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Olin K, Klinga C, Ekstedt M, Pukk-Härenstam K. Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study. BMC Health Serv Res 2023; 23:651. [PMID: 37331961 DOI: 10.1186/s12913-023-09674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/08/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Safety has been described as a dynamic non-event and as constantly present in professionals' work processes. Investigating management of complex everyday situations may create an opportunity to elucidate safety management. Anaesthesia has been at the frontline of enhancing patient safety - testing and implementing knowledge from other high-reliability industries, such as aviation, in the complex, adaptive system of an operating room. The aim of this study was to explore factors supporting anaesthesia nurses and anaesthesiologists in managing complex everyday situations during intraoperative anaesthesia care processes. METHODS Individual interviews with anaesthesia nurses (n = 9) and anaesthesiologists (n = 6) using cognitive task analysis (CTA) on case scenarios from previous prospective, structured observations. The interviews were analysed using the framework method. RESULTS During intraoperative anaesthesia care, management of everyday complex situations is sustained through preparedness, support for mindful practices, and monitoring and noticing complex situations and managing them. The prerequisites are created at the organization level. Managers should ensure adequate resources in the form of trained personnel, equipment and time, team and personnel sustainability and early planning of work. Management of complex situations benefits from high-quality teamwork and non-technical skills (NTS), such as communication, leadership and shared situational awareness. CONCLUSION Adequate resources, stability in team compositions and safe boundaries for practice with shared baselines for reoccurring tasks where all viewed as important prerequisites for managing complex everyday work. When and how NTS are used in a specific clinical context depends on having the right organizational prerequisites and a deep expertise of the relevant clinical processes. Methods like CTA can reveal the tacit competence of experienced staff, guide contextualized training in specific contexts and inform the design of safe perioperative work practices, ensuring adequate capacity for adaptation.
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Affiliation(s)
- Karolina Olin
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
- Supervisory Centre, Wellbeing Services County of Southwest Finland, Turku, Finland.
| | - Charlotte Klinga
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Research and Development Unit for Elderly Persons (FOU Nu), Region Stockholm, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Karin Pukk-Härenstam
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden
- Department of Women and Children's Health, Karolinska University Hospital, Stockholm, Sweden
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Jeon Y, Ritmala-Castrén M, Meretoja R, Vahlberg T, Leino-Kilpi H. Anaesthesia nursing competence: Self-assessment of nursing students. NURSE EDUCATION TODAY 2020; 94:104575. [PMID: 32942247 DOI: 10.1016/j.nedt.2020.104575] [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: 11/25/2019] [Revised: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The importance of competence assessment in anaesthesia nursing education has increased since nurse educators and anaesthesia care employers have identified the gap between nursing education and nursing practice. In order to ensure nursing students' preparedness for entry into anaesthesia nursing practice, it is necessary to measure whether nursing students have achieved the required competence to practice as anaesthesia care providers. OBJECTIVES To assess the anaesthesia nursing competence of nursing students and to describe factors related to their anaesthesia nursing competence. This study will provide new knowledge to support the curricula of nursing education and new nurses' practice in anaesthesia care. DESIGN Cross-sectional survey design. METHODS Data from a sample of Finnish nursing students (n = 205) were collected by using an on-line/paper and pencil survey (the Anaesthesia Nursing Competence Scale, 7 categories) in 2017. The assessment was based on self-assessment and used a Visual Analogue Scale (0-100). Descriptive statistics, a Pearson correlation coefficient, independent sample t-tests and a multivariable regression were used to analyse the data. RESULTS The self-assessed overall competence of graduating nursing students was 59 (range 43-73). Approximately half of the students reached an acceptable level (60≤) and half did not. The highest self-assessed category was collaboration within patient care, and the lowest was knowledge of anaesthesia patient care. The number of credits, anaesthesia courses, and experience of clinical practice in anaesthesia nursing were significantly related to anaesthesia nursing competence. CONCLUSIONS Competence development in the knowledge of anaesthesia patient care should be considered in general nursing education. Student nurses' competence could be developed by providing more opportunities for theoretical studies and clinical practice in anaesthesia nursing. A specialised post-registration education in anaesthesia nursing might be one solution to overcome the limitations in the competence that general nursing education is not fully able to cover for anaesthesia nursing.
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Affiliation(s)
- Yunsuk Jeon
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; Joint Authority Administration, Helsinki University Hospital, 00029 Helsinki, Finland.
| | - Marita Ritmala-Castrén
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; Joint Authority Administration, Helsinki University Hospital, 00029 Helsinki, Finland.
| | - Riitta Meretoja
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; Joint Authority Administration, Helsinki University Hospital, 00029 Helsinki, Finland.
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, 20014 Turku, Finland.
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; Turku University Hospital, 20521 Turku, Finland.
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Kerzman H, Van Dijk D, Eizenberg L, Khaikin R, Phridman S, Siman-Tov M, Goldberg S. Attitudes toward expanding nurses' authority. Isr J Health Policy Res 2015; 4:19. [PMID: 26331004 PMCID: PMC4556055 DOI: 10.1186/s13584-015-0005-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 02/15/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In recent years, an increasing number of care procedures previously under the physician's authority have been placed in the hands of registered nurses. The purpose of this study was to examine the attitudes of nurses towards expanding nurses' authority and the relationships between these attitudes and job satisfaction facets, professional characteristics, and demographics. METHOD A cross-sectional study was conducted between 2010 and 2011 in three major medical centers in Israel. Participants included 833 nurses working in 89 departments. Attitudes toward the expansion of nurses' authority were assessed by self-report questionnaire, as well as job satisfaction facets including perception of professional autonomy, nurse-physician working relations, workload and burnout, perceptions of quality of care, and nursing staff satisfaction at work. RESULTS Nurses reported positive attitudes toward the expansion of nurses' authority and moderate attitudes for interpretation of diagnostic tests in selected situations. The results of multivariate regression analyses demonstrate that the nurses' satisfaction from professional autonomy and work relations were the most influential factors in explaining their attitudes toward the expansion of nurses' authority. In addition, professionally young nurses tend to be more positive regarding changes in nurses' authority. CONCLUSIONS In the Israeli reality of a nurse's shortage, we are witnessing professional transitions toward expansion of the scope of nurses' accountability and decision-making authority. The current research contributes to our understanding of attitudes toward the expansion of nurses' authority among the nursing staffs. The findings indicate the necessity of redefining the scope of nursing practice within the current professional context.
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Affiliation(s)
- Hana Kerzman
- />Nursing Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Limor Eizenberg
- />Nursing Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Rut Khaikin
- />Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- />Nursing Division, Tel Aviv University, Tel Aviv, Israel
| | | | - Maya Siman-Tov
- />Gertner Institute for Epidemiology and Public Health Policy, Tel-Hashomer, Israel
| | - Shoshi Goldberg
- />Nursing Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
- />Nursing Division, Tel Aviv University, Tel Aviv, Israel
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Jeon Y, Lahtinen P, Meretoja R, Leino-Kilpi H. Anaesthesia nursing education in the Nordic countries: Literature review. NURSE EDUCATION TODAY 2015; 35:680-688. [PMID: 25676736 DOI: 10.1016/j.nedt.2015.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/15/2014] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this review was to analyse post-registration anaesthesia nursing education in the Nordic countries. The analysis was based on key determinants fundamental to analysing nursing education: 1) the sys]tem of anaesthesia nursing education, 2) entry requirements, 3) credits, the duration and the title or degree awarded, and 4) the amount of practical training. METHODS A scoping review was approached in a systematic manner. The literature was analysed using deductive content analysis. Data was gathered based on key determinants. The data were quantified into frequencies and percentages to compare the similarities and differences of anaesthesia nursing. RESULTS The Nordic countries have different types of post-registration anaesthesia nursing education from non-degree supplementary programmes to Master's degree programmes. Even though the entry requirements correspond between countries, many more differences than similarities in anaesthesia nursing education were noted. A title granting the right to work as a nurse anaesthetist can be obtained through a variety of educational systems, credit requirements, the duration, and the amount of practical training in post-registration anaesthesia nursing programmes. CONCLUSION This aim of the study was to analyse post-registration anaesthesia nursing education from the Nordic perspective. Harmonising the educational system and minimum education requirements in anaesthesia nursing education is recommended in order to facilitate free movement and assure the quality of care from the Nordic perspective. Since each Nordic country has its own native language, it was difficult to gather information from all the Nordic countries. Therefore, creating common educational database published in English can help to bench mark each country's educational system.
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Affiliation(s)
- Yunsuk Jeon
- Department of Nursing Science, University of Turku, 20014 Turku, Finland.
| | - Pia Lahtinen
- Department of Nursing Science, University of Turku, 20014 Turku, Finland.
| | | | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; Turku University Hospital, Turku, Finland.
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Jokiniemi K, Haatainen K, Meretoja R, Pietilä AM. The Future of the Clinical Nurse Specialist Role in Finland. J Nurs Scholarsh 2014; 47:78-86. [DOI: 10.1111/jnu.12109] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Krista Jokiniemi
- Doctoral student; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science, and Assistant Head Nurse; Kuopio Finland
| | - Kaisa Haatainen
- Docent; University of Eastern Finland; and Patient Safety Manager; Kuopio University Hospital; Kuopio Finland
| | - Riitta Meretoja
- Docent; Universtity of Turku; and Development Manager; Corporate Headquarters; Hospital District of Helsinki; Uusimaa Helsinki Finland
| | - Anna-Maija Pietilä
- Professor; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science; Social and Health Care Services; Kuopio Finland
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Development of an anaesthesia resident curriculum at the European level. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dexter F, Logvinov II, Brull SJ. Anesthesiology Residents’ and Nurse Anesthetists’ Perceptions of Effective Clinical Faculty Supervision by Anesthesiologists. Anesth Analg 2013; 116:1352-5. [DOI: 10.1213/ane.0b013e318286dc01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Egger Halbeis CB, Schubert A. Staffing the operating room suite: perspectives from Europe and North America on the role of different anesthesia personnel. Anesthesiol Clin 2008; 26:637-vi. [PMID: 19041621 DOI: 10.1016/j.anclin.2008.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In North America and Europe, a spectrum of anesthesia personnel exists to deliver anesthesia care. The common transatlantic features, however, are increasing demand for and shortage of anesthesia caregivers. Mechanisms counteracting this shortage include increased entry into practice from higher numbers of anesthesia residents and changes in the delivery of anesthesia care by extension of the role of nonphysician anesthesia providers. The training, professional and technical roles, and workforce contribution of anesthesiologists, anesthetists, and various support personnel in Europe and the United States are described. Current and future factors influencing the relationship between provider availability, use, and demand differ across the Atlantic and within Europe.
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Affiliation(s)
- Christoph B Egger Halbeis
- Department of Anesthesia, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Drive H3580, Stanford, CA 94305, USA.
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Abstract
Operating room (OR) is a cost-intensive environment, and it should be managed efficiently. When improving efficiency, shortening case duration by parallel processing, training of the resident surgeons, the choice of anesthetic methods, effective scheduling, and monitoring of the overall OR performance are important. When redesigning the OR processes, changes should be given a clear target and the achieved results monitored and reported to everyone involved. Advanced, reliable, and easy to use information technology solutions for OR management are under development. Pre-operative clinic and functionally designed facilities support efficiency. OR personnel must be kept motivated by clear management and leadership, supported by superiors.
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Affiliation(s)
- R Marjamaa
- Department of Anesthesiology and Intensive Care Medicine, Peijas Hospital, Helsinki University Hospital, Helsinki, Finland
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Egger Halbeis CB, Cvachovec K, Scherpereel P, Mellin-Olsen J, Drobnik L, Sondore A. Anaesthesia workforce in Europe. Eur J Anaesthesiol 2007; 24:991-1007. [PMID: 17608964 DOI: 10.1017/s0265021507000762] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE The European anaesthesia workforce is facing increased demand and expansion of the labour market, which may likely exceed supply. This survey assesses the numbers and practice patterns of anaesthesiologists and studies migration and shortage of the anaesthesia workforce in Europe. METHODS A questionnaire was sent to all national European anaesthesia societies. Countries were grouped according to their relationship with the European Union. RESULTS The number of anaesthesiologists per 100,000 population varies between 2.7 (Turkey) and 20.7 (Estonia). There seems to be no clear evidence for feminization of the anaesthesia workforce. Anaesthesia physician training lasts between 3 yr (Armenia, Belarus, Uzbekistan) and 7 yr (Ireland, UK), and seems to positively correlate with the number of trainees. Throughout Europe, anaesthesiologists typically work in public practice, and are involved in the entire care chain of surgical patients (anaesthesia, intensive care, chronic pain and pre-hospital emergency medicine). The differences between European salaries for anaesthesiologists are up to 50-fold. Most Western European countries are recipients of migrating anaesthesiologists who often originate from the new member states of the European Union. However, it seems that expectations about anaesthesia workforce shortages are not confined to Eastern Europe. CONCLUSIONS Each European country has its own unique workforce constellation and practice pattern. Westward migration of anaesthesiologists from those countries with access to the European Union labour market may be explained by substantial salary differences. There is a European-wide lack of systematic, comparable data about the anaesthesia workforce, which makes it difficult to accurately assess the supply of anaesthesiologists.
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Affiliation(s)
- C B Egger Halbeis
- Stanford University School of Medicine, Department of Anesthesiology, Stanford, CA 94305-H5640, USA.
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Lindfors PM, Meretoja OA, Töyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta Anaesthesiol Scand 2007; 51:815-22. [PMID: 17578460 DOI: 10.1111/j.1399-6576.2007.01343.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Organizational changes and relative growth of the ageing population together with related health problems seem to have increased stressfulness in the work of anaesthesiologists. However, little is known about their work-related well-being and the factors through which their situation could be improved. METHODS A cross-sectional questionnaire study of the level and the determinants of job satisfaction, work ability and life satisfaction among female and male anaesthesiologists involved 258 Finnish anaesthesiologists working full time (53% men). RESULTS The respondents had fairly high job satisfaction, work ability and life satisfaction. No gender differences appeared in these well-being indicators, but their determinants differed by gender. Job satisfaction was only associated with work-related factors in both genders: with job control in women and with job control and organizational justice in men. Work ability correlated with job control and health in both genders and with family life in women. Life satisfaction correlated with individual- and family related factors such as social support and family problems in both genders. Life satisfaction correlated with physical workload in men and health in women. Women had less job control, fewer permanent job contracts and more domestic workload than men. CONCLUSIONS Job control and organizational justice were the most important determinants in work-related well-being. Work-related factors were slightly more important correlates of well-being in males, and family life seems to play a larger role in the well-being of female anaesthesiologists. Organizational and gender issues need to be addressed in order to maintain a high level of well-being among anaesthesiologists.
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Affiliation(s)
- P M Lindfors
- Department of Anesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland.
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