Interprofessional collaboration mediates the relationship between perceived organizational learning and safety climate in hospitals: A cross-sectional study

BACKGROUND

Organizational learning (OL) and interprofessional collaboration (IPC) are said to enhance medical safety in hospitals, but the relationship between these variables has not been quantitatively tested.

OBJECTIVE

This study examines the mediating effects of IPC on the relationship between OL and safety climate (improvement, compliance, and patient/family involvement).

METHODS

An anonymous self-reporting questionnaire was administered to 1,495 healthcare workers from November 2021 to January 2022. The questions regarded the hospital's safety climate, OL, and IPC. A mediation analysis using structural equation modeling was conducted to examine the mediating role of IPC on the relationship between OL and the three safety climates. The indirect effect was estimated using 2,000 bootstrap samples.

RESULTS

Responses from 643 healthcare workers were analyzed. The direct effects of OL were 𝛽 = .74, 75 (p < .001) on improvement and involvement and 𝛽 = 0.1 (p > .05) on compliance. The indirect effects of IPC on improvement and involvement were 𝛽 = .14 (95%CI: .00 ∼ .06) and 𝛽 = .37 (95%CI: .04 ∼ .09), respectively.

CONCLUSION

This study determined the mechanisms that enhance a hospital's safety climate, demonstrating that IPC mediates the relationship between OL and improvement and patient/family involvement. However, OL and IPC are not related to compliance.

COVID-19 and hospice community palliative care in New Zealand: A qualitative study

Within the context of an ageing population and the added challenges posed by COVID-19, the need to optimise palliative care management in the community - the setting where a significant proportion of people prefer to die - cannot be underestimated. To date, there has been a dearth of research exploring community palliative care delivery during the pandemic. This study aimed to explore the impact of and response to COVID-19 for hospice community services in Aotearoa/New Zealand. Eighteen structured interviews were conducted (10 February-18 August 2021) with healthcare professionals from sixteen purposively sampled community hospices from New Zealand regions according to the number of COVID-19-positive patients per 100,000 inhabitants (low, medium and high) with oversampling of high prevalence areas. Two overarching themes emerged 'challenges' and 'adaptations'. Each theme had several subthemes related to service delivery in communication, visiting, allied health team collaboration and volunteer services. Adaptations involved adjusting official health advice to the local context, increased use of telehealth, reducing infection risk during in-home visits through triaging of cases, division of the workforce into teams and repurposing volunteers' services. Despite these adaptations, challenges remained, including increased workload pressures for staff and an absence of the human touch for patients and families. Implications for hospice practice and recommendations for future research are discussed. Governments must acknowledge the essential contribution of hospice to the COVID-19 pandemic and ensure that these services are incorporated into the healthcare system response.

Examining Medical Office Owners and Clinicians Perceptions on Patient Safety Climate

OBJECTIVE

An essential element of effective medical practice management is having a shared set of beliefs among members regarding patient safety climate. Recognizing the need for improving patient safety, the Agency for Healthcare Research and Quality began a series of surveys to assess medical practice members' attitudes and beliefs on patient safety climate. The aim of the study was to examine owners and clinicians perceptions of their medical practice's patient safety climate.

METHODS

We used the 2010-2011 Medical Office Survey on Patient Safety Culture collected by the Agency for Healthcare Research and Quality. We used hierarchical linear modeling to examine owners' and clinicians' perceptions of practice's patient safety climate while controlling for the nested nature of individuals within practices.

RESULTS

Managers with ownership responsibility, clinicians with ownership responsibility, and staff clinicians have different perceptions of the practice's patient safety climate. In particular, managers with ownership responsibility have more positive perceptions of the patient safety climate, as compared with non-owners. Clinicians with ownership responsibility had less favorable views than managers in a similar role. Finally, staff clinicians have the most negative perceptions of patient safety climate as compared with individuals in the ownership positions.

CONCLUSIONS

There is a statistically significant lack of agreement among medical office team members depending on their backgrounds and roles. Increasing the communication among organizational members about their practice's patient safety climate is a principal aim whether improvements in care quality are to be achieved.

Nurses' experiences of providing ethical care to the patients with COVID-19: A phenomenological study

INTRODUCTION

Coronavirus disease (COVID-19) is a newly emerging infectious disease that bringing a heavy workload on nursing staff.

OBJECTIVE

This study explores the nurses' experiences of providing ethical care for patients with COVID-19.

METHODS

This qualitative study was carried out based on hermeneutic phenomenology. Unstructured interviews were conducted with 18 Iranian nurses. Data were analyzed based on the hermeneutic approach using the Diekelmann approach.

RESULTS

Three themes emerged: strong clinical dilemma, flourishing of professional values, and strengthening human and organizational communication.

CONCLUSION

The findings highlight ethical care and its dimensions for COVID-19 patients. Nurses need support from health managers to provide ethical care in such health crises.

Relational coordination and staff outcomes among healthcare professionals: a scoping review

Relational coordination (RC) is a process of coordinating work between professionals that can be used as a framework to enhance interprofessional collaborative practice (IPCP) in various healthcare settings. RC encompasses four communication dimensions (frequent, timely, accurate, problem-solving) and three relational dimensions (shared knowledge, shared goals, mutual respect). RC has been associated with better staff and patient outcomes; it has wide applicability, and it has been examined nationally and internationally in various healthcare settings. The aim of this scoping review is to identify and synthesize available evidence on RC and staff outcomes among healthcare professionals. Literature searches were conducted on articles published between May 2000 until February 2020. Sixteen abstracts were screened from four databases (PubMed, Psych Info, CINAHL, and Scopus). Eleven empirical studies fulfilled the inclusion criteria. Articles were excluded if they did not measure RC and staff outcomes. RC was reported as positively associated with higher job satisfaction, better work engagement, lower burnout, lower turnover, and reciprocal learning among healthcare professionals. Literature on this topic is scarce, despite RC being a promising framework for healthcare professionals in various disciplines to enhance IPCP and improve staff outcomes across healthcare settings.

Psychosocial working conditions of shiftworking nurses: A long-term latent transition analysis

AIM

This study aimed to identify profiles of working conditions to which nurses were exposed to over time and investigate how changes in working conditions relate to shiftworking and health.

BACKGROUND

Previous studies rarely addressed the issue of working conditions development over long periods and the effects of such development on nurses' health.

METHODS

Data from a national cohort of nurses in Sweden (N = 2936) were analysed using a person-centred analytical approach-latent profile and latent transition analysis.

RESULTS

Nurses report better psychosocial working conditions as they progress into mid-career. Shiftworking nurses experience poorer working conditions than their dayworking counterparts and tend to move from shiftwork to daywork as they progress into mid-career. In mid-career, nurses in work environments characterized by low autonomy and support tend to report poorer health outcomes.

CONCLUSION

Current analyses suggest that shiftworking nurses are particularly in need of interventions that address poor work environments. Not only do they experience more negative psychosocial working conditions than their dayworking counterparts, but they do so while having to contend with demanding schedules.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings highlight that organisational interventions should target different aspects of the work environment for nurses in diverse stages of their careers.

"Spine Surgery Checklist": A Step towards Perfection through Protocols

Study Design

This was a retrospective study.

Purpose

This study aimed to evaluate the effectiveness of a novel checklist that was designed specifically for the "spine-surgerysubspecialty" to reduce the incidence of some common preventable human errors and major perioperative complications in spine surgery.

Overview of Literature

We proposed a unique spine surgery-specific checklist that recognizes the risk factors, anticipates the possible human errors, and thus helps in preventing these errors. This checklist is associated with increased patient safety awareness, improved communication (keeps everyone updated regarding their responsibilities), reduction in the surgical claims, and reduction in the number of postoperative complications, including mortality.

Methods

This retrospective pilot study was performed at single center on 858 spine surgery patients. The patients were divided into the following two groups: the study group (after implementation of the checklist [2016-2017]) and the control group (before the implementation of the checklist [2015-2016]). The incidence of common preventable human errors and major perioperative complications in spine surgeries were recorded and compared between the two groups.

Results

The prevalence of wrong-level surgeries was 0%, and the overall prevalence of the preventable errors was 1.22% (5/410). The rate of adverse, near-miss, and no-harm events was 0%, 0.73% (3/410), and 0.48% (2/410), respectively. The preoperative, intraoperative, and postoperative errors were 0.48% (2/410), 0.24% (1/410), and 0.48% (2/410), respectively. The reoperation rate related to preventable errors reduced after the checklist was used. There were significant differences in the total preventable errors related to complications, such as infections, prolonged hospital stays, and unplanned hospital readmission/revision surgeries (p=0.001).

Conclusions

The authors proposed the first-of-its kind spine surgery-specific checklist that is comprehensive and involves perioperative parameters. The checklist is easy to use, safe, and effective for reducing the unforgiving errors and perioperative complications. However, its broader implementation would require validation in large, multi-center, randomized control studies.

Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study

BACKGROUND

Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct-care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians' delay identification and action on patients' clinical deterioration.

AIM

To identify barriers and facilitators that influence clinicians' absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework.

METHODS

The Theoretical Domains Framework guided: (a) semi-structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines.

FINDINGS

Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources.

DISCUSSION

The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team-based training. As a result, patient safety was compromised, and clinicians frustrated.

CONCLUSIONS

These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration.

RELEVANCE TO CLINICAL PRACTICE

Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision-making.

Application of an adapted relationship scale for assessing the occurrence of six different relationships as perceived by seven health care professions in Northern Italy

Interprofessional working relationships can influence the quality of collaborative practices, with consequences for patient safety outcomes. This article reports findings of an adapted relationship scale comprising six different relationship types, ranging from hostile to collegial, between seven health-care professions: physicians, nurses, dieticians, occupational therapists, physiotherapists, speech therapists, and psychologists. Survey data were gathered within amixed-method study aiming to explore the current status quo of interprofessional collaboration in aHealth Trust, located in Northern Italy. An online questionnaire was completed by 2,238 health professionals achieving aresponse rate of 44%. The working relationship element was answered by 1,897 respondents. The results of the survey are used as abasis for recommending strategies for advancing interprofessional collaboration in the Trust. Descriptive statistics were used to examine relationship-types, with frequency of occurrence considered. The non-parametric Mann Whitney and Kruskal Wallis tests were used to explore relationship differences among groups defined by sociodemographic variables. Participants reported overall positive relationships with other health professions. We noted variability in the occurrence of different relationship-types amongst the health professions. In particular, the six professions viewed their relationships with doctors more negatively than physicians who reported amore positive perception of their relationships with the six professions.

Using Qualitative Methods to Explore Communication Practices in the Context of Patient Care Rounds on General Care Units

BACKGROUND

Poor communication between physicians and nurses is a significant contributor to adverse events for hospitalized patients. Overcoming communication difficulties requires examining communication practices to better understand some of the factors that affect the nurse-physician communication process.

OBJECTIVE

To develop a more detailed understanding of communication practices between nurses and physicians on general care units. We focused on patient care rounds as an important activity in the care delivery process for communication.

DESIGN

Qualitative study design PARTICIPANTS: A total of 163 physicians, registered nurses, and nurse practitioners who worked on pre-specified general care units in each of four hospitals in the Midwest.

APPROACH

On each unit, data collection consisted of 2 weeks of observing and shadowing clinicians during rounds and at other times, as well as asking clinicians questions about rounds and communication during interviews and focus groups. A directed content analysis approach was used to code and analyze the data.

KEY RESULTS

Workflow differences contributed to organizational complexity, affecting rounds and subsequently communication practices, both across and within provider types. Nurse and patient participation during rounds appeared to reduce interruptions and hence cognitive load for physicians and nurses. Physicians adopted certain behaviors within the social context to improve communication, such as socializing and building relationships with the nurses, which contributed to nurse participation in rounds. When rapport was lacking, some nurses felt uncomfortable joining physicians during rounds unless they were explicitly invited.

CONCLUSIONS

Improving communication requires bringing attention to three contextual dimensions of communication: organizational complexity, cognitive load, and the social context. Initiatives that seek to improve communication may be more successful if they acknowledge the complexity of communication and the context in which it occurs.

A mixed-methods examination of the nature and frequency of medical error among junior doctors

PURPOSE OF THE STUDY

To examine junior doctors' experience and perceptions of medical errors in which they had been involved.

STUDY DESIGN

A mixed-methods design, consisting of an error survey and critical incident technique (CIT) interviews, was used. The survey asked doctors in the first year of postgraduate training in Ireland whether they had made a medical error that had 'played on (their) mind', and if so, to identify factors that had contributed to the error. The participants in the CIT interviews were asked to describe a medical error in which they had been involved.

RESULTS

A total of 201 out of 332 (60.5%) respondents to the survey reported making an error that 'played on their mind'. 'Individual factors' were the most commonly identified group of factors (188/201; 93.5%), with 'high workload' (145/201; 72.1%) the most commonly identified contributory factor. Of the 28 CIT interviews which met the criteria for analysis, 'situational factors' (team, staff, task characteristics, and service user factors) were the most commonly identified group of contributory factors (24/28; 85.7%). A total of eight of the interviews were judged by subject matter experts (n=8) to be of medium risk to patients, and 20 to be of high-risk to patients. A significantly larger proportion of high-risk scenarios were attributed to 'local working conditions' than the medium-risk scenarios.

CONCLUSIONS

There is a need to prepare junior doctors to manage, and cope with, medical error and to ensure that healthcare professionals are adequately supported throughout their careers.

Psychometric validation of the Multidimensional Nursing Generations Questionnaire (MNGQ)

AIMS

To perform a psychometric test of the factor structure of the Multidimensional Nursing Generation Questionnaire, an instrument developed to measure nursing generational characteristics in the workplace and investigate the relations among its factors and background variables.

BACKGROUND

Nurses today include members of the Baby Boomer and X and Y generations, whose characteristics in the work environment have not been studied thoroughly.

DESIGN

Instrument and construct cross-sectional study for psychometric testing/validation.

METHODS

Questionnaire components and constructs were tested using confirmatory factor analysis (CFA), structural equation modelling and Cronbach's alpha. For this purpose, a survey was conducted in November 2016 on a sample of Finnish and Italian nurses working in public hospitals (N = 3,218).

RESULTS

Eight hundred twenty-two nurses completed the questionnaire, where CFA identified 48 items and six factors with acceptable internal consistency (Cronbach's alpha range: 0.73-0.88): (a) Conflicts between generations; (b) Patient safety view; (c) Relationships issues between generations; (d) Working as a multigenerational team; (e) Orientation to change; and (f) Work propensity and availability. Various relations were identified among the background variables and factors that related largely to generational belonging, educational level and country.

CONCLUSION

The final version of the questionnaire demonstrates a more robust factor structure than did the preliminary. Further tests should be conducted on nurses in different countries/cultures and work environments.

IMPACT

The complete validation of the Multidimensional Nursing Generation Questionnaire will provide research evidence useful to create an inclusive work environment for each generation.

Nurses' Generational Differences Related to Workplace and Leadership in Two European Countries

A cross-sectional study was conducted with a convenience sample (N = 3,093) of Finnish and Italian registered nurses to identify differences related to generation, country, gender, and educational level in their perceptions and opinions about workplace-related dimensions of nursing and their managers' leadership practices. The Multidimensional Nursing Generations Questionnaire (MNGQ) and two subscales of the Transformational Leadership Scale (TLS), "Feedback and Rewards" and "Professional Development," were used as survey tools. Data were analyzed with descriptive and inferential statistics. Statistically significant (p < .05) generational and country differences emerged in the MNGQ components "Conflicts between generations," "Patient safety view," "Relationships between generations," "Working as a multigenerational team," "Orientation to change," "Intention to leave," and "Flexibility and availability." Generational and country differences also emerged for the two TLS subscales. Generational differences existed between registered nurses of different generations and countries, and should be considered in leading multigenerational nurses' workforces.

When Team Conflicts Threaten Quality of Care: A Study of Health Care Professionals' Experiences and Perceptions

OBJECTIVES

To explore professionals' experiences and perceptions of whether, how, and what types of conflicts affected the quality of patient care.

PATIENTS AND METHODS

We conducted 82 semistructured interviews with randomly selected health care professionals in a Swiss teaching hospital (October 2014 and March 2016). Participants related stories of team conflicts (intra-/interprofessional, among protagonists at the same or different hierarchical levels) and the perceived consequences for patient care. We analyzed quality of care using the dimensions of care proposed by the Institute of Medicine Committee on Quality of Health Care in America (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity).

RESULTS

Seventy-seven of 130 conflicts had no perceived consequences for patient care. Of the 53 conflicts (41%) with potential perceived consequences, the most common were care not provided in a timely manner to patients (delays, longer hospitalization), care not being patient-centered, and less efficient care. Intraprofessional conflicts were linked with less patient-centered care, whereas interprofessional conflicts were linked with less timely care. Conflicts among protagonists at the same hierarchical level were linked with less timely care and less patient-centered care. In some situations, perceived unsatisfactory quality of care generated team conflicts.

CONCLUSION

Based on participants' assessments, 4 of 10 conflict stories had potential consequences for the quality of patient care. The most common consequences were failure to provide timely, patient-centered, and efficient care. Management of hospitals should consider team conflicts as a potential threat to quality of care and support conflict management programs.

What does it take to deliver brilliant home-based palliative care? Using positive organisational scholarship and video reflexive ethnography to explore the complexities of palliative care at home

Background:

Despite the increasing number of people requiring palliative care at home, there is limited evidence on how home-based palliative care is best practised.

Aim:

The aim of this participatory qualitative study is to determine the characteristics that contribute to brilliant home-based palliative care.

Design:

This study was inspired by the brilliance project – an initiative to explore how positive organisational scholarship in healthcare can be used to study brilliant health service management from the viewpoint of patients, families, and clinicians. The methodology of positive organisational scholarship in healthcare was combined with video-reflexive ethnography.

Setting/participants:

Home-based specialist palliative care services across two Australian states participated in the study. Clinicians were able to take part in the study at different levels. Pending their preference, this could involve video-recording of palliative care, facilitating and/or participating in reflexive sessions to analyse and critique the recordings, identifying the characteristics that contribute to brilliant home-based palliative care, and/or sharing the findings with others.

Results:

Brilliance in home-based palliative care is contingent on context and is conceptualised as a variety of actions, people, and processes. Care is more likely to be framed as brilliant when it is epitomised: anticipatory aptitude and action; a weave of commitment; flexible adaptability; and/or team capacity-building.

Conclusion:

This study is important because it verifies the characteristics of brilliant home-based palliative care. Furthermore, these characteristics can be adapted for use within other services.

Through the resident lens: examining knowledge and attitudes about midwifery among physician trainees

Interprofessional collaboration optimizes maternal-newborn outcomes and satisfaction with care. Since 2002, midwives have provided an increasing proportion of maternity care in British Columbia (BC). Midwives often collaborate with and/or refer to physicians; but no study to date has explored Canadian medical trainees' exposure to, knowledge of, and attitudes towards midwifery practice. We designed an online cross-sectional questionnaire that included a scale to measure attitudes towards midwifery (13 items) and residents' knowledge of midwifery (94 items across 5 domains). A multi-disciplinary expert panel rated each item for importance, relevance, and clarity. The survey was distributed to family medicine (n = 338) and obstetric (n = 40) residents in BC. We analyzed responses from 114 residents. Residents with more favourable exposures to midwifery during their education had significantly more positive attitudes towards midwives (rs = 0.32, p = 0.007). We also found a significant positive correlation between residents' attitudes towards midwifery and four of five knowledge domains: scope of practice (rs = 0.41, p < 0.001); content of education (rs = 0.30, p = 0.002), equipment midwives carry to home births (rs = 0.30, p = 0.004) and tests that midwives can order (rs = 0.39, p < 0.001). The most unfavourable exposures were observing interprofessional conversations (66.2%), and providing inpatient consultations for midwives (61.4%). Findings suggest increased interprofessional education may foster improved midwife-physician collaboration. Abbreviations: BC - British Columbia; UBC - University of British Columbia.

Seeing what works: identifying and enhancing successful interprofessional collaboration between pathology and surgery

Utilising frozen section technologies, Mayo Clinic has one of the lowest reoperation rates for breast lumpectomy in the United States. The research reported on sought to understand the successful teamwork between the Breast Surgery Team and the Frozen Section Laboratory at Mayo Clinic. Researchers worked collaboratively with healthcare staff from breast surgery and the frozen section pathology laboratory to identify communication styles and strategies that contribute to the timely and accurate intraoperative evaluation of breast cancer specimens. Using the video-reflexive ethnography (VRE) methodology underpinned by a positive theoretical approach to researching quality and safety in healthcare, the researchers video-recorded the communications associated with specimen resections in surgery and the subsequent pathology diagnoses. Then, 57 staff from the breast surgery and frozen section laboratory teams attended video-reflexivity sessions to collaboratively analyse their communication practices and identify opportunities to optimize interprofessional communication. In this article, we focus on how the flexible, interdisciplinary, and cross-hierarchical communication within the frozen section laboratory supports a rapid and accurate intraoperative evaluation and communication, previously conceptualized by staff as being performed in a linear fashion. Moreover, we detail how the VRE methodology led surgeons and pathologists to implement new strategies and optimize their interprofessional communication.

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

METHODS

Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the 'on the ground' relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race.

RESULTS

MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state.

CONCLUSION

The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.

A Systematic Review of Assessment Tools Measuring Interprofessional Education Outcomes Relevant to Pharmacy Education

Objective. To identify and describe the available quantitative tools that assess interprofessional education (IPE) relevant to pharmacy education. Methods. A systematic approach was used to identify quantitative IPE assessment tools relevant to pharmacy education. The search strategy included the National Center for Interprofessional Practice and Education Resource Exchange (Nexus) website, a systematic search of the literature, and a manual search of journals deemed likely to include relevant tools. Results. The search identified a total of 44 tools from the Nexus website, 158 abstracts from the systematic literature search, and 570 abstracts from the manual search. A total of 36 assessment tools met the criteria to be included in the summary, and their application to IPE relevant to pharmacy education was discussed. Conclusion. Each of the tools has advantages and disadvantages. No single comprehensive tool exists to fulfill assessment needs. However, numerous tools are available that can be mapped to IPE-related accreditation standards for pharmacy education.

The Multidimensional Nursing Generations Questionnaire: development, reliability, and validity assessments

PURPOSE

To develop and perform reliability and validity assessments of the international Multidimensional Nursing Generations Questionnaire.

BACKGROUND

There are three generations of nurses in the European workforce. There is little research on the characteristics of these generations and the ways in which to manage them professionally, and no instrument has yet been developed to measure these aspects specifically.

METHODS

With results from previous studies, 69 nursing generations-oriented items were created in English, translated into Italian and Finnish, and pretested to form the basis of an instrument that was tested between September and October 2014 on a sample of Finnish and Italian nurses (n = 1302) using principal component analysis and Cronbach's alpha.

RESULTS

Fifty-four items and eight components (Cronbach's α range: 0.61-0.81) were identified in the instrument: (1) conflicts between generations; (2) patient safety view; (3) relationships between generations; (4) working as a multigenerational team; (5) orientation to change; (6) presenteeism and job propensity; (7) intention to leave, and (8) flexibility and availability.

CONCLUSIONS

The instrument showed acceptable preliminary psychometric properties and satisfactory internal consistency.

IMPLICATIONS FOR NURSING MANAGEMENT

The Multidimensional Nursing Generations Questionnaire is a useful tool to measure the characteristics of different generations of nurses and to develop management strategies tailored to those generations.

Interface transition checklists in spinal surgery

ISSUE

Recently, quality tools have been promoted to improve patient safety and process efficiency in healthcare. While surgeons primarily focused on surgical issues, like infection rates or implant design, we introduced pre-admission and preoperative checklists in the early 2000s.

INITIAL ASSESSMENT

To assess the efficiency of these tools in a neurosurgical department, we performed a survey of all spinal instrumentation patients operated in 2011 (n = 147). The results revealed several problems.

CHOICE OF SOLUTION

We consequently redesigned the checklists accompanied by flanking measures, such as written  and online accessible standards. Furthermore, the staff was trained to use the updated quality tools.

IMPLEMENTATION

The measures were implemented in 2012.

EVALUATION

Results were re-evaluated in a second survey in 2013 (n = 162). We found that the use of pre-admission checklists significantly increased from 47 to 96%, while the use of preoperative checklists significantly decreased from 86 to 75%. Within the same period, the quality and completeness of the checklists did, however, increase, so that in 2013, 43% of the patients had a completely processed preoperative checklist, compared to 29% in 2011.

LESSONS LEARNED

The introduction of checklists alone did not in itself guarantee an improved workflow. The introduction must be accompanied by other measures, like written standards and regular training of employees. Otherwise, the positive effect wears off quickly. Nevertheless, we could show that the stringent application of quality tools can induce a sustainable change. Our data further suggest that the clear and traceable delegation of responsibilities is of high importance.

Safety climate and attitude toward medication error reporting after hospital accreditation in South Korea

OBJECTIVE

This study compared registered nurses' perceptions of safety climate and attitude toward medication error reporting before and after completing a hospital accreditation program. Medication errors are the most prevalent adverse events threatening patient safety; reducing underreporting of medication errors significantly improves patient safety. Safety climate in hospitals may affect medication error reporting.

DESIGN

This study employed a longitudinal, descriptive design. Data were collected using questionnaires.

SETTING

A tertiary acute hospital in South Korea undergoing a hospital accreditation program.

PARTICIPANTS

Nurses, pre- and post-accreditation (217 and 373); response rate: 58% and 87%, respectively.

INTERVENTIONS

Hospital accreditation program.

MAIN OUTCOME MEASURES

Perceived safety climate and attitude toward medication error reporting.

RESULTS

The level of safety climate and attitude toward medication error reporting increased significantly following accreditation; however, measures of institutional leadership and management did not improve significantly. Participants' perception of safety climate was positively correlated with their attitude toward medication error reporting; this correlation strengthened following completion of the program.

CONCLUSIONS

Improving hospitals' safety climate increased nurses' medication error reporting; interventions that help hospital administration and managers to provide more supportive leadership may facilitate safety climate improvement. Hospitals and their units should develop more friendly and intimate working environments that remove nurses' fear of penalties. Administration and managers should support nurses who report their own errors.

A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses

OBJECTIVES

This study aimed to collect and analyse examples of poor teamwork between junior doctors and nurses; identify the teamwork failures contributing to poor team function; and ascertain if particular teamwork failures are associated with higher levels of risk to patients.

DESIGN

Critical Incident Technique interviews were carried out with junior doctors and nurses.

SETTING

Two teaching hospitals in the Republic of Ireland.

PARTICIPANTS

Junior doctors (n = 28) and nurses (n = 8) provided descriptions of scenarios of poor teamwork. The interviews were coded against a theoretical framework of healthcare team function by three psychologists and were also rated for risk to patients by four doctors and three nurses.

RESULTS

A total of 33 of the scenarios met the inclusion criteria for analysis. A total of 63.6% (21/33) of the scenarios were attributed to 'poor quality of collaboration', 42.4% (14/33) to 'poor leadership' and 48.5% (16/33) to a 'lack of coordination'. A total of 16 scenarios were classified as high risk and 17 scenarios were classified as medium risk. Significantly more of the high-risk scenarios were associated with a 'lack of a shared mental model' (62.5%, 10/16) and 'poor communication' (50.0%, 8/16) than the medium-risk scenarios (17.6%, 3/17 and 11.8%, 2/17, respectively).

CONCLUSION

Poor teamwork between junior doctors and nurses is common and places patients at considerable risk. Addressing this problem requires a well-designed complex intervention to develop the team skills of doctors and nurses and foster a clinical environment in which teamwork is supported.

Task shifting of mental health care services in Ghana: ease of referral, perception and concerns of stakeholders about quality of care

OBJECTIVES

To examine the perceptions of stakeholders about the ease of referral of patients from community mental health workers (CMHWs) to psychiatrists in Ghana and the level of stakeholder concerns about the quality of care provided to these community health cadres.

DESIGN

A cross-sectional survey.

PARTICIPANTS

Eleven psychiatrists, 26 health policy directors and 164 community mental health workers, including 71 (43.3%) community psychiatric nurses, 19 (11.6%) clinical psychiatric officers and 74 (45.1%) community mental health officers.

METHODS

We administered three separate, self-administered, semi-structured questionnaires to the study participants.

RESULTS

Although many respondents including almost all CMHWs perceive that it is easy for them to refer difficult cases to a psychiatrist who will usually see such patients in a timely manner, less than a quarter of these health cadres reported that they always or often refer patients to see a psychiatrist. The majority of CMHWs were of the opinion that patients, psychiatrists and other healthcare workers have concerns about the quality of care they provide, sentiments that were echoed by all psychiatrists and over half of all the health policy directors.

CONCLUSION

There is also a need for policy directors to educate CMHWs about their roles and to clarify referral pathways so that cases that are difficult to manage will be appropriately referred to psychiatrists or appropriately trained and incentivized district medical doctors for further management.