Patient Participation in Patient Safety and Its Relationships with Nurses' Patient-Centered Care Competency, Teamwork, and Safety Climate

The relationship between patient safety culture and attitudes toward incident reporting among registered nurses

BACKGROUND

Patient safety is a primary concern in healthcare due to errors and low incident reporting rates. A strong safety culture and positive attitudes towards reporting are crucial for improving patient safety culture (PSC). Overcoming barriers and conducting research can enhance incident reporting, foster a safety culture, and improve patient outcomes.

AIM

To investigate the relationship between patient safety culture and attitudes toward incident reporting among Jordanian nurses.

METHODOLOGY

This study employed a cross-sectional descriptive correlational design. A convenient sample of 307 registered staff nurses from Jordanian hospitals across different sectors was selected. Validated and translated questionnaires, which included the Incident Reporting Culture Questionnaire and the Hospital Survey on Patient Safety Culture, were used for data collection. Statistical analyses, such as descriptive and inferential statistics (including Pearson correlation, independent sample t-test, one-way ANOVA, and hierarchical regression analysis), were employed to address research questions using SPSS version 26.

RESULTS

The findings revealed that the Patient Safety Culture (PSC) organizational learning dimension had the highest positive response rate (70.6%), while the hands-off and transition dimension had the lowest score (24.9%). Approximately 43.6% of participants reported no events in the last 12 months, whereas only 4.2% reported experiencing 12 or more events. The overall perception of patient safety was rated as 'very good' by 55.7% of the participants. The results from the Incident Reporting Culture Questionnaire (IRCQ) indicated a moderate overall willingness among nurses to report incidents, along with positive attitudes toward implementing lessons learned from errors and offering feedback on incident reports. Significant differences in attitudes toward incident reporting were observed based on the type of hospital (p = 0.037) and working hours (p = 0.012). Moreover, significant correlations were found between Patient Safety Culture dimensions and Incident Reporting Culture Questionnaire dimensions. The most robust positive correlation was observed between the feedback and communication about errors dimension in Patient Safety Culture and the learning from errors dimension in Incident Reporting Culture Questionnaire (r = 0.401, p = 0.000). Through hierarchical multiple regression analysis, it was demonstrated that Patient Safety Culture significantly predicted attitudes toward incident reporting (β = 0.441, p < 0.001), while controlling for demographic variables.

CONCLUSION

This study discovered a positive correlation between patient safety culture and attitudes toward incident reporting among Jordanian nurses. Enhancing patient safety culture and adopting non-punitive measures can effectively improve incident reporting behavior within healthcare settings.

Features of and barriers to effective teamwork at university and on clinical placement: The student radiographer perspective

INTRODUCTION

Radiography departments require effective teamwork in order to deliver high standards of safe and efficient patient care. The aim of this study was to explore the features of and barriers to effective teamwork as experienced by pre-registration BSc and MSc diagnostic radiography students at university and during clinical placement.

METHOD

This qualitative study used semi-structured interviews and the thematic analysis approach of Braun and Clark to investigate the views of diagnostic radiography students on BSc and MSc pre-registration programmes from one university in the Northwest of England.

RESULTS

Barriers to teamwork were identified in a main theme, acceptance into the team and two subthemes, theory-practice gap and trying on the professional self. Features of effective teams were identified in two main themes, positive experiences of teamwork and an ideal team. Students highlighted caring for the team, as equally as important as caring for the patient, and another main theme, a caring team, described both the barriers to, and features of, effective teams.

CONCLUSION

Students had a developed understanding of the features of effective teams and equated a team that cares for each other, as one able to provide the best care to patients. This study provides an insight into the impact of teamwork on radiography students experiences of university and clinical placement. Barriers to teamwork affect students' sense of belonging and overall professional development in a clinical environment.

IMPLICATIONS FOR PRACTICE

This study can better inform university and clinical staff regarding improvements to teamworking education and practice for students. It may also provide insights which may influence the teamworking practice of clinical staff.

People's experiences of their involvement in nursing care: a systematic review protocol

BACKGROUND

People's involvement and participation in their own care are the essential basis of nursing care. This phenomenon can be characterised as an approach based on the integration of the person's values, beliefs, and preferences during nursing care. This process contributes to improve quality of care, improve satisfaction levels, and result in a better experience for people receiving care. To promote the person's participation in nursing care, it is necessary to better understand their experiences about this topic.

AIM

To synthesise the available evidence on people's experiences of their involvement and participation in nursing care in a hospital setting.

DESIGN & SETTING

A systematic review that will be conducted according to the JBI methodology for systematic reviews of qualitative evidence.

METHOD

The study selection, critical appraisal, and data extraction will be conducted by two independent reviewers. This review will consider studies with a qualitative approach, published and unpublished, in Portuguese, English, or Spanish, with no temporal limit, which include adults, aged 18 years or older, who have experienced an admission to a hospital, that explored people's experiences of their involvement and participation in nursing care in hospital ward settings. Findings will be presented using a meta-aggregation approach and narrative format, and the final synthesised findings will be graded according to the ConQual approach.

CONCLUSION

It is expected that this qualitative synthesis will inform people, health professionals, and policymakers, allowing them to develop recommendations to promote the person's participation in nursing care.

Intensive and critical care nurses patient safety, care quality, professional self-efficacy, and missed nursing care: Structural equation model analysis

BACKGROUND

Globally, nurses' patient safety, care quality, and missed nursing care are well documented. However, there is a paucity of studies on the mediating roles of care quality and professional self-efficacy, particularly among intensive and critical care unit (ICCU) nurses in developing countries like the Philippines.

AIM

To test a model of the interrelationships of patient safety, care quality, professional self-efficacy, and missed nursing care among ICCU nurses.

METHODS

A cross-sectional, correlational design study was used. ICCU nurses (n = 335) were recruited via consecutive sampling from August to December 2023 and completed four validated self-report scales. Spearman Rho, structural equation modeling, mediation, and path analyses were utilized for data analysis.

RESULTS

The emerging model demonstrated acceptable fit parameters. Patient safety positively influenced care quality (β = .34, p = .002) and professional self-efficacy (β = .18, p = .011), while negatively affecting missed nursing care (β = -.34, p = .003). Care quality positively and negatively influenced professional self-efficacy (β = .40, p = .003) and missed nursing care (β = -.13, p = .003), respectively. Professional self-efficacy indirectly impacted missed nursing care (β = -.32, p = .003). Care quality (β = -.10, p = .003) and professional self-efficacy (β = .13, p = .003) showed mediating effects between patient safety and missed nursing care.

LINKING EVIDENCE TO ACTION

ICCU nurses' care quality and professional self-efficacy are essential mediating factors that can bolster patient safety practices, hence reducing missed nursing care. Therefore, healthcare organizations, nurse managers, and policymakers should cultivate care quality and self-efficacy by creating support programs and providing a positive practice environment. Nurses and nurse supervisors could directly observe missed nursing care in the ICCU to understand its underreported causes.

The effect of teamwork, communication skills, and structural empowerment on the provision of patient-centered care among nurses in Eswatini: A cross-sectional study

AIMS

To identify the influence of teamwork, communication skills, and structural empowerment on providing patient-centered care among nurses in Eswatini.

DESIGN

A quantitative, cross-sectional survey was used.

METHODS

This survey conducted in Eswatini selected registered nurses working as full-time nurses with more than 3 months of working experience using convenience sampling. Different measures were adopted and used to collect data among 130 eligible nurses from February to March 2022. Data were analyzed using Statistical Program for Social Sciences version 26.0.

RESULTS

A total of 123 nurses responded in the study and the mean age was 31.05 years with a standard deviation of 5.49. The overall response rate was 94.6% in this study. Hierarchical multiple regression analysis revealed that teamwork (β = 0.236, p < 0.05) and communication skills (β = 0.328, p < 0.05) were significant predictors of the provision of patient-centered care among nurses.

CONCLUSION

Team-building exercises and management interventions to empower nurses should be established to improve the provision of patient-centered care among nurses. Nurses should be empowered to provide patient-centered care in health facilities by encouraging them to provide their input in management procedures and planning programs.

IMPACT

Clinical practice requires nurses to use effective communication skills and work as a team. Nursing care established on teamwork, respect, empathy, and communication skills allows patients to express their concerns and views in health facilities as they feel involved in care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in this paper. This study only involved registered nurses as health professionals.

RETRACTED: Safety climate, quality of care, adherence to and compliance with standard precautions among nurses: Structural equation modeling

AIMS

The aim was to investigate the interrelationships of nurses' safety climate, quality of care, and adherence to and compliance with standard precautions (SPs).

BACKGROUND

Investigations about nurses' safety climate and quality care and their association with adherence to and compliance with SPs remain remarkably scant across literature, specifically among developing countries like the Philippines.

DESIGN

Cross-sectional design and structural equation modeling (SEM) approach while complying with STROBE guidelines.

METHODS

Participant nurses were recruited using convenience sampling (n = 870). Four validated self-report instruments were used to collect data from February to August 2022. Spearman rho, SEM, mediation, and path analyses were employed for data analysis.

RESULTS

The emerging model showed acceptable model fit parameters. The safety climate positively influenced the quality of care and adherence to and compliance with SPs. Quality of care directly affected adherence to SPs, while adherence to SPs directly affected compliance with SPs. The quality of care mediated the relationship between safety climate and adherence to SPs. Whereas adherence to SPs mediated the relationships between safety climate and compliance with SPs and the quality of care and compliance with SPs.

CONCLUSIONS

Nurses' safety climate directly affected the quality of care and SPs adherence and compliance. The quality of care mediated the impact of safety climate on SPs adherence. Finally, SPs adherence demonstrated a mediating effect among quality of care, safety climate, and SPs compliance.

IMPLICATIONS FOR NURSING POLICY AND PRACTICE

Nursing policymakers and administrators can use the findings to design strategic policies and sustainable in-service educational courses fostering and maintaining nurses' safety climate, quality of care, and SPs adherence and compliance.

Effectiveness of an educational intervention to increase professional nurses' person-centred care competence in long-term care of older people-Quasi-experimental study

BACKGROUND

Based on previous evidence person-centred care (PCC) as a quality indicator is important in long-term care (LTC) settings for older people. Effective ways to increase nurses' person-centred care competence are missing.

AIM

To evaluate the effectiveness of a continuing education (CE) intervention named 'Person First-Please' (PFP) for improving nurses' PPC competence and its connection to PPC climate.

METHODS

Quasi-experimental cluster design with intervention and control groups was carried out in LTC settings for older people. The intervention group (n = 77) received a 10-week CE intervention, with control group (n = 123) working as usual. The primary outcome was professional nurses' PCC competence. Secondary outcome was the PCC climate as perceived by nurses and, residents with their next of kin. Measurements were conducted pre-/post-intervention and after 6 weeks using the validated, Person-centred Care Competence scale and the Person-centred Care Climate questionnaire, staff and patient versions. Data was analysed with descriptive and inferential statistics.

RESULTS

PCC competence was significantly increased in the intervention group and remained after 6 weeks of follow-up. PCC climate increased in the intervention group in total score and also in all sub-scales, across residents with their next of kin. The control group did not show any significant change. Comparisons of PCC competence and PCC climate in time between intervention and control groups confirmed that changes seen between groups were statistically significant in intervention group.

LIMITATIONS

Measurements were self-assessments, which may have been affected by bias, especially in context of competence assessment.

CONCLUSION

The intervention was effective in increasing professional nurses' PCC competence and on person-centred care climate in long-term care settings for older people.

Perception gaps of patient engagement for patient safety between healthcare professionals and the public in Korea

BACKGROUND

To ensure effective patient engagement, patients' efforts, partnerships with healthcare professionals, and the organisation's role in providing safe healthcare settings must be emphasised. Perception gaps regarding patient engagement between the public and healthcare professionals could prevent healthy partnerships from forming and hinder patient engagement activities. This study examined healthcare professionals' perception of patient engagement and compared the findings with that determined for the public in a previous study.

METHODS

An anonymous online survey was conducted in February 2020 among 1,007 healthcare professionals (physicians, nurses). The questionnaire comprised five parts regarding the perception of patient engagement. Descriptive analysis and Chi-squared/Fisher's exact tests determined the frequency and significant differences among the public from previous study and healthcare professionals in this study.

RESULTS

The perception of the importance of patient safety was high among healthcare professionals and the public. However, statistically significant differences in perceptions were observed among the public and healthcare professionals in all categories. The perception gaps were substantial between the groups in sub-categories of engagement for patient safety during medical treatment; 86% of physicians and 90% of nurses agreed that patients participate in the decision-making for the treatment process. Conversely, 58% of the public agreed. Only 22% of the public agreed with confirming healthcare professionals' hand washing to prevent infection, versus 57% of physicians and 65% of nurses. More than 89% of healthcare professionals positively perceived medical dispute mediation versus only half of the public. In certain areas such as "medical dispute mediation and arbitration programs", "fall prevention", and "infection prevention", there was a statistically significant difference in the perception of patient involvement among healthcare professionals, with nurses' perception being particularly more positive than that of physicians.

CONCLUSIONS

The healthcare professionals' perception of patient engagement was more positive than that of the public. To narrow the perception gaps and enhance the public's perception, strategies involving changes in healthcare systems, promotional efforts, and educational initiatives should be developed. Additionally, strategies should be formulated for healthcare professionals to better engage as partners in patient care.

Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study

INTRODUCTION

Investigations about the interrelationships of nurses' safety climate, quality of care, and standard precautions (SP) adherence and compliance remain particularly scarce in the literature. Thus, we tested a model of the associations between nurses' safety climate, quality of care, and the factors influencing adherence and compliance with SPs utilizing the structural equation modeling (SEM) approach.

DESIGN

Cross-sectional design complying with STROBE guidelines.

METHODS

Using convenience sampling, nurses (n = 730) from the Philippines were recruited. Data were collected between April and September 2022 using four validated self-report measures. Spearman Rho, mediation and path analyses, and SEM were employed for data analysis.

RESULTS

Acceptable model fit indices were shown by the emerging model. The safety climate is positively associated with quality of care and factors influencing adherence to and compliance with SPs. Quality of care directly affected factors influencing adherence to SPs. The factors influencing adherence to SPs directly affected SP compliance. Quality of care mediated between safety climate and the factors influencing adherence to SPs. Factors influencing adherence to SPs mediated between safety climate, quality of care, and SP compliance.

CONCLUSIONS

The study's variables are not distinct but overlapping nursing concepts that must be examined collectively. Nurse administrators can utilize the emerging model to formulate strategies and regulations for evaluating and enhancing nurses' safety climate, quality of care, and SP adherence and compliance.

CLINICAL RELEVANCE

Our findings may impact policymaking, organizational, and individual levels to improve nurses' clinical practice.

PATIENT OR PUBLIC CONTRIBUTION

This study had no patient contribution or public funding.

Effectiveness and feasibility of an interprofessional training program to improve patient safety-A cluster-randomized controlled pilot study

Introduction

Interprofessional healthcare teams are important actors in improving patient safety. To train these teams, an interprofessional training program (IPTP) with two interventions (eLearning and blended learning) was developed to cover key areas of patient safety using innovative adult learning methods. The aims of this study were to pilot test IPTP regarding its effectiveness and feasibility. The trial was registered with DRKS-ID: DRKS00012818.

Methods

The design of our study included both a pilot investigation of the effectiveness of the two interventions (eLearning and blended learning) and testing their feasibility (effectiveness-implementation hybrid design). For testing the effectiveness, a multi-center cluster-randomized controlled study with a three-arm design [intervention group 1 (IG1): eLearning vs. intervention group 2 (IG2)]: blended learning (eLearning plus interprofessional in-person training) vs. waiting control group (WCG) and three data collection periods (pre-intervention, 12 weeks post-intervention, and 24 weeks follow-up) was conducted in 39 hospital wards. Linear mixed models were used for the data analysis. The feasibility of IPTP was examined in 10 hospital wards (IG1) and in nine hospital wards (IG2) using questionnaires (formative evaluation) and problem-focused interviews with 10% of the participants in the two intervention groups. The collected data were analyzed in a descriptive exploratory manner.

Results

Pilot testing of the effectiveness of the two interventions (eLearning and blended learning) showed no consistent differences between groups or a clear pattern in the different outcomes (safety-related behaviors in the fields of teamwork, error management, patient involvement, and subjectively perceived patient safety). Feasibility checks of the interventions showed that participants used eLearning for knowledge activation and self-reflection. However, there were many barriers to participating in eLearning, for example, lack of time or access to computers at the ward. With regard to in-person training, participants stated that the training content sensitized them to patient-safety-related issues in their everyday work, and that awareness of patient safety increased.

Discussion

Although the interventions were judged to be feasible, no consistent effects were observed. A possible explanation is that the duration of training and the recurrence rate may have been insufficient. Another conceivable explanation would be that participants became more sensitive to patient safety-critical situations due to their knowledge acquired through the IPTP; therefore, their assessment post-intervention was more critical than before. In addition, the participants reported high pre-measurement outcomes. Future studies should examine the evidence of the intervention within a confirmatory study after adapting it based on the results obtained.

Person-centred care competence and person-centred care climate described by nurses in older people's long-term care-A cross-sectional survey

BACKGROUND

Person-centred care requires that nurses are competent in this approach to care. There may be an association between person-centred care competence and person-centred care climate, but it has not been demonstrated in the literature. This is the justification for the survey study to gain staff's perceptions of such a relationship.

OBJECTIVES

The aim of this study was to analyse the levels and associations between person-centred care competence and the person-centred care climate as assessed by professional nurses in long-term care settings for older people.

METHODS

A descriptive cross-sectional survey design with cluster sampling was used to recruit professional nurses of different levels from six long-term care institutions for older people. Data were collected using the Patient-centred Care Competency scale (PCC) and the Person-centred Climate Questionnaire staff version (PCQ-S) in September 2021 and analysed with descriptive and inferential statistics.

RESULTS

The mean score on the PCC was rated at a good level of 3.80 (SD 0.45), and the PCQ-S was rated at a good level of 3.87 (SD 0.53). The correlation between PCC and PCQ-S total scores (r = .37, p < .001) indicated that person-centred care competence and person-centred care climate were associated. No associations were detected between nurses' educational levels and PCC (p = .19) or PCQ-S (p = .13) or in terms of age or work experience.

CONCLUSIONS

The results provide insights into competence and climate levels of person-centred care and preliminary evidence of an association between nurses' assessed competence in person-centred care and the perceived person-centred care climate in long-term care. Nurses' individual characteristics did not appear to affect the level of person-centred care competence or climate. In the future professional nurses of different levels could benefit from effective continuing education in person-centred care. This study design serving for the future intervention study registered to the ClinicalTrials.goc NCT04833153.

Factors Associated With Changes in Patient-Centered Care in Undergraduate Nursing Students

AIM

The purpose of this study was to examine active listening, self-awareness, and empathy and how they relate to changes in patient-centered care (PCC) in undergraduate nursing students.

BACKGROUND

PCC is associated with better patient outcomes, but the level of PCC has been found to be low in nursing students.

METHOD

This secondary analysis used baseline and follow-up data at two time points from 50 undergraduate nursing students.

RESULTS

Changes in self-awareness were associated with changes in PCC directly (Follow-Up 1) or directly and indirectly through the effects on changes in empathy (Follow-Up 2), controlling for age, experience, and intervention. Changes in active listening were associated with changes in PCC only indirectly through the effect on changes in empathy only at Follow-Up 2.

CONCLUSION

Changes in self-awareness and active listening need to be the first targets of interventions to improve PCC in undergraduate nursing students.

Nurses' patient safety competency, a predictor for safe care in psychiatric wards?

PURPOSE

This study examined the relationship between patient safety competence and safe care from the viewpoints of nurses working in psychiatry wards.

DESIGN AND METHODS

The present descriptive correctional study was conducted in two psychiatry hospitals in Iran in 2020. All the nurses were selected as the study participants using the census sampling method (N = 209).

FINDINGS

Nurses' patient safety competency was at a low level (2.54 ± 0.52), but nurses' safe care was at a moderate level (242.08 ± 61.32). A strong positive relationship was found between the patients' safety competency and nurses' safe care (p = 0.001, r = 0.84).

PRACTICE IMPLICATIONS

Nursing managers should support nurses by providing the required resources and operational strategies to improve their competency and safe care in providing quality care.

Effects of Mindfulness Meditation on Doctors' Mindfulness, Patient Safety Culture, Patient Safety Competency and Adverse Event

OBJECTIVE

This study investigated the effects of mindfulness meditation on doctors' mindfulness, patient safety culture, patient safety competency, and adverse events.

METHODS

We recruited 91 doctors from a hospital in China and randomized them to mindfulness meditation group (n = 46) and a waiting control group (n = 45). The mindfulness meditation group underwent an 8-week mindfulness meditation intervention, while the control group underwent no intervention. We measured four main variables (mindfulness, patient safety culture, patient safety competency, and adverse event) before and after the mindfulness meditation intervention.

RESULTS

In the experimental group, mindfulness, patient safety culture and patient safety competency were significantly higher compared with those of the control group. In the control group, there were no significant differences in any of the three variables between the pre-test and post-test. Adverse events in the experimental group were significantly lower than in the control group.

CONCLUSIONS

The intervention of mindfulness meditation significantly improved the level of mindfulness, patient safety culture and patient safety competency. During the mindfulness meditation intervention, the rate of adverse events in the meditation group was also significantly lower than in the control group. As a simple and effective intervention, mindfulness meditation plays a positive role in improving patient safety and has certain promotional value.

Patient Participation in Healthcare Activities: Nurses' and Patients' Perspectives in Taiwan

Patient participation in healthcare activities is key in producing successful patient-centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients, using a qualitative study with a purposive sample of 39 nurses and 15 patients. A semi-structured interview was applied to focus groups for nurses, and face-to-face interview for patients. Content analysis was utilized to analyze the data, and common themes and subthemes were identified showing three similarities- authoritative culture, participation behaviors, and obstacles to participation; and two differences- sources of acquiring patient-related health information and responsible party. Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman language to explain, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced to enhance patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge. This article is protected by copyright. All rights reserved.

Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety

BACKGROUND

Patients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness.

METHODS

A systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane-Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible; two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted.

RESULTS

Twenty-six papers reporting on twenty-seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of 'patient engagement' varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user-friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care.

CONCLUSIONS

Agency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient-provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information.

PATIENT OR PUBLIC CONTRIBUTION

Review progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).

Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals' perspectives: A systematic review and meta-synthesis

AIMS

To explore patients' and healthcare professionals' (HCPs) perceived barriers and facilitators to patient engagement in patient safety.

METHODS

We conducted a systematic review and meta-synthesis from five computerized databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus and PsycINFO, as well as grey literature and reference lists of included studies. Data were last searched in December 2019 with no limitation on the year of publication. Qualitative and Mix-methods studies that explored HCPs' and patients' perceptions of barriers and facilitators to patient engagement in patient safety were included. Two authors independently screened the titles and the abstracts of studies. Next, the full texts of the screened studies were reviewed by two authors. Potential discrepancies were resolved by consensus with a third author. The Mixed Methods Appraisal Tool was used for quality appraisal. Thematic analysis was used to synthesize results.

RESULTS

Nineteen studies out of 2616 were included in this systematic review. Themes related to barriers included: patient unwillingness, HCPs' unwillingness, and inadequate infrastructures. Themes related to facilitators were: encouraging patients, sharing information with patients, establishing trustful relationship, establishing patient-centred care and improving organizational resources.

CONCLUSION

Patients have an active role in improving their safety. Strategies are required to address barriers that hinder or prevent patient engagement and create capacity and facilitate action.

Factors influencing the patient safety climate in intensive care units: cross-sectional study

BACKGROUND

Measuring the patient safety climate of a health service provides important information about the safety status at a given time. This study aimed to determine the factors influencing the patient safety climate in Intensive Care Units.

METHODS

An analytical and cross-sectional study conducted in 2017 and 2018 in two adult Intensive Care Units of a Brazilian Teaching Hospital. The Safety Attitudes Questionnaire instrument was applied with the multidisciplinary teams to determine the factors influencing the patient safety climate. Data were double entered into a database and processed using the R (version 3.5.0) statistical software. Position, central tendency and dispersion measures were taken and absolute and relative frequencies, mean and confidence intervals were calculated for the quantitative variables. Linear regression was performed to verify the effect of variables on the SAQ domains. Variables with a p-value of less than 0.25 were selected for multivariate analysis.

RESULTS

A total of 84 healthcare providers participated in the study. The mean Safety Attitudes Questionnaire score was 59.5, evidencing a negative climate. The following factors influenced the safety climate: time since course completion, professional category, type of employment contract, complementary professional training, and weekly workload.

CONCLUSIONS

The factors identified indicate items for planning improvements in communication, teamwork, work processes, and management involvement, aiming to ensure care safety and construct a supportive safety climate.

How to Mitigate the Negative Effect of Emotional Exhaustion among Healthcare Workers: The Role of Safety Climate and Compensation

This study examines the relationship between emotional exhaustion and job satisfaction. We further propose a safety climate and compensation as contextual variables that weaken the effect of emotional exhaustion. Survey data collected from 694 employees of a public hospital provided support for the hypothesized research model. The hierarchical multiple regression results reveal that high emotional exhaustion is negatively related to job satisfaction. In addition, the results suggest that compensation and a safety climate are moderating variables that mitigate the negative effects of emotional exhaustion. The theoretical implications and future directions are discussed.

Validation of the Patient-Centred Care Competency Scale Instrument for Finnish Nurses

Patient-centredness in care is a core healthcare value and an effective healthcare delivery design requiring specific nurse competences. The aim of this study was to assess (1) the reliability, validity, and sensitivity of the Finnish version of the Patient-centred Care Competency (PCC) scale and (2) Finnish nurses' self-assessed level of patient-centred care competency. The PCC was translated to Finnish (PCC-Fin) before data collection and analyses: descriptive statistics; Cronbach's alpha coefficients; item analysis; exploratory and confirmatory factor analyses; inter-scale correlational analysis; and sensitivity. Cronbach's alpha coefficients were acceptable, high for the total scale, and satisfactory for the four sub-scales. Item analysis supported the internal homogeneity of the items-to-total and inter-items within the sub-scales. Explorative factor analysis suggested a three-factor solution, but the confirmatory factor analysis confirmed the four-factor structure (Tucker-Lewis index (TLI) 0.92, goodness-of-fit index (GFI) 0.99, root mean square error of approximation (RMSEA) 0.065, standardized root mean square residual (SRMR) 0.045) with 61.2% explained variance. Analysis of the secondary data detected no differences in nurses' self-evaluations of contextual competence, so the inter-scale correlations were high. The PCC-Fin was found to be a reliable and valid instrument for the measurement of nurses' patient-centred care competence. Rasch model analysis would provide some further information about the item level functioning within the instrument.

Factors Influencing Patient-Centeredness among Korean Nursing Students: Empathy and Communication Self-Efficacy

In recent years, there is a growing tendency in the extent to which patients wish to be actively involved in processes related to their healthcare and relevant decision-making. This was a cross sectional study. We examined undergraduate nursing students’ patient-centeredness and investigated its associated factors including empathy and communication self-efficacy using a structured questionnaire. A total of 201 undergraduate nursing students who provided written consent to participate in the study completed measures on patient-centeredness (sharing and caring), empathy (fantasy, perspective taking, personal distress, and empathic concern), and communication self-efficacy. The factors affecting patient-centeredness were analyzed using multiple regression. Communication self-efficacy affected patient-centered sharing, while age, empathy (fantasy, personal distress, empathic concern), and communication self-efficacy affected patient-centered caring. Empathy and communication self-efficacy positively affected patient-centeredness. Therefore, strategies that promote empathy and communication self-efficacy are needed to increase patient-centered care competency.

Patients' expectations and experiences of being involved in their own care in the emergency department: A qualitative interview study

AIMS AND OBJECTIVES

To investigate patients' experiences of being involved in their care in the emergency department (ED).

BACKGROUND

Previous research shows that when patients experience involvement during care visits, this increased their trust in the care, gave a sense of control and promoted their autonomy.

DESIGN

A qualitative descriptive design with semi-structured interviews, using the "Consolidated criteria for reporting qualitative research" (COREQ) checklist.

METHODS

Using convenience sampling, semi-structured interviews were conducted with 16 patients in the ED.

RESULTS

The study identified four categories: attention and inattention; communication and understanding; varying levels of participation; and inefficient and inaccessible care. The results show that patients expected to be treated with respect and to be involved in an open dialogue about their care. Patients' experiences of participation were related to their sense of control.

CONCLUSIONS

Based on the results of the study, the authors found that factors such as dialogue, information, attention and participation affected the patients' involvement during the ED visit. Experiences of involvement and control were linked to patients' experiences of care and of patients as individuals.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers' awareness of the importance of paying attention to the patient as an individual, and of the need for simple, continuous communication could facilitate patient involvement in own care.

Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

INTRODUCTION

Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine's (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice.

OBJECTIVE

The purpose of the study was to examine the factors that influence health professional's likelihood of accomplishing the IOM core competencies.

METHODS

A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey.

RESULTS

The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts.

CONCLUSION

There is a need to understand how health professionals' age and experience impact their engagement with IOM's core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers' age and experience.

Assessment and analysis of patient safety competency of Chinese nurses with associate degrees: A cross-sectional study

Aim

To analyse the patient safety competency (PSC) of Chinese nurses with associate degrees (ADNs) and explore factors.

Design

A cross-sectional study.

Methods

A convenience sample of 451 ADNs working in 18 hospitals located in Chongqing city of China was investigated using the Patient Safety Competency Nurse Evaluation Scale (PSCNES). Descriptive and inferential statistics were used to analyse the data.

Results

ADNs had a moderate level of PSC. In terms of the six dimensions of PSC, ADNs performed well in clinical practice and safety risk management, while they performed poorly in patient-centred care and patient safety culture. Statistically significant differences were reported in two items. Firstly, ADNs who have participated in patient safety training had a higher level in all dimensions of PSC than those who have not participated in related training. Secondly, ADNs without professional titles had a higher level of patient safety culture than those with professional titles.

Psychometric properties of the Chinese version of the TeamSTEPPS teamwork perceptions questionnaire to measure teamwork perceptions of Chinese residents: a cross-sectional study

OBJECTIVES

The purpose of this research was to evaluate the psychometric properties of the TeamSTEPPS Teamwork Perception Questionnaire (T-TPQ) among the Chinese residents.

DESIGN

Cross-sectional study.

SETTING

A clinical hospital of the China Medical University in Liaoning Province, China.

PARTICIPANTS

A total of 664 residents were enrolled in this research. The valid response rate was 83.0% (664 of 800 residents).

MAIN OUTCOME MEASURES

Internal consistency and test-retest reliability were used to assess the reliability of the questionnaire. The construct validity of the Chinese T-TPQ was evaluated by confirmatory factor analysis. Furthermore, the concurrent, convergent and discriminant validity were analysed.

RESULTS

Cronbach's α coefficient of the T-TPQ in Chinese language was 0.923. Except for the communication dimension (0.649), the Cronbach's α coefficient of all dimensions were satisfactory. The T-TPQ and its five dimensions reported a good test-retest reliability (0.740-0.881, p<0.01). Moreover, the results of the confirmatory factor analysis demonstrated that the construct validity of the Chinese T-TPQ was satisfactory. All dimensions significantly correlated with the Hospital Survey on Patient Safety Culture (HSOPSC) teamwork within units dimension and the Safety Attitudes Questionnaire (SAQ) teamwork climate dimension (p<0.01), and the questionnaire showed satisfactory convergent and discriminant validity.

CONCLUSIONS

The T-TPQ in Chinese language demonstrated good psychometric characteristics and was a reliable and valid questionnaire to measure the Chinese health professionals' perception of teamwork. Thus, the Chinese version of the T-TPQ could be applied in teamwork training programmes and medical education research.

The Frontline Nurse's Experience of Nursing Outlier Patients

The frontline nurses' experience of nursing with overstretched resources in acute care setting can affect their health and well-being. Little is known about the experience of registered nurses faced with the care of a patient outside their area of expertise. The aim of this paper is to explore the phenomenon of nursing the outlier patient, when patients are nursed in a ward that is not specifically developed to deal with the major clinical diagnosis involved (e.g., renal patient in gynecology ward). Using a hermeneutic phenomenological approach, eleven individual face-to-face in-depth interviews were conducted with registered nurses in New South Wales, Australia. The study identified that each nurse had a specialty construct developed from nursing in a specialized environment. Each nurse had normalized the experience of specialty nursing and had developed a way of thinking and practicing theorized as a "care ladder". By grouping and analyzing various "care ladders" together, the nursing capacities common to nurses formed the phenomenological orientation, namely "the composite care ladder". Compared to nursing specialty-appropriate patients, nursing the outlier patient caused disruption of the care ladder, with some nurses becoming less capable as they were nursing the outlier patient. Nursing the outlier patient disrupted the nurses' normalized constructs of nursing. This study suggests that nursing patients in specialty-appropriate wards will improve patient outcomes and reduce impacts on the nurses' morale.

Factors related to the patient safety climate in an emergency hospital

Objective:

to verify the relationship between the socio-demographic and work profile of the nursing professionals and the patient safety climate in a public emergency hospital.

Method:

a cross-sectional study carried out with 177 nursing professionals from a public emergency hospital. For data collection, the Safety Attitudes Questionnaire - Short Form 2006 was used, validated and cross-culturally adapted to the Portuguese language. To check the factors related to the instrument’s domains, bivariate and multivariate analyses were performed.

Results:

working in the medical and surgical clinic or emergency room, on a night shift, and having the intention to leave nursing, reduced the general safety climate in the multiple regression analysis. The younger professionals, with less than four years in the institution, and those who worked in the night shift had a lower safety climate related to the perception of the management. On the other hand, having a work contract with a hired worker improved the general safety climate and workplace satisfaction.

Conclusion:

identifying predictors on patient safety scores is an important management tool that allows diagnosing, planning and executing activities from the domains that need to be improved.

Patient Participation in Nursing Care: Views From Ghanaian Nurses, Nursing Students, and Patients

Previous studies on patient participation reported inconclusive benefits of patient participation in health care. Consequently, the World Health Organization is actively highlighting the need for the participation of patients and their families in their care. The aim of this study was to explore the views of nurses, nursing students, and patients on patient participation in Ghanaian hospitals. Sixty-five participants made up of 15 patients, 25 registered general nurses, and 25 undergraduate nursing students were involved in the study. Data collection was done through interviews and focus group discussions. Content analysis was utilized in analyzing the data to generate four main categories. These categories were as follows: (a) meaning of patient participation in Ghana, (b) patient participation encouraged more during discharge education, (c) patient participation in nursing care higher in private and smaller hospitals, and (d) perceived facilitators and inhibitors of patient participation in nursing care. Participants in this study indicated that patient participation in nursing care meant involvement of patient in treatment decisions and nursing care procedures. Participants agreed that patient participation in nursing care was mostly encouraged during discharge education. Participation was perceived to be higher in private and smaller hospitals. Wealth and higher education were perceived as facilitators of patient participation while workload and high patient acuity were perceived as inhibitors.