Motivators and inhibitors of nurses' speaking up behaviours: A descriptive qualitative study

Perceived authority gradients among anaesthetic teams in Malta

Over the decades, cases like those of Elaine Bromiley, who passed away after a 'cannot intubate, cannot ventilate' scenario, have prompted deeper analyses of team dynamics and authority gradients. It is thought that a steep authority gradient may have impeded lifesaving communication between members of the anaesthetic team, leading to her death. Using an online questionnaire, we carried out a cross-sectional observational study exploring the perceived authority gradients within anaesthetic teams in the main operating theatres at Mater Dei Hospital, Malta. Nurses were found to experience a steeper authority gradient than anaesthetists. They were less comfortable making suggestions too and also felt like the suggestions they made were less listened to by lead anaesthetists. To a lesser extent, females also experienced a steeper authority gradient. Increasing age and grade were associated with a flatter authority gradient. Further research needs to be carried out to identify the underlying reasons behind the steeper perceived authority gradient affecting nurses. Interventions are being planned to attempt to decrease the perceived authority gradient.

Adaptation and validation of a Korean version of the speaking up about patient safety questionnaire (KSUPS-Q)

BACKGROUND

Speaking up by healthcare providers is an essential assertive communication strategy for ensuring patient safety and preventing incidents. However, more is needed to know about speaking up and instruments to assess it in the Korean context. Therefore, we assessed the psychometric properties of the Korean version of the Speaking Up about Patient Safety Questionnaire (KSUPS-Q) for measuring speaking up-related behavior and climate among nurses.

METHODS

The translation and adaptation process followed the guidelines of the International Society for Pharmacoeconomics and Outcomes Research and the World Health Organization. Content validity was assessed by a six-member expert panel using the content validity index. In total, 314 nurses participated in an online survey to examine the psychometric properties. Internal consistencies were tested using Cronbach's alpha and McDonald's omega. Confirmatory factor analyses were conducted to examine the subscales' construct. The convergent validity of the speaking up-related climate scale was assessed by testing correlations with teamwork and safety climate domains of the Safety Attitudes Questionnaire. In addition, we investigated the convergent validity of the speaking up-related behavior scale by examining its correlation with the climate scale.

RESULTS

The reliability of the 11-item behavior scale was satisfactory. Confirmatory factor analysis confirmed that a three-subscale model (perceived concerns, withholding voice, and speaking up) was appropriate (CFI = 0.98, TLI = 0.98, and SRMR = 0.05). Furthermore, the 11-item climate scale demonstrated satisfactory internal consistency. A three-subscale model (psychological safety, encouraging environment, and resignation) was confirmed (CFI = 0.98, TLI = 0.97, and SRMR = 0.05). The convergent validity of the climate scale was verified based on correlations with the teamwork (r = 0.68, p < 0.001) and safety climate (r = 0.68, p < 0.001) domains of the Safety Attitudes Questionnaire. In addition, speaking up-related behavior and climate showed a significant association, indicating that the behavior scale is conceptually valid.

CONCLUSIONS

This study demonstrates that the KSUPS-Q is a valid and reliable instrument in Korea. This instrument can help nurse managers simultaneously monitor the behavior and climate of their organizations and evaluate the outcomes of interventions to enhance speaking up. Future research is needed to explore diverse factors contributing to speaking up, including clinical roles, team relationships, and supportive culture, to identify areas requiring further improvement.

The Speaking Up Climate of Nurses for Patient Safety Concerns and Unprofessional Behaviors: The Effects of Teamwork and Safety Climate

PURPOSE

This study aims to investigate the influence of teamwork and safety climate on nurses' speaking up for patient safety concerns and unprofessional behaviors.

DESIGN

This study incorporates a cross-sectional research design.

METHODS

The study included 217 surgical nurses employed in a Turkish university hospital. The research data were collected between April and June 2023 using the Teamwork Climate, Safety Climate Survey, Speaking Up Climate for Patient Safety, and Speaking Up Climate for Professionalism instruments. The relationships between these scales were assessed using Pearson correlation analysis. The Turkish validity and reliability of the Speaking Up Climate for Patient Safety and Speaking Up Climate for Professionalism scales were verified. The research model was tested using path analysis.

FINDINGS

The mean age of the 217 surgical nurses was 25.88 ± 5.64 years. Teamwork climate showed a positive effect on safety climate and speaking up climate about patient safety concerns and unprofessional behaviors. Safety climate showed a positive association with nurses' speaking up climate about patient safety concerns and unprofessional behaviors.

CONCLUSIONS

Teamwork climate and safety climate both positively affect the speaking up climate about patient safety concerns and unprofessional behaviors. Nurse managers who wish to promote a culture of speaking up about patient safety and unprofessional behaviors should prioritize improvements in the teamwork climate and safety climate.

Voice, silence, perceived impact, psychological safety, and burnout among nurses: A structural equation modeling analysis

BACKGROUND

The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context.

OBJECTIVE

This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence.

DESIGN

A cross-sectional, correlational study design was employed.

SETTINGS

Study data were collected in 34 general hospitals in South Korea.

PARTICIPANTS

A total of 1255 registered nurses providing direct care to patients were included in this study.

METHODS

Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %.

RESULTS

The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (β = -0.10, 95 % confidence interval [-0.143, -0.059]) and silence (β = -0.04, 95 % confidence interval [-0.058, -0.014]), and psychological safety also decreased burnout through voice (β = -0.04, 95 % confidence interval [-0.057, -0.016]) and silence (β = -0.07, 95 % confidence interval [-0.101, -0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant.

CONCLUSIONS

It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ.

REGISTRATION

Not applicable.

TWEETABLE ABSTRACT

Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.

Addressing Burnout among Healthcare Technology Management Professionals

This article suggests ways in which healthcare delivery organizations (HDOs) may address and mitigate burnout among healthcare technology management (HTM) professionals. Burnout is defined as a state of emotional and physical exhaustion resulting from workplace stressors. Although not intended to be a fully comprehensive empirical analysis of causes of burnout, this article discusses four likely causes for burnout that are particularly relevant to HTM professionals in HDOs: (1) gaps in developing a trained and sustainable workforce, (2) growing demand for HTM expertise across knowledge domains, (3) increasing occupational stressors related to patient safety, and (4) perceived lack of understanding of employee needs. Next, based on existing literature, the article proposes four possible solutions in response to each of these issues: (1) developing human resource planning and mentoring to ensure adequate transfer of skills and knowledge, (2) implementing ways to accomplish knowledge filtering, (3) integrating HTM workers in quality improvement initiatives, and (4) implementing employee voice practices. The article concludes by discussing the possible benefits that may be derived from implementing these solutions.

The perspectives of in-hospital healthcare professionals on the timing and collaboration in advance care planning: A survey study

Background

Hospital admissions are common in the last phase of life. However, palliative care and advance care planning (ACP) are provided late or not at all during hospital admission.

Aim

To provide insight into the perceptions of in-hospital healthcare professionals concerning current and ideal practice and roles of in-hospital palliative care and advance care planning.

Methods

An electronic cross-sectional survey was send 398 in-hospital healthcare professionals in five hospitals in the Netherlands. The survey contained 48 items on perceptions of palliative care and ACP.

Results

We included non-specialists who completed the questions of interest, resulting in analysis of 96 questionnaires. Most respondents were nurses (74%). We found that current practice for initiating palliative care and ACP was different to what is considered ideal practice. Ideally, ACP should be initiated for almost every patient for whom no treatment options are available (96.2%), and in case of progression and severe symptoms (94.2%). The largest differences between current and ideal practice were found for patients with functional decline (Current 15.2% versus Ideal 78.5%), and patients with an estimated life expectancy <1 year (Current 32.6% versus ideal 86.1%). Respondents noted that providing palliative care requires collaboration, however, especially nurses noted barriers like a lack of inter-professional consensus.

Conclusions

The differences between current and ideal practice demonstrate that healthcare professionals are willing to improve palliative care. To do this, nurses need to increase their voice, a shared vision of palliative care and recognition of the added value of working together is needed.

Organizational support and Nurse-Physician collaboration during SARS-CoV-2 pandemic: A qualitative study

Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes - negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.