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Eriksen AA, Fegran L, Fredwall TE, Larsen IB. Patients' negative experiences with health care settings brought to light by formal complaints: A qualitative metasynthesis. J Clin Nurs 2023; 32:5816-5835. [PMID: 36975841 DOI: 10.1111/jocn.16704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Narratives of negative patient experiences expressed in complaints can help health care professionals reflect on their practices. AIMS To synthesise evidence from qualitative primary studies on patients' negative experiences with different health care settings and to obtain a detailed picture of what patients find problematic while receiving health care. DESIGN Metasynthesis inspired by Sandelowski and Barroso. METHODS A protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO). A systematic search was conducted in CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycInfo (Ovid) and Scopus, on 20.04.2021. Backward and forward citations of included reports were searched for relevant studies and the search was completed in March 2022. Two researchers independently screened and appraised the included reports. A metasynthesis using reflexive thematic analysis and a metasummary were conducted. RESULTS Twenty-four reports were included, and four main themes were extracted from the metasynthesis: (1) problems with access to health care services; (2) failure to acquire information about diagnosis, treatment and the expected patient role; (3) experiencing inappropriate care and bad treatment; (4) problems with trusting health care service providers. CONCLUSIONS Negative patient experiences impact patients' physical and psychological health, leading to suffering and hampering patients from involving themselves in their health care. RELEVANCE TO CLINICAL PRACTICE Narratives of negative patient experiences aggregated from the findings provide knowledge about what patients need and expect from health care providers. These narratives can help health care professionals reflect on the way they interact with patients and improve their practice. Health care organisations need to prioritise patient participation. REPORTING METHOD Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION Findings were presented and discussed in a meeting with a reference group representing patients, health care professionals and the public.
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Affiliation(s)
- Alison Axisa Eriksen
- Centre for Care Research, Faculty of Health and Sports Sciences, University of Agder, Box 509, 4898, Grimstad, Norway
| | - Liv Fegran
- Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, Box 422, 4604, Kristiansand, Norway
| | - Terje Emil Fredwall
- Centre for Care Research, Faculty of Health and Sports Sciences, University of Agder, Box 509, 4898, Grimstad, Norway
| | - Inger Beate Larsen
- Department of Psychosocial Health, Faculty of Health and Sports Sciences, University of Agder, Box 509, 4898, Grimstad, Norway
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Zhao X, Shi C, Zhao L. Nurses' Intentions, Awareness and Barriers in Reporting Adverse Events: A Cross-Sectional Survey in Tertiary Hospitals in China. Risk Manag Healthc Policy 2022; 15:1987-1997. [PMID: 36329826 PMCID: PMC9624208 DOI: 10.2147/rmhp.s386458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This study explored nurses’ intentions, awareness and barriers in reporting adverse events in tertiary hospitals in China. We also analyzed its associated factors to increase the chance to evaluate preventable errors, enhance care delivery, and improve patient outcomes. Patients and Methods A cluster sampling method was used to recruit 1382 nurses from two tertiary hospitals in Chenzhou and Handan City. An online structured questionnaire was used to collect data, which included general information questionnaire (eight questions), reporting awareness questionnaire (eight items with scores ranging from 0 to 8), reporting intention questionnaire (15 items with scores ranging from 0 to 15), and reporting barriers questionnaire (22 items with scores ranging from 22 to 110). Results We received 1565 completed questionnaires from 1734 potential participants (a response rate of 90.25%), with 1382 valid questionnaires, yielding an effective rate of 88.31%. The scores of reporting awareness, reporting intention, and reporting barriers in adverse events for nurses in tertiary hospitals were 8 (1), 15 (0), and 83.04 (±12.21) out of 110, respectively. Reporting awareness and barriers to adverse events were positively correlated with nurses’ intention to report adverse events (rs = 0.237 and 0.361, respectively; P < 0.001). Regression analyses showed that reporting awareness and barriers in adverse events and professional title influenced nurses’ intention to report adverse events (P < 0.05) in tertiary hospitals. Conclusion Nurses in tertiary hospitals have a strong intention to report adverse events. The higher the reporting awareness of adverse events or the fewer perceived reporting barriers, the stronger the nurses’ intention to report. Hospital managers should deliver patient safety education and training for nurses, to increase their reporting awareness and decrease their perceived reporting barriers, improve their intention to report adverse events.
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Affiliation(s)
- Xiaoying Zhao
- Handan First Hospital, Handan, 056000, People’s Republic of China
| | - Chunhong Shi
- School of Nursing, Xiangnan University, Chenzhou, People’s Republic of China,Affiliated Hospital of Xiangnan University, Chenzhou, 423000, People’s Republic of China,Correspondence: Chunhong Shi, School of Nursing, Xiangnan University, 889 Chenzhou Avenue, Suxian District, Chenzhou, 423000, People’s Republic of China, Tel +86 15907354840, Fax +86-735-2325007, Email
| | - Lihua Zhao
- Handan First Hospital, Handan, 056000, People’s Republic of China
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Sümen A, Ünal A, Aksoy S. Nursing students' self-reported experiences and attitudes regarding patient safety: A cross-sectional study comparing the classroom and clinical settings. Collegian 2022. [DOI: 10.1016/j.colegn.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Andersson I, Bååth C, Nilsson J, Eklund AJ. A scoping review-Missed nursing care in community healthcare contexts and how it is measured. Nurs Open 2021; 9:1943-1966. [PMID: 34033697 PMCID: PMC9190696 DOI: 10.1002/nop2.945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Aim To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments. Design Scoping review. Methods Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram. Results Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA‐NH), modified MISSCARE survey and study‐specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.
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Affiliation(s)
- Ingrid Andersson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
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Morey S, Magnusson C, Steven A. Exploration of student nurses' experiences in practice of patient safety events, reporting and patient involvement. NURSE EDUCATION TODAY 2021; 100:104831. [PMID: 33676347 DOI: 10.1016/j.nedt.2021.104831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND/INTRODUCTION Qualified and student nurses remain at the forefront of dealing with, and reporting, patient safety events or incidents. There has been limited exploration of whether and how the patient's perspective is represented by staff or student nurses using formal reporting systems. OBJECTIVES The overall aim of the study was to explore the student nurses' experiences in practice of patient safety events they were themselves directly or indirectly involved in. This specifically explored the subsequent reporting and inclusion of the patient perspectives that may or may not have taken place. DESIGN A qualitative approach to this research was selected using the principles of thematic analysis to analyse data gathered from focus groups of student nurses across all year groups. SETTING Three universities participated in the study located in the north east, south east and east of England. PARTICIPANTS Student nurses from across the year groups attended focus groups. METHODS Following ethical approval and informed consent, participants took part in focus groups within each university setting. Data were transcribed verbatim and analysed using thematic analysis. RESULTS Three themes were identified: the benefit of reporting and patient involvement, the barriers experienced by the students in reporting and the support needed to ensure they do the right thing in practice. CONCLUSION Learning for students from patient safety incidents is important and seeking patients' views and perceptions adds to the learning experience. There are however challenges for the student in practice in both reporting and patient involvement. Resources are needed that follow and feed into the student learning alongside a workforce that see the benefit of learning from those we care for.
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Affiliation(s)
- Sarah Morey
- Northumbria University, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne NE77TR, United Kingdom.
| | - Carin Magnusson
- University of Surrey, Stag Hill University Campus, Guildford. GU27XH, United Kingdom.
| | - Alison Steven
- Northumbria University, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne NE77TR, United Kingdom.
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Park JY, Hwang JI. [Relationships among Non-Nursing Tasks, Nursing Care Left Undone, Nurse Outcomes and Medical Errors in Integrated Nursing Care Wards in Small and Medium-Sized General Hospitals]. J Korean Acad Nurs 2021; 51:27-39. [PMID: 33706329 DOI: 10.4040/jkan.20201] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/17/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to identify the degree of non-nursing tasks and nursing care left undone in integrated nursing care wards, and examine their relationships with nurses' burnout, job satisfaction, turnover intentions, and medical errors. METHODS A cross-sectional questionnaire survey was conducted. Data were collected using self-report questionnaires from 346 nurses working in 20 wards of seven small and medium-sized general hospitals, and analyzed using multiple regression and multiple logistic regression analysis with the SPSS WIN 25.0 program. RESULTS The mean score for non-nursing tasks was 7.32±1.71, and that for nursing care left undone was 4.42 ± 3.67. An increase in non-nursing tasks (β = .12, p = .021) and nursing care left undone (β = .18, p < .001) led to an increase in nurses' burnout (F = 6.26, p < .001). As nursing care left undone (β = .13, p = .018) increased, their turnover intentions also (F = 3.96, p < .001) increased, and more medical errors occurred (odds ratio 1.08, 95% confidence interval 1.02~1.15). CONCLUSION Non-nursing tasks and nursing care left undone are positively associated with nurses' burnout, turnover intentions, and the occurrence of medical errors. Therefore, it is important to reduce non-nursing tasks and nursing care left undone in order to deliver high quality nursing care and in turn increase patient safety.
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Affiliation(s)
- Ju Young Park
- Department of Nursing, Kunjang University, Gunsan, Korea
| | - Jee In Hwang
- College of Nursing Science, Kyung Hee University, Seoul, Korea.
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Mello JFD, Barbosa SDFF. TRANSLATION AND TRANSCULTURAL ADAPTATION OF THE PATIENT MEASURE OF SAFETY (PMOS) QUESTIONNAIRE TO BRAZILIAN PORTUGUESE. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2018-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective to translate and culturally adapt the Patient Measure of Safety questionnaire to Brazilian Portuguese. Method a transcultural adaptation study conducted in six stages: translation, synthesis, back-translation, review by experts committee, pre-test, and presentation of the documentation of the entire process to the authors of the instrument. Results in the initial translation and cultural adaptation stage, two versions of the questionnaire were generated. The divergences between both versions and other suggestions were discussed, and the decisions were made by consensus, thus creating a single version. In the back-translation stage, there were no significant differences between the versions and the original instrument. The assessment of the semantic, idiomatic, cultural and conceptual equivalences of the Patient Measure of Safety items was performed by a committee of experts from different Brazilian regions. The results of the content validity index were above 0.9 for most of the items. The pre-test was conducted with 30 patients. The mean time for the application of the questionnaire was 31.9 minutes. In relation to the understanding of the items by the patients, a regular or poor interpretation was identified only for 6 of the 44 items, which were modified. Conclusion the “Questionário de Avaliação da Segurança pelo Paciente”, name given to the translated and transculturally adapted version, resulted from a thoughtful process, presenting consistency in the equivalence of the translation and constituting an applicable instrument understood by the target population.
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Liukka M, Steven A, Vizcaya Moreno MF, Sara-aho AM, Khakurel J, Pearson P, Turunen H, Tella S. Action after Adverse Events in Healthcare: An Integrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134717. [PMID: 32630041 PMCID: PMC7369881 DOI: 10.3390/ijerph17134717] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/04/2022]
Abstract
Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.
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Affiliation(s)
- Mari Liukka
- Department of Nursing Science/Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland; (H.T.); (S.T.)
- South Karelia Social and Health Care District, 53130 Lappeenranta, Finland
- Correspondence: ; Tel.: +358-44-791-4871
| | - Alison Steven
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne NE7 7XA, UK; (A.S.); (P.P.)
| | | | - Arja M Sara-aho
- Faculty of Health Care & Social Services, LAB University of Applied Sciences, 53850 Lappeenranta, Finland;
| | - Jayden Khakurel
- Research Center for Child Psychiatry, University of Turku, 20500 Turku, Finland;
| | - Pauline Pearson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne NE7 7XA, UK; (A.S.); (P.P.)
| | - Hannele Turunen
- Department of Nursing Science/Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland; (H.T.); (S.T.)
- Clinical Development, Education and Research Unit of Nursing (CDERUN), Kuopio University Hospital, 70210 Kuopio, Finland
| | - Susanna Tella
- Department of Nursing Science/Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland; (H.T.); (S.T.)
- Faculty of Health Care & Social Services, LAB University of Applied Sciences, 53850 Lappeenranta, Finland;
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Kalánková D, Kirwan M, Bartoníčková D, Cubelo F, Žiaková K, Kurucová R. Missed, rationed or unfinished nursing care: A scoping review of patient outcomes. J Nurs Manag 2020; 28:1783-1797. [DOI: 10.1111/jonm.12978] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dominika Kalánková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Marcia Kirwan
- School of Nursing and Human Sciences Dublin City University in Dublin Glasnevin, Dublin Ireland
| | - Daniela Bartoníčková
- Department of Nursing 2nd Faculty of Medicine Charles University in Prague Prague Czech Republic
| | - Floro Cubelo
- School of Health and Social Studies Jyväskylä University of Applied Sciences Jyväskylä Finland
| | - Katarína Žiaková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Radka Kurucová
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
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Terry D, Kim JA, Gilbert J, Jang S, Nguyen H. "Thank You for Listening": An Exploratory Study Regarding the Lived Experience and Perception of Medical Errors Among Those Who Receive Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 52:292-302. [PMID: 31816256 DOI: 10.1177/0020731419893036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The issue of medical errors, or adverse events caused within a health care context or by a health care provider, is largely under-researched. While the experience and perspective of health care professionals regarding medical errors have been explored, little attention is paid to the health care consumers regarding their perceptions and experiences. Therefore, there is a need to better understand the public's views on medical errors to enhance patient safety and quality care. The current study sought to examine Australian public perceptions and experiences, especially concerning what errors had occurred, the perceived sources of the errors, and if the errors had been reported. This paper reports the qualitative findings of an online survey for Australian residents who have accessed or received medical services at any time in Australia. Responses from 304 surveys were analyzed and discussed, including demographic information and key themes about medical errors, which were categorized into engagement and patients' voices being heard, the quality of care being provided, and the system's accountability. Based on the findings, the study highlights the importance of effective health professional-patient communication, enhanced capacity to deliver high quality care, and improved mechanism for error reporting and resolution where patients feel safe and confident about positive changes being made.
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Affiliation(s)
- Daniel Terry
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Jeong-Ah Kim
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Julia Gilbert
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Sunny Jang
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Hoang Nguyen
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
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Johnsson A, Wagman P, Boman Å, Pennbrant S. Striving to establish a care relationship-Mission possible or impossible?-Triad encounters between patients, relatives and nurses. Health Expect 2019; 22:1304-1313. [PMID: 31588667 PMCID: PMC6882259 DOI: 10.1111/hex.12971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022] Open
Abstract
Background When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction. Objective To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people. Design A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective. Method Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015‐September 2016 and analysed together with field notes using ethnographic analysis. Result The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view. Conclusion The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives’ stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health‐care setting, therefore making the mission to establish a care relationship possible.
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Affiliation(s)
- Anette Johnsson
- Department of Health Sciences, University West, Trollhättan, Sweden.,School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Petra Wagman
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Åse Boman
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Sandra Pennbrant
- Department of Health Sciences, University West, Trollhättan, Sweden
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Qian S, Yu P, Bhattacherjee A. Contradictions in information technology mediated work in long-term care: An activity theoretic ethnographic study. Int J Nurs Stud 2019; 98:9-18. [PMID: 31238234 DOI: 10.1016/j.ijnurstu.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The growing demand for aged care services coupled with a global shortage of skilled nursing staff has hindered long-term care facilities' ability to provide necessary services to their residents. Healthcare information technology is expected to mitigate this challenge by streamlining nursing work, while also improving quality of care and productivity. OBJECTIVES This study set out to examine how nurses and care workers work, the role of information technology (IT) in their work and what contradictions they face in their IT mediated work. DESIGN Ethnographic study informed by six components of activity theory: subject, object, tool, rule, community and division of labor. SETTING Eight care units in two long-term care facilities in Australia. PARTICIPANTS Eleven staff from two long-term care facilities including registered nurses (n = 2), endorsed enrolled nurses (n = 5) and personal care workers (n = 4) participated in this study. METHODS Participants were shadowed during morning shifts (6:30 am to 3:00 pm). A total of 24 morning shifts were observed over four months. Field notes were created based on observational data and informal interviews, in addition to document review. RESULTS Through the lens of activity theory, the work activity system of nurses and care workers in the long-term care facilities consisted of the subject (nurses and care workers), their object (resident care), tools used for work including IT, rules of work, community, and division of labor. These components interacted through work processes; therefore, a "process" component was added in the activity system. Special attention was given to the role of IT as the conduit of information in the work processes. Although IT helped track medication rounds, automated documentation and communication among the staff, it introduced contradictions. Seven contradictions involving IT were identified, including contradictions within the IT tool, between the IT tool and the object of work, between the subjects and documentation rules, between the work activity system using paper records and the system using IT, and between the activity system within the long-term care facility and the pharmacists' work activity system outside the facility. CONCLUSIONS Activity theory provided a theoretic framework to model the work activity system of nurses and care workers. Information technology played an important role in supporting information flow in this system, however it also caused contradictions.
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Affiliation(s)
- Siyu Qian
- Centre for IT-enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales 2522, Australia; Digital Health and Digital Aged Care, Smart Infrastructure, University of Wollongong, Wollongong, New South Wales 2522, Australia.
| | - Ping Yu
- Centre for IT-enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales 2522, Australia; Digital Health and Digital Aged Care, Smart Infrastructure, University of Wollongong, Wollongong, New South Wales 2522, Australia
| | - Anol Bhattacherjee
- Information Systems & Decision Sciences, Muma College of Business, University of South Florida, Tampa, FL 33620, USA
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Clinical Instructors' Experience of Managing Students' Errors: A Qualitative Study. Nurs Educ Perspect 2018; 40:231-233. [PMID: 30407982 DOI: 10.1097/01.nep.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Given the importance of patient safety, this study aimed to explore clinical instructors' experience of managing students' errors. A qualitative approach was adopted to conduct semistructured interviews with 12 clinical nursing and midwifery instructors. Three main categories emerged: prevention (orienting, review of the knowledge, repeating procedure by instructor, checking steps prior to performing procedure, and reminding), action (correcting, monitoring and follow-up, and informing), and feedback (cause analysis, notifying, and affecting assessment). Patient safety and error management programs should be included in the nursing curriculum and nursing education.
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Lin C, Cohen E, Livingston PM, Botti M. Perceptions of patient participation in symptom management: A qualitative study with cancer patients, doctors, and nurses. J Adv Nurs 2018; 75:412-422. [DOI: 10.1111/jan.13853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Cen Lin
- School of Nursing; Fudan University; Shanghai China
- Faculty of Health; School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
| | - Emma Cohen
- Olivia Newton-John Cancer, Research and Wellness Centre; Austin Hospital; Heidelberg Vic. Australia
| | - Patricia M. Livingston
- Faculty of Health; School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
| | - Mari Botti
- Faculty of Health; School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Centre for Quality and Patient Safety Research: Deakin University and Epworth HealthCare Partnership; Melbourne Vic. Australia
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Erichsen Andersson A, Egerod I, Knudsen VE, Fagerdahl AM. Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative Nordic multi-center study. BMC Infect Dis 2018; 18:429. [PMID: 30153808 PMCID: PMC6114743 DOI: 10.1186/s12879-018-3355-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 08/22/2018] [Indexed: 01/11/2023] Open
Abstract
Background Necrotizing soft tissue infection is the most serious of all soft tissue infections. The patient’s life is dependent on prompt diagnosis and aggressive treatment. Diagnostic delays are related to increased morbidity and mortality, and the risk of under- or missed diagnosis is high due to the rarity of the condition. There is a paucity of knowledge regarding early indications of disease. The aim of the study has thus been to explore patients’ and families’ experiences of early signs and symptoms and to describe their initial contact with the healthcare system. Methods A qualitative explorative design was used to gain more knowledge about the experience of early signs and symptoms. Fifty-three participants from three study sites were interviewed. The framework method was used for data analysis. Results Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. The experience of illness varied among the participants depending on the duration of antecedent signs and symptoms. Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear. Conclusion Our study adds to the understanding of the lived experience of NSTI by providing in-depth description of antecedent signs and symptoms precipitating NSTI-diagnosis. We have described diagnostic delay as patient-related, primary care related, or hospital related and recommend that patient and family narratives should be considered when diagnosing NSTI to decrease diagnostic delay.
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Affiliation(s)
- Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden. .,Department of Orthopaedic Surgery, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden.
| | - Ingrid Egerod
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Rigshospitalet, Copenhagen University Hospital, Intensive care unit 4131, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Vibeke E Knudsen
- Rigshospitalet, Copenhagen University Hospital, Intensive care unit 4131, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ann-Mari Fagerdahl
- Wound Centre, Södersjukhuset, Department of Clinical Science and Education, 118 83 Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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16
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González-Samartino M, Delgado-Hito P, Adamuz-Tomás J, Cano MFV, Creus MC, Juvé-Udina ME. Accuracy and completeness of records of adverse events through interface terminology. Rev Esc Enferm USP 2018; 52:e03306. [PMID: 29668785 DOI: 10.1590/s1980-220x2017011203306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. METHOD Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. RESULTS The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration. CONCLUSION The adverse event recorded by nurses with greatest accuracy is pressure ulcers.
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17
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Skär L, Söderberg S. Patients' complaints regarding healthcare encounters and communication. Nurs Open 2018; 5:224-232. [PMID: 29599998 PMCID: PMC5867282 DOI: 10.1002/nop2.132] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/25/2018] [Indexed: 11/05/2022] Open
Abstract
Aim To explore patient-reported complaints regarding communication and healthcare encounters and how these were responded to by healthcare professionals. Design A retrospective and descriptive design was used in a County Council in northern part of Sweden. Both quantitative and qualitative methods were used. Methods The content of 587 patient-reported complaints was included in the study. Descriptive statistical analysis and a deductive content analysis were used to investigate the content in the patient-reported complaints. Results The results show that patients' dissatisfaction with encounters and communication concerned all departments in the healthcare organization. Patients were most dissatisfied when they were not met in a professional manner. There were differences between genders, where women reported more complaints regarding their dissatisfaction with encounters and communication compared with men. Many of the answers on the patient-reported complaints lack a personal apology and some of the patients failed to receive an answer to their complaints.
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Affiliation(s)
- Lisa Skär
- Department of Health Blekinge Institute of Technology Karlskrona Sweden
| | - Siv Söderberg
- Department of Nursing Sciences Mid Sweden University Östersund Sweden
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18
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Kim I, Won S, Lee M, Lee W. A risk-factor analysis of medical litigation judgments related to fall injuries in Korea. MEDICINE, SCIENCE, AND THE LAW 2018; 58:16-24. [PMID: 29065775 DOI: 10.1177/0025802417735265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to find out the risk factors through analysis of seven medical malpractice judgments related to fall injuries. The risk factors were analysed by using the framework that approaches falls from a systems perspective and comprised people, organisational or environmental factors, with each factor being comprised of subfactors. The risk factors found in each of the seven judgments were aggregated into one framework. The risk factors related to patients (i.e. the people factor) were age, pain, related disease, activities and functional status, urination state, cognitive function impairment, past history of fall, blood transfusion, sleep endoscopy state and uncooperative attitude. The risk factors related to the medical staff and caregivers (i.e. people factor) were observation negligence, no fall prevention activities and negligence in managing high-risk group for fall. Organisational risk factors were a lack of workforce, a lack of training, neglecting the management of the high-risk group, neglecting the management of caregivers and the absence of a fall prevention procedure. Regarding the environment, the risk factors were found to be the emergency room, chairs without a backrest and the examination table. Identifying risk factors is essential for preventing fall accidents, since falls are preventable patient-safety incidents. Falls do not happen as a result of a single risk factor. Therefore, a systems approach is effective to identify risk factors, especially organisational and environmental factors.
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Affiliation(s)
- Insook Kim
- 1 Department of Nursing Environments and Systems, College of Nursing, Yonsei University, Mo-Im Kim Nursing Research Institute, Korea
| | - Seonae Won
- 2 College of Nursing, Yonsei University, Korea
| | - Mijin Lee
- 3 Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Korea
| | - Won Lee
- 4 Department of Medical Law and Ethics, College of Medicine, Yonsei University, Asian Institute for Bioethics and Health Law, Korea
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