Safety culture in healthcare: mixed method study

Examining patient safety protocols amidst the rise of digital health and telemedicine: nurses' perspectives

BACKGROUND

Integrating digital health and telemedicine technologies is transforming healthcare delivery. In light of this transition, it is critical to ascertain the efficacy of patient safety protocols and evaluate the awareness of healthcare professionals, particularly nurses, regarding the integration of digital health technologies.

AIM

This study examines the factors influencing the successful adoption of digital health and telemedicine technologies from the nurses' perspective, focusing on ensuring patient safety and enhancing organizational readiness for digital health integration.

METHODS

A cross-sectional study included 246 nurses from outpatient healthcare centers in Egypt. The data collected included demographic information and responses to a series of questionnaires, namely the Patient Safety Culture Survey (PSCS), the Telemedicine Risk Assessment and Mitigation Matrix (TRAMM), the Digital Health Adoption Readiness Assessment (DHARA), and the Digital Health Impact Assessment Tool (DHIA). The descriptive statistical analyses were conducted using the IBM SPSS Statistics software, version 26.

RESULTS

The sample was predominantly composed of nurses aged 18-35 (40.65%) and 36-55 (44.72%), with a near-equal gender distribution (48.78% male, 51.22% female). Most nurses held college degrees (73.17%) and were familiar with telemedicine (73.17%). The PSCS indicated positive scores for Communication Openness (4.5), Leadership Support (4.2), Teamwork (4.3), and Organizational Learning (4.1), with an overall mean score of 4.275. The TRAMM scores were notably high (total mean score 4.9), indicating effective risk management. The DHARA demonstrated considerable preparedness, as evidenced by a Total Mean Score of 7.85. The DHIA further substantiated this readiness, indicating a robust anticipated impact, particularly in Patient Engagement (9.0) and Usability (8.2).

CONCLUSION

The favorable assessment scores indicate a strong awareness of integrating digital health and telemedicine, suggesting the potential for enhanced patient care and healthcare delivery. It is recommended that healthcare organizations prioritize providing ongoing training and support for nurses, enabling them to utilize digital health tools and thereby enhance patient safety effectively.

CLINICAL TRIAL NUMBER

Not applicable.

Educational technology to support patient safety in the operating room: clinical simulation guides

to develop and validate two clinical simulation guides to support and disseminate a culture of safety in the surgical environment.

methodological study supported by the International Nursing Association for Clinical Simulation and Learning theoretical framework. The snowball technique was used to validate the clinical guidelines with experts on the subject. Two scales validated for Brazil were used for the pilot test.

89 operating room professionals took part, including 41 doctors, 40 nursing technicians, four nurses, two radiology technicians, and two nursing trainees. Two guides were created, one on conflict management and teamwork in patient safety during the transfer of the patient from the operating room to the post-anesthetic recovery room, and the other dealing with the assistance of the healthcare team in the transfer of care in the post-anesthetic recovery room. The evaluation of Satisfaction with Simulated Clinical Experiences had an average score of 8.3 and Satisfaction and Self-confidence in learning 4.1.

the guides have been validated and are suitable for replication in any surgical environment. We believe that this technology could contribute to improving the safety culture in the operating room by providing an opportunity for reflection and critical thinking.

Instruments for Patient Safety Assessment: A Scoping Review

BACKGROUND

Patient safety is an important component of healthcare service quality, and there are numerous instruments in the literature that measure patient safety. This scoping reviewaims to map the instruments/scales for assessing patient safety in healthcare services.

METHOD

This scoping review follows the JBI methodology. The protocol was registered on the Open Science Framework. Eligibility criteria were defined based on studies that include instruments or scales for assessing patient safety in healthcare services, in any language, and without temporal restrictions. It adhered to all scoping review checklist items [PRISMA-ScR], with searches in the Embase, Lilacs, MedLine, and Scopus databases, as well as the repository of the Brazilian Digital Library of Theses and Dissertations. Two independent reviewers performed selection and data extraction in July 2023.

RESULTS

Of the 4019 potential titles, 63 studies reported on a total of 47 instruments/scales and 71 dimensions for patient safety assessment. The most-described dimensions were teamwork, professional satisfaction, safety climate, communication, and working conditions.

CONCLUSION

The diversity of instruments and dimensions for patient safety assessment characterizes the multidimensionality and scope of patient safety. However, it hinders benchmarking between institutions and healthcare units.

Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study

A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.

Care Transition From the Perspectives of Oncological Patients and the Multiprofessional Care Team: A Mixed Methods Study

BACKGROUND

Integration into the health system is essential for safe care and efficient use of resources.

OBJECTIVES

The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site.

METHODS

The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out.

RESULTS

The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care.

CONCLUSION

The low score for the care plan factor indicates weakness in the care transition.

IMPLICATIONS FOR PRACTICE

The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.

Teamwork and safety climate in Polish long-term care facilities: questionnaire reliability and usability

The Teamwork and Safety Climate Survey (TSCS) is one of the questionnaires used to measure patient safety. The questionnaire includes two scales: teamwork climate and safety climate. The objective of the study is the linguistic and cultural adaptation of the TSCS to Polish conditions and checking the reliability and usability of the tool in long-term care facilities. Firstly, the TSCS was translated into Polish. Then, a cross-sectional survey was conducted among the medical and auxiliary personnel of long-term care facilities all over Poland. The psychometric properties of the questionnaire were analysed (including Cronbach's alpha coefficient). Correlations between the areas of the questionnaire and individual variables relating to facility parameters were also calculated. Respondents (n = 558) working in 26 different long-term care facilities participated in the study. The analysis has provided four scales instead of two of the original version of the questionnaire (teamwork climate, safety climate, ability to speak up and following the rules, work organisation). Correlation analysis revealed a number of significant correlations between the scales and individual variables corresponding to the parameters of long-term care facilities and respondents themselves. In conclusion, the Polish version of the TSCS may be a useful tool to measure aspects related to patient safety culture in long-term care facilities.

Quality of life in the voice of children who depend on health technologies: Mixed methods study

OBJECTIVE

To examine the quality of life of children who depend on health technologies as expressed in their own words.

METHODS

A parallel and convergent mixed methods design was employed with 30 aged five to 12 year old children who depend on health technologies. Data collection was done through a characterization form, Pediatric Quality of Life Inventory 4.0 questionnaire with the total sample in quantitative phase; semi-structured interviews with a subset of nine participants in qualitative phase. Quantitative and qualitative data were analyzed using descriptive statistics and deductive thematic content analyses, respectively.

RESULTS

Findings from PedsQL 4.0 showed that quality of life for children who depend on health technologies is average. However, data integration through mixed methods showed that this average goes beyond quantitative data through hearing the children's own voices. The results from data integration pointed out that children recognize their limitations and adapt to them; what most affects their quality of life is the emotional domain; children reported suffering prejudice due to their physical limitations; and that the school positively impacts their quality of life.

CONCLUSIONS

Data integration highlighted that children acknowledge their limitations and pain generated by these devices. Concerns about the future and the ability to do things that other children the same age can do was the most impactful aspect on their quality of life.

IMPLICATIONS FOR PRACTICE

Nursing care plans should consider that what affects most children who depend on health technologies' quality of life is anxiety for the future of being incapacitated or dependent.

Evaluating the psychometric properties of the Chinese version of the Safety Attitudes Questionnaire among medical staff in Taiwan

PURPOSE

The rapid changes that the healthcare services industry is undergoing pose a challenge to obtaining accurate measurements of the delivery of medical services to patients. Current Chinese measures of patient safety culture may not adequately capture how medical staff perceives the promotion of patient safety. This study aims to construct a valid and applicable patient safety culture instrument by re-estimating the Chinese version of the Safety Attitudes Questionnaire (SAQ) with medical staff in Taiwan.

DESIGN/METHODOLOGY/APPROACH

Exploratory factor analysis (EFA) was conducted on data collected from a sample of 448 medical workers at a regional teaching hospital in Taiwan, and data from 804 participants at a medical center were subjected to confirmatory factor analysis (CFA). The distribution of the questions among the dimensions was different from that in the Chinese version of the SAQ.

FINDINGS

The authors' results confirm that 3 correlated first-order factors, including 11 items, can be used to measure collaboration and safety, stress recognition and emotional exhaustion (EE). The authors' data suggest that the cooperation mechanism, patient safety promotion, stress management and emotional management are drivers of patient safety and should be prioritized when seeking to evaluate the perceptions of hospital staff toward patient safety culture in hospitals in Taiwan.

ORIGINALITY/VALUE

To improve the quality and safety of patient care, the measurement scale should be revisited and modified as the industry changes over time and to take account of cultural variation. The authors restructured the current Chinese version of the SAQ developed by the Joint Commission of Taiwan (JCT) to offer more precise measures that increase the sensitivity of the measurement of the level of care in items of patient safety and that serve as a diagnostic instrument to review patient safety management.