.95). Psychological Safety scores differed significantly by role, shift, shift length, and years in specialty. The PS scale correlated significantly and in expected directions with safety culture scales. The PS score was significantly higher in work settings with higher rates of exposure to Safety WalkRounds or Positive Leadership WalkRounds.

CONCLUSIONS

The PS scale is brief, diagnostic, and actionable. It exhibits strong psychometric properties; is associated with better safety, teamwork climate, and well-being; differs by demographic factors; and is significantly higher for those who have been exposed to PS-enhancing initiatives.

Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study

AIMS

This study aimed to assess predictors of patient safety competency among emergency nurses.

BACKGROUND

The role of emergency nurses is to provide high-quality health care to patients and ensure their safety. The patient safety competency includes the absence of unnecessary or potential harm when providing health care to patients. In providing health care, effective teamwork can affect patient safety and outcomes. Psychological safety is essential to effective teamwork. Psychological safety allows health care workers to accept the interpersonal risks needed to perform effective teamwork and maintain patient safety.

METHODS

This study was cross-sectional correlational research. Using convenience sampling methods, 254 emergency department nurses from five educational hospitals were enrolled in the study. Patient Safety in Nursing Education Questionnaire was used to measure the patient safety competency, the teamwork questionnaire to examine the teamwork, and Edmondson psychological safety questionnaire was used to measure psychological safety. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multivariate stepwise linear regression analysis were applied using SPSS 14.0.

RESULTS

Participants' mean patient safety competency score was 2.97 (1-4). Between 18 independent variables evaluated in the multiple regression analysis, seven had a significant effect on the patient safety competency of emergency nurses (R²: 0.39, p < .001).

CONCLUSIONS

The patient safety competency of emergency department nurses was primarily related to the structure and leadership of the team and secondary to psychological safety and experience in patient safety activity. The results demonstrated that policymakers and hospital managers should improve and enhance team structure and leadership via supervision and cooperation with the nursing staff. The development of training programs in patient safety activities, improvement, and increase of psychological safety at the levels of the nursing units is essential to increase patient safety competencies in the emergency nursing program.

Safe to speak: Fostering psychological safety among incoming predoctoral dental students

PURPOSE

To describe the implementation and impact of an introductory session on psychological safety for incoming first-year Doctor of Dental Surgery (DDS) learners.

METHODS

In August 2020, first-year DDS students participated in a 2-h online instructional session focused on defining psychological safety, the behaviors that promote and disrupt it, and setting expectations for learner and faculty behavior to foster it. Learners worked in small groups to discuss the various components of psychological safety and document their discussion in a collaborative workspace before a large group debriefs. Participants were requested to complete an electronic survey before and after the session to evaluate their change in knowledge, confidence in performing tasks to foster psychological safety, and perceptions about their level of control. Six months after the session, learners were requested to participate in a focus group for additional feedback and reflections.

RESULTS

Seventy-four participants completed the before and after experience survey. There was a statistically significant increase in knowledge of the components of psychological safety and perceptions of control. In addition, self-reported measures of confidence to perform the tasks increased from an average rating of 36% confident before the session to 86% confident afterward. In the experience, learners were active in their discussion and generated many ideas about behaviors that promote and disrupt psychological safety, which informed the creation of learner and faculty classroom expectations.

CONCLUSION

Engaging learners in discussions about psychological safety can be a useful activity to establish expectations and create group norms that may support collaborative learning environments.

A concept analysis of psychological safety: Further understanding for application to health care

AIM

To clarify the concept of psychological safety in a healthcare context and to provide the first theoretical framework for improving interpersonal relationships in the workplace to better patient care.

DESIGN

A Rodgers' concept analysis.

METHODS

The concept analysis was conducted using a systematic search strategy on PubMed, CINAHL, PsycINFO and Ichushi-Web.

RESULTS

An analysis of 88 articles studying psychological safety in health care identified five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, group-level phenomenon, safe work environment for taking interpersonal risks and non-punitive culture. The antecedents included structure/system factors, interpersonal factors and individual factors. The four consequences included performance outcomes, organizational culture outcomes, and psychological and behavioural outcomes.

COVID-19 event strength, psychological safety, and avoidance coping behaviors for employees in the tourism industry

The impact of COVID-19 on the emotions or behaviors of employees in tourism enterprises would be worthwhile for investigation since COVID-19 has harmed not only people's health and lives but also most tourism enterprises. By identifying the effect of COVID-19 event strength on avoidance coping behaviors, the behaviors isolated from customers unlikely beneficial for tourism enterprises, we not only revealed that COVID-19 event strength indirectly affects avoidance coping behaviors through either the fear of external threat or psychological safety, but also disclosed that supervisor safety support would moderate the effect of psychological safety on such coping behaviors. We argue that understanding potential causes, such as the fear of external threat and psychological safety, and identifying possible solutions, like supervisor safety support, may be key factors for restarting tourism enterprises successfully under the severe impact of the COVID-19 pandemic.