1
|
Schuermann AA, Arkin L, Loerzel V. An Exploration of Nurses' Attitudes and Beliefs on Reporting Medication Errors. J Nurs Care Qual 2024; 39:279-285. [PMID: 38704643 DOI: 10.1097/ncq.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
BACKGROUND Medication errors in health care are prevalent. Nurses play an important role in reporting; however errors remain underreported in incident reporting systems. Understanding the perspective of nurses will inform strategies to improve reporting and build systems to reduce errors. PURPOSE The purpose of this study was to explore nurses' perceptions and attitudes of medication error reporting practices. METHODS This qualitative study used direct content analysis to analyze interview sessions with 21 total nurses. RESULTS Participant's description of medication error reporting practices fell into 2 themes. Internal factors described circumstances within nurses themselves that affect reporting. External factors described outside influences from processes or places. CONCLUSIONS Medication error reporting is a multidimensional phenomenon with internal and external factors impacting nurses' attitudes and willingness to report errors. Nurses need support from leadership to understand that reporting medication errors can improve practice and impact patient outcomes.
Collapse
Affiliation(s)
- Andrea A Schuermann
- Author Affiliations: Quality Department, Orlando Health South Seminole Hospital, Longwood, Florida (Ms Schuermann); Orlando Health Jewett Orthopedic Institute, Orlando, Florida (Ms Arkin); and University of Central Florida College of Nursing, Orlando, Florida (Dr Loerzel)
| | | | | |
Collapse
|
2
|
Lassoued L, Gharssallah I, Tlili MA, Sahli J, Kouira M, Abid S, Chaieb A, Khairi H. Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals. BMC Health Serv Res 2024; 24:704. [PMID: 38840130 DOI: 10.1186/s12913-024-11152-3] [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: 08/11/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.
Collapse
Affiliation(s)
- Latifa Lassoued
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Ines Gharssallah
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Mohamed Ayoub Tlili
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie.
- Department of Nursing Administration, College of Nursing, University of Hail, Hail, Saudi Arabia.
| | - Jihene Sahli
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
| | - Mouna Kouira
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Skender Abid
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Anouar Chaieb
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Hedi Khairi
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| |
Collapse
|
3
|
Järvisalo P, Haatainen K, Von Bonsdorff M, Turunen H, Härkänen M. Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions. J Adv Nurs 2024; 80:2552-2565. [PMID: 38071607 DOI: 10.1111/jan.16013] [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: 05/15/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
AIMS To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them. DESIGN A qualitative study using interviews. METHODS A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis. RESULTS The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture. CONCLUSION Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety. IMPACT Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work. REPORTING METHOD COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.
Collapse
Affiliation(s)
- Paula Järvisalo
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Haatainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Monika Von Bonsdorff
- Jyväskylä University School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
4
|
Levine KJ, Cantor-Cutiva LC, Castillo-Allendes A, Hunter EJ. Persuasion Through Focus Groups: Helping Teachers Maintain Healthy Voices. J Voice 2024:S0892-1997(24)00126-7. [PMID: 38729777 DOI: 10.1016/j.jvoice.2024.04.009] [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: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024]
Abstract
This study was designed to determine whether participation in a single, 1-hour focus group would spur a change in health-related behavior. All the respondents were teachers who had participated in a focus group designed to learn about teachers' understanding that voice is a working tool. In the discussions, health-related behaviors were discussed as ways to deal with possible vocal strain or injury. Two months later, a follow-up survey was distributed to these participants asking them if they recalled the discussion and if they had sought out more information and/or had changed their vocal behavior due to their participation in the focus group. The qualitative data shows that the majority of these respondents both recalled the messages and had engaged in some type of health-related behavior change due to their participation in the focus group. Behavior change included such modifications as drinking more water and use of voice-amplification equipment in the classroom. Implications of this finding are discussed.
Collapse
Affiliation(s)
- Kenneth J Levine
- Department of Communication, University at Albany, SUNY, Albany, New York.
| | - Lady Catherine Cantor-Cutiva
- Department of Communication Sciences and Disorders, University of Iowa, Wendell Johnson Speech and Hearing Center, Iowa City, Iowa
| | - Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Eric J Hunter
- Department of Communication Sciences and Disorders, University of Iowa, Wendell Johnson Speech and Hearing Center, Iowa City, Iowa
| |
Collapse
|
5
|
Fathizadeh H, Mousavi SS, Gharibi Z, Rezaeipour H, Biojmajd AR. Prevalence of medication errors and its related factors in Iranian nurses: an updated systematic review and meta-analysis. BMC Nurs 2024; 23:175. [PMID: 38481264 PMCID: PMC10938711 DOI: 10.1186/s12912-024-01836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Nurses may make medication errors during the implementation of therapeutic interventions, which initially threaten the patient's health and safety and prolong their hospital stay. These errors have always been a challenge for healthcare systems. Given that factors such as the timing, type, and causes of medication errors can serve as suitable predictors for their occurrence, we have decided to conduct a review study aiming to investigate the prevalence of medication errors and the associated factors among Iranian nurses. METHODS In this systematic review and meta-analysis, studies were searched on PubMed, Web of Science, Scopus, Google Scholar, IranMedex, Magiran, and SID databases using a combination of keywords and Boolean functions. The study that reported the prevalence of medication errors among nurses in Iran without time limitation up to May 2023 was included in this study. RESULTS A total of 36 studies were included in the analysis. The analysis indicates that 54% (95% CI: 43, 65; I2 = 99.3%) of Iranian nurses experienced medication errors. The most common types of medication errors by nurses were wrong timing 27.3% (95% CI: 19, 36; I2 = 95.8%), and wrong dosage 26.4% (95% CI: 20, 33; I2 = 91%). Additionally, the main causes of medication errors among nurses were workload 43%, fatigue 42.7%, and nursing shortage 38.8%. In this study, just 39% (95% CI: 27, 50; I2 = 97.1%) of nurses with medication errors did report their errors. Moreover, the prevalence of medication errors was more in the night shift at 41.1%. The results of the meta-regression showed that publication year and the female-to-male ratio are good predictors of medical errors, but they are not statistically significant(p > 0.05). CONCLUSIONS To reduce medication errors, nurses need to work in a calm environment that allows for proper nursing interventions and prevents overcrowding in departments. Additionally, considering the low reporting of medication errors to managers, support should be provided to nurses who report medication errors, in order to promote a culture of reporting these errors among Iranian nurses and ensure patient safety is not compromised.
Collapse
Affiliation(s)
- Hadis Fathizadeh
- Department of Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
| | | | - Zahra Gharibi
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | | |
Collapse
|
6
|
Soyer Er Ö, Gül İ. The Speaking Up Climate of Nurses for Patient Safety Concerns and Unprofessional Behaviors: The Effects of Teamwork and Safety Climate. J Perianesth Nurs 2024:S1089-9472(23)01070-5. [PMID: 38493404 DOI: 10.1016/j.jopan.2023.12.008] [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: 10/19/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 03/18/2024]
Abstract
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.
Collapse
Affiliation(s)
- Özlem Soyer Er
- Surgical Nursing Department, Afyonkarahisar Health Sciences University, Faculty of Health Sciences, Afyonkarahisar, Turkey
| | - İsa Gül
- Department of Healthcare Management, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| |
Collapse
|
7
|
Jafari MJ, Mostafazadeh P, Mojebi MR, Nemati-Vakilabad R, Mirzaei A. Identifying predictors of patient safety competency based on sleep quality in student faculty of nursing and midwifery during the internship period: a multidisciplinary study. BMC Nurs 2024; 23:67. [PMID: 38267940 PMCID: PMC10807159 DOI: 10.1186/s12912-024-01725-2] [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: 11/10/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Ensuring patient safety is of paramount importance in healthcare services. Sleep disorders not only have detrimental effects on the health of healthcare students but also significantly impair their performance, leading to an increased risk of medication errors. These errors can pose a grave threat to the safety and well-being of patients. It is crucial to address and mitigate sleep disorders among internship healthcare students to safeguard the quality of care and minimize potential patient harm. OBJECTIVES This study aimed to investigate the predictors of Patient Safety Competency (PSC) based on the sleep quality of internship healthcare students. METHODS A study was conducted on 331 students from the Ardabil School of Nursing and Midwifery at Ardabil University of Medical Sciences in northwest Iran from August to December 2022. The participants were selected by stratified random sampling. Data were collected using a demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Health Professional Education in Patient Safety Survey (H-PEPSS). The collected data were analyzed using SPSS software version 22.0. Person correlation coefficients were used to examine the relationship between PSC level, its dimensions, and sleep quality, while multiple linear regression was conducted to identify the predictors of PSC. RESULTS The competency of nurses in patient safety was average in both classroom and clinical settings. However, their ability to work as a team with other healthcare professionals scored the lowest. In addition, the quality of sleep was found to be a predictor of patient safety competency among healthcare students during their internships. CONCLUSIONS It is important to note that healthcare students tend to have moderate patient safety competence (PSC), which is positively correlated with their sleep quality. Therefore, it is vital to identify the key factors that directly affect PSC. This would enable nursing and midwifery faculty administrators to take preventive measures to enhance patient safety competence in both classroom and clinical settings. Additionally, organizing educational workshops that engage students and improve their sleep quality could improve patient care. Practical courses are recommended for health professionals and students in clinical settings to enhance patient safety competencies. Additionally, student internships should receive hands-on training to improve teamwork and rest conditions.
Collapse
Affiliation(s)
- Mohammad Javad Jafari
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Pouya Mostafazadeh
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Reza Mojebi
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Reza Nemati-Vakilabad
- Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Mirzaei
- Department of Emergency Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
| |
Collapse
|
8
|
Al-Oweidat IA, Saleh A, Khalifeh AH, Tabar NA, Al Said MR, Khalil MM, Khrais H. Nurses' perceptions of the influence of leadership behaviours and organisational culture on patient safety incident reporting practices. Nurs Manag (Harrow) 2023; 30:33-41. [PMID: 37190777 DOI: 10.7748/nm.2023.e2088] [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] [Accepted: 02/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Patient safety is a priority for all healthcare organisations. Enhancing patient safety incident reporting practices requires effective leadership behaviours at all levels in healthcare organisations. AIM To explore nurses' perceptions of the influence of nurse managers' leadership behaviours and organisational culture on patient safety incident reporting practices. METHOD A descriptive, cross-sectional, correlational design was adopted with a convenience sample of 325 nurses from 15 Jordanian hospitals. RESULTS Respondents had positive perceptions of their nurse managers' leadership behaviours and organisational culture. There was a significant positive relationship between leadership behaviours and organisational culture (r=0.423, P<0.001) and between leadership behaviours and actual incident-reporting practices (r=0.131, P<0.001). Additionally, there was a significant positive relationship between organisational culture and incident-reporting practices (r=0.250, P<0.001). CONCLUSION Healthcare organisations must develop leaders who will foster a supportive and just culture that will enhance nurses' practice with regards to reporting patient safety incidents.
Collapse
Affiliation(s)
| | - Ali Saleh
- The University of Jordan, Amman, Jordan
| | | | - Nazih Abu Tabar
- Fatima College of Health Sciences, Al Ain, United Arab Emirates
| | | | | | | |
Collapse
|
9
|
Song MO, Yun SY, Jang A. Patient Safety Error Reporting Education for Undergraduate Nursing Students: A Scoping Review. J Nurs Educ 2023; 62:489-494. [PMID: 37672496 DOI: 10.3928/01484834-20230712-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND Patient safety error reporting is essential for learning and preventing errors, and nursing students should develop error reporting capabilities through error reporting education. This study examined undergraduate error reporting education to identify a sustainable development direction. METHOD A systematic literature search of three major scientific databases identified nine articles that met the inclusion criteria. Data on error reporting education features and future error reporting education challenges were extracted. RESULTS Eight studies presented content and error levels according to World Health Organization incident type. Simulations and error reporting systems were used frequently as teaching-learning methods. Although most programs involved Level 3 of Kirkpatrick's levels in error reporting education, programs involving innovative thinking for sustainable error reporting education development are lacking. CONCLUSION For more effective error reporting education, active teaching methods such as virtual reality simulations and planning, applying, and evaluating methods for long-term direct clinical error reporting are required. [J Nurs Educ. 2023;62(9):489-494.].
Collapse
|
10
|
Gencer O, Duygulu S. Speak-Up Behavior of Oncology Nurses: Organizational Trust and Structural Empowerment as Determinants. J Nurs Adm 2023; 53:453-459. [PMID: 37585495 DOI: 10.1097/nna.0000000000001315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE The aim of this study is to examine the mediating roles of organizational trust and structural empowerment on the speak-up behavior of oncology nurses. BACKGROUND Organizational trust can create opportunities for a good working environment. Structural empowerment is an important factor affecting the speak-up behavior of nurses. The intermediary roles of organizational trust and structural empowerment on speak-up behavior are not specific. METHODS A correlational descriptive research design was used, and 232 nurses from 2 different hospital levels (the Ministry of Health hospital and university hospital) responded to 4 questionnaires. RESULT The results reflect that organizational trust and structural empowerment are a factor on nurses' speak-up behavior. CONCLUSION The findings demonstrate that a work environment where organizational trust is developed and a structural empowerment framework is in place contributes to nurses' speak-up behavior among oncology nurses.
Collapse
Affiliation(s)
- Ozge Gencer
- Author Affiliations: Nurse and PhD Candidate (Gencer), Education Unit, Ankara Etlik City Hospital; and Associate Professor (Dr Duygulu), Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | | |
Collapse
|
11
|
Peradejordi-Torres RM, Valls-Matarín J. Perception of the safety culture in a critical area. ENFERMERIA INTENSIVA 2023; 34:148-155. [PMID: 37246107 DOI: 10.1016/j.enfie.2022.11.001] [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: 07/10/2022] [Accepted: 11/04/2022] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Critical care Area (CCA) is one of the most complex in the hospital system, requiring a high number of interventions and handling of amounts of information. Therefore, these areas are likely to experience more incidents that compromise patient safety (PS). AIM To determine the perception of the healthcare team in a critical care area about the patient safety culture. METHOD Cross-sectional descriptive study, September 2021, in a polyvalent CCA with 45 beds, 118 health workers (physicians, nurses, auxiliary nursing care technicians). Sociodemographic variables, knowledge of the person in charge in PS and their general training in PS and incident notification system were collected. The validated Hospital Survey on Patient Safety Culture questionnaire, measuring 12 dimensions was used. Positive responses with an average score ≥75%, were defined as an area of strength while ≥50% negative responses were defined as an area of weakness. Descriptive statistics and bivariate analysis: X2 and t-Student tests, and ANOVA. Significance p ≤ 0.05. RESULTS 94 questionnaires were collected (79.7% sample). The PS score was 7.1 (1.2) range 1-10. The rotational staff scored the PS with 6.9 (1.2) compared to 7.8 (0.9) for non-rotational staff (p = 0.04). A 54.3% (n = 51) was familiar with the incident reporting procedure, 53% (n = 27) of which had not reported any in the last year. No dimension was defined as strength. There were three dimensions that behaved like a weakness: security perception: 57.7% (95% CI: 52.7-62.6), staffing: 81.7% (95% CI: 77.4-85.2) and management support: 69 .9% (95% CI: 64.3-74.9). CONCLUSIONS The assessment of PS in the CCA is moderately high, although the rotational staff has a lower appreciation. Half of the staff do not know the procedure for reporting an incident. The notification rate is low. The weaknesses detected are perception of security, staffing and management support. The analysis of the patient safety culture can be useful to implement improvement measures.
Collapse
Affiliation(s)
- R M Peradejordi-Torres
- Unidad de Cuidados Intensivos del Hospital Universitari Mútua Terrassa, Barcelona, Spain.
| | - J Valls-Matarín
- Unidad de Cuidados Intensivos del Hospital Universitari Mútua Terrassa, Barcelona, Spain
| |
Collapse
|
12
|
Rihari-Thomas J, Glarcher M, Ferguson C, Davidson PM. Why We Need a Re-think of Patient Safety Practices. Contemp Nurse 2023:1-5. [PMID: 37015901 DOI: 10.1080/10376178.2023.2200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
| | - Manela Glarcher
- Assistant Professor, Institute of Nursing, Science and Practice
- Paracelsus medical University, Salzburg, Austria
| | - Caleb Ferguson
- A/Professor and Principal Research Fellow, School of Nursing, University of Wollongong, Australia
| | | |
Collapse
|
13
|
Chen YC, Issenberg SB, Chiu YJ, Chen HW, Issenberg Z, Kang YN, Lin CW, Wu JC. Exploration of students' reaction in medical error events and the impact of personalized training on the speaking-up behavior in medical error events. MEDICAL TEACHER 2023; 45:368-374. [PMID: 36288746 DOI: 10.1080/0142159x.2022.2137394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The ability of medical students to speak up before a medical error occurs is a timely and necessary interaction to prevent potential patient harm. As it may be crucial to improve patient safety, we explored how medical students react to a medical error and provided them appropriate training regarding speaking up about medical issues. METHODS A quasi-experimental study was conducted in Taiwan involving 153 medical students who participated in a speaking-up simulation course. They were divided into two groups. The first group participated in a non-life-threatening scenario before the intervention, followed by a personalized debriefing session, then a life-threatening scenario after the intervention. The second group participated in a life-threatening scenario before the intervention, followed by a personalized debriefing session, then a non-life-threatening scenario after the intervention. Students also completed patient safety attitude survey. RESULTS During the preintervention scenario, the overall medical students' speaking-up rate to medical error was 45.1%. The speaking-up rate of medical students in life-threatening scenario was significantly higher than the rate in non-life-threatening scenario before the intervention (64.6% vs 24.3%, p < 0.001). After personalized debriefing, the speaking-up rate to medical errors was significantly improved both in life-threatening scenarios (95.9%, p < 0.001) and in non-life-threatening scenarios (100%, p < 0.001). Male medical students had significantly higher speaking-up rates than female students in life-threatening scenario (76.2% vs 51.4%, p = 0.02). On post-intervention surveys, students provided several reasons for their likelihood of speaking up or remaining silent during a medical error event. CONCLUSIONS Medical students' rate of speaking-up to medical error was higher in a simulated life-threatening scenario than in a simulated non-life-threatening scenario. Faculty-led personalized debriefing can facilitate medical students' adoption of communication strategies to speak up more in medical error events. Educators should also consider gender differences when they design effective assertive communication courses.[Box: see text].
Collapse
Affiliation(s)
- Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - S Barry Issenberg
- Michael S. Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Wen Chen
- NP, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | | | - Yi-No Kang
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Che-Wei Lin
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| |
Collapse
|
14
|
Magon A, Caruso R. Comment on 'Speaking up during the COVID-19 pandemic: Nurses' experiences of organizational disregard and silence'. J Adv Nurs 2023. [PMID: 36942785 DOI: 10.1111/jan.15644] [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: 01/29/2023] [Revised: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
AIM We aimed to highlight some salient thoughts regarding the importance of addressing the challenges nurses face when speaking up, particularly in situations involving power, hierarchy, fear and threat, and boost scientific and professional debates around this timely topic, starting from the qualitative article published by Abrams et al. (Journal of Advanced Nursing; 2023). BACKGROUND Although acknowledging the contribution of nurses to patient care and their ability to detect and manage potential safety hazards through observations and insights, nurses may encounter challenges in expressing their concerns, particularly in situations that involve power dynamics and hierarchical structures. In this regard, Abrams et al. (Journal of Advanced Nursing; 2023) studied nurse challenges in speaking up during COVID-19, identifying key elements related to speaking up, consequences and responses. Discussing this topic may aid scientific and professional debate. DESIGN Commentary on a qualitative design performed with a social constructionist approach to critically evaluate how nurses spoke up during the COVID-19 pandemic and the resulting outcomes. METHOD Searching for relevant literature to support acknowledging and addressing obstacles nurses face when expressing concerns by speaking up and promoting scholarly and professional discussions on this topic. FINDINGS The challenges faced by nurses when speaking up during the COVID-19 pandemic might reflect broader social, cultural and academic trends: power dynamics, hierarchical structures, deference to authority in healthcare organizations and a lack of attention to nurses' experiences in the literature can make it difficult for nurses to raise their concerns. CONCLUSION Creating a supportive environment that values nurses' perspectives can help healthcare organizations tap into their knowledge and make data-driven decisions leading to better patient outcomes, job satisfaction and organizational performance. Effective policies, best practices and research are necessary to understand nurses' experiences in speaking up and designing strategies to create healthy work environments.
Collapse
Affiliation(s)
- Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
15
|
Peradejordi-Torres R, Valls-Matarín J. Percepción de la cultura de seguridad del paciente en un área de críticos. ENFERMERÍA INTENSIVA 2023. [DOI: 10.1016/j.enfi.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
16
|
Speaking Up for Patient Safety: Will Nurses Report Errors Now a Nurse Has Been Convicted of a Criminal Act? CLIN NURSE SPEC 2022; 36:230-232. [PMID: 35984973 DOI: 10.1097/nur.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Barry JS, Swanson JR, Pearlman SA. Is medical error a crime? The impact of the State v. Vaught on patient safety. J Perinatol 2022; 42:1271-1274. [PMID: 35931799 DOI: 10.1038/s41372-022-01481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Affiliation(s)
- James S Barry
- Department of Pediatrics, NICU Medical Director, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan R Swanson
- Department of Pediatrics, Chief Quality Officer for Children's Services, University of Virginia Children's Hospital, Charlottesville, VA, USA
| | - Stephen A Pearlman
- Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, USA. .,ChristianaCare, Clinical Effectiveness Officer, Newark, DE, USA.
| |
Collapse
|
18
|
Kee K, de Jong D. Factors influencing newly graduated registered nurses' voice behavior: An interview study. J Nurs Manag 2022; 30:3189-3199. [PMID: 35862097 PMCID: PMC10087583 DOI: 10.1111/jonm.13742] [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: 08/19/2021] [Revised: 06/23/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
AIM To gain insight into the factors that affect newly graduated registered nurses' voice behavior. BACKGROUND Employees with little work experience may experience difficulties with speaking up. Given that a lack of voice can negatively affect the delivery of safe client care and lower nurses' job satisfaction, it is important to understand which factors facilitate and hinder newly graduated nurses' voice behavior. METHODS A qualitative descriptive study was conducted using semi-structured interviews with 17 newly graduated registered nurses working in inpatient hospital settings. RESULTS In total, seven factors emerged from our data, which were grouped in four, overarching themes. Whether newly graduated nurses speak up depends on (1) their levels of self-confidence; (2) whether they feel encouraged and welcome to speak up; (3) their relationship with the voice target; and (4) the content of their voice message. CONCLUSION Factors that affect newly graduated nurses' voice behavior are multifaceted, but mostly center around time spent in and relationships at the workplace. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers and colleagues can build an environment that fosters newly graduated nurses' voice behavior. Specifically, induction programs, assigning mentors and offering additional training can support newly graduated nurses in developing voice behavior.
Collapse
Affiliation(s)
- Karin Kee
- Department of Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Demi de Jong
- Department of Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| |
Collapse
|
19
|
Langevin M, Ward N, Fitzgibbons C, Ramsay C, Hogue M, Lobos AT. Improving Safety Recommendations Before Implementation: A Simulation-Based Event Analysis to Optimize Interventions Designed to Prevent Recurrence of Adverse Events. Simul Healthc 2022; 17:e51-e58. [PMID: 34137738 PMCID: PMC8812408 DOI: 10.1097/sih.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pediatric inpatients are at high risk of adverse events (AE). Traditionally, root cause analysis was used to analyze AEs and identify recommendations for change. Simulation-based event analysis (SBEA) is a protocol that systematically reviews AEs by recreating them using in situ simulated patients, to understand clinician decision making, improve error discovery, and, through guided sequential debriefing, recommend interventions for error prevention. Studies suggest that these interventions are rarely tested before dissemination. This study investigates the use of simulation to optimize recommendations generated from SBEA before implementation. METHODS Recommendations and interventions developed through SBEA of 2 hospital-based AEs (event A: error of commission; event B: error of detection) were tested using in situ simulation. Each scenario was repeated 8 times. Interventions were modified based on participant feedback until the error stopped occurring and data saturation was reached. RESULTS Data saturation was reached after 6 simulations for both scenarios. For scenario A, a critical error was repeated during the first 2 scenarios using the initial interventions. After modifications, errors were corrected or mitigated in the remaining 6 scenarios. For scenario B, 1 intervention, the nursing checklist, had the highest impact, decreasing average time to error detection to 6 minutes. Based on feedback from participants, changes were made to all but one of the original proposed interventions. CONCLUSIONS Even interventions developed through improved analysis techniques, like SBEA, require testing and modification. Simulation optimizes interventions and provides opportunity to assess efficacy in real-life settings with clinicians before widespread implementation.
Collapse
|
20
|
Glarcher M, Kaiser K, Kutschar P, Nestler N. Safety climate in hospitals: A cross-sectional study on the perspectives of nurses and midwives. J Nurs Manag 2022; 30:742-749. [PMID: 35088479 PMCID: PMC9314869 DOI: 10.1111/jonm.13551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/07/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022]
Abstract
Aims To explore nurses' and midwives' perspectives of safety climate in Austrian hospitals as measurable elements of safety culture and to identify areas of quality improvement. Background Due to close contact with patients, nurses and midwives play a vital role in ensuring patient safety. Method An online survey among 713 nurses and midwives was conducted, using the 19‐item Safety Climate Survey (SCS). To answer the survey, a 5‐point Likert scale was provided with higher ratings indicating a more positive safety climate. Results Results demonstrate a positive safety culture (MD 4.09, SD 0.53). Significant group differences in overall safety climate score could be found regarding nurses and midwives in managerial positions, between gender and participants age with low effect size. High item missing rates focus aspects on management/leadership, institutional concerns, leadership by physicians, and handling of adverse events. In addition, these items present the lowest ratings in safety climate. Conclusion Results indicate potentials for optimization in the areas of leadership communication and feedback, the handling of safety concerns, and visibility or improvement of patient safety strategies. Implications for Nursing Management A regular, standardized safety climate measurement can be a valuable tool for nurse managers and (political) decision‐makers to manage patient safety initiatives.
Collapse
Affiliation(s)
- Manela Glarcher
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| | - Karin Kaiser
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| | - Patrick Kutschar
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| | - Nadja Nestler
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| |
Collapse
|
21
|
Chen YC, Issenberg SB, Issenberg Z, Chen HW, Kang YN, Wu JC. Factors associated with medical students speaking-up about medical errors: A cross-sectional study. MEDICAL TEACHER 2022; 44:38-44. [PMID: 34477475 DOI: 10.1080/0142159x.2021.1959904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Training medical students to speak up when they witness a potential error is an important competency for patient safety, but details regarding the barriers that prevent medical students from effectively communicating are lacking. Therefore, this study aimed at exploring the factors affecting medical students' willingness to speak up for patient safety when a medical error was observed. METHODS This is a cross-sectional study at a medical university in Taiwan, and 151 medical students in clinical clerkship completed a survey including demographic characteristics, conflict of interests/social relationship, personal capability, and personality and characteristics of senior staff domains. Data were analyzed using t-test. RESULTS Three of five items in the conflict of interests/social relationship domain showed statistically significant importance, including 'I am afraid of being punished' (Mean difference, MD = 0.37; p < 0.01), 'I do not want to break unspoken rules' (MD = 0.55; p < 0.01), and 'I do not want to have bad team relationship' (MD = 0.58; p < 0.01). Two items (perception of knowledge/understanding and communication skills) in the personal capability domain were significantly important to speaking up. Six of 10 items in personality and characteristics of senior staff domain were rated significantly important in deciding to speak up. The top three factors of them were senior personnel with 'Grumpy' personality (MD = 1.20; p < 0.01), 'hierarchy gap' (MD = 1.12; p < 0.01), and senior personnel with 'Stubborn' personality (MD = 1.06; p < 0.01). CONCLUSION Our findings demonstrated medical students' perspectives on barriers to speaking up in the event of medical error. Some factors related to characteristics of senior staff could compromise medical students' ability to speak up in the event of medical error. These results might be important for medical educators in designing personalized educational activities related to medical students' ability to speak up for patient safety.
Collapse
Affiliation(s)
- Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - S Barry Issenberg
- Medicine and Michael S. Gordon Chair of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Nursing and Health in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Continuing Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Hui-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yi-No Kang
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University Taipei, Taiwan
| | - Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| |
Collapse
|
22
|
Jomaa C, Dubois CA, Caron I, Prud'Homme A. Staffing, teamwork and scope of practice: Analysis of the association with patient safety in the context of rehabilitation. J Adv Nurs 2021; 78:2015-2029. [PMID: 34841549 PMCID: PMC9300032 DOI: 10.1111/jan.15112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Aims To describe the organization of nursing services (staffing, scope of practice, teamwork) and its association with medication errors and falls, in rehabilitation units. Background The healthcare system is greatly impacted by the ageing population and the complexity of care associated with chronic diseases. It is therefore necessary to have enough staff who are using their full scope of practice and who are operating in a favourable working environment. However, these conditions are not always met, which can lead to threats to patient safety. Design A correlational descriptive study. Methods Staffing data and reported safety incidents were collected by shift from 01 October 2019 until 15 January 2020 in five rehabilitation units. In addition, a total of 75 nursing staff members responded to a missed care and teamwork survey. Descriptive analysis and logistic regression analysis were performed. Results The mean staff hours per patient shift was 1.39 (SD = 0.60). The teams reported a global missed care score as ‘rarely missed’ at 1.14 (SD = 0.07) and a moderate teamwork score at 3.36 (SD = 0.58) on a five‐point scale. The safety incidents decreased 10‐fold with a predominance of bachelor compared with technician nurses and decreased by 67% when there was an increase of 1 h of care per patient shift. Conclusions This study showed that the organization of nursing services in the observed rehabilitation units is characterized by a moderate staffing intensity, a moderate perception of teamwork level and a relatively low level of missed care. It indicated the key role of the staffing in reducing the risk of occurrence of safety incidents. Future research specific to rehabilitation hospitals are greatly needed to improve patient outcomes in this setting. Impact Nurse Managers should consider all the aspects of the organization of nursing services (staffing, scope of practice and teamwork) in their efforts to improve patient safety in rehabilitation settings. A central finding of this study is that the staffing intensity, the proportion of bachelor prepared nurses and the proportion of agency staff were positively associated with a reduction of safety incidents.
Collapse
Affiliation(s)
- Carla Jomaa
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Ouest de l'île de Montréal, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- School of Public Health, University of Montreal (ESPUM), Montreal, QC, Canada
| | - Isabelle Caron
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Ouest de l'île de Montréal, Montreal, QC, Canada
| | | |
Collapse
|
23
|
Vaismoradi M, Fredriksen Moe C, Vizcaya-Moreno F, Paal P. Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective. PHARMACY 2021; 9:174. [PMID: 34707079 PMCID: PMC8552074 DOI: 10.3390/pharmacy9040174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Prescription and administration of pro re nata (PRN) medications has remained a poorly discussed area of the international literature regarding ethical tenets influencing this type of medication practice. In this commentary, ethical tenets of PRN medicines management from the clinical perspective based on available international literature and published research have been discussed. Three categories were developed by the authors for summarising review findings as follows: 'benefiting the patient', 'making well-informed decision', and 'follow up assessment' as pre-intervention, through-intervention, and post-intervention aspects, respectively. PRN medicines management is mainly intertwined with the ethical tenets of beneficence, nonmaleficence, dignity, autonomy, justice, informed consent, and error disclosure. It is a dynamic process and needs close collaboration between healthcare professionals especially nurses and patients to prevent unethical practice.
Collapse
Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway;
| | | | - Flores Vizcaya-Moreno
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain;
| | - Piret Paal
- WHO Collaborating Centre, Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria;
| |
Collapse
|
24
|
Kritsotakis G, Gkorezis P, Andreadaki E, Theodoropoulou M, Grigoriou G, Alvizou A, Kostagiolas P, Ratsika N. Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses. J Adv Nurs 2021; 78:434-445. [PMID: 34337760 DOI: 10.1111/jan.14994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 12/29/2022]
Abstract
AIMS To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses. DESIGN Multicentre cross-sectional study. METHODS Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations. FINDINGS Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses. CONCLUSIONS Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety. IMPACT On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.
Collapse
Affiliation(s)
- George Kritsotakis
- Department of Bussiness Administration & Tourism, Hellenic Mediterranean University, Crete, Greece.,School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Panagiotis Gkorezis
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Faculty of Economics and Political Sciences, Aristotle University of Thessaloniki, Thesaloniki, Greece
| | - Eirini Andreadaki
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Aghios Nikolaos General Hospital, Crete, Greece
| | | | | | | | - Petros Kostagiolas
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Department of Archives, Library Science and Museology, School of Information Science and Informatics, Ionian University, Kerkyra, Greece
| | - Nikoleta Ratsika
- Department of Social Work, Hellenic Mediterranean University, Crete, Greece
| |
Collapse
|
25
|
Culbreth RE, Spratling R, Scates L, Frederick L, Kenney J, Gardenhire DS. Associations between safety perceptions and medical error reporting among neonatal intensive care unit staff. J Clin Nurs 2021; 30:3230-3237. [PMID: 33928694 DOI: 10.1111/jocn.15828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Critically ill neonates are particularly susceptible to medical errors; however, few studies have evaluated NICU safety climate in the context of medical error reporting. This study aims to identify the association between perceptions of safety and culture among NICU staff with medical error reporting behaviours. METHODS This study used a convenience sample of 79 NICU staff members (38 Nurses and 41 Respiratory Therapists). Questionnaires consisted of demographic factors (years of experience, sex and education), the Safety Attitudes Questionnaire (SAQ) and hypothetical medical error reporting scenarios (categorized into minor harm or major harm). The SAQ consists of six domains: job satisfaction, teamwork climate, safety climate, perceptions of management, working conditions and stress recognition. Scores ranged from 0-5, with a 5 indicating a more positive perception. Logistic regression was used to determine statistically significant predictors for each individual harm scenario (odds of being very likely/likely to report vs. all other responses). RESULTS Among those who completed the study, approximately 84.8% were female. Safety attitude domain scores were similar for both NICU respiratory therapists and nurses across all domains except for job satisfaction and stress. Respiratory therapists reported higher levels of job satisfaction compared to nurses (24 vs. 23, respectively, p = 0.01). However, nurses reported higher levels of stress management compared to respiratory therapists (12 vs. 9, respectively, p < 0.01). While we did not find a significant association between safety attitudes and hypothetical medical error reporting, NICU staff overall were more likely to report major medical errors compared to minor medical errors. CONCLUSIONS This study suggests that safety climate may not play a significant role in promoting medical error reporting in the NICU setting. RELEVANCE TO CLINICAL PRACTICE Interventions aimed at increasing medical error reporting should also incorporate established employees rather than targeting new employees only.
Collapse
Affiliation(s)
- Rachel E Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Regena Spratling
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Lauranne Scates
- Department of Respiratory Care Services, Neurophysiology, and Sleep Services, Piedmont Atlanta Hospital, Atlanta, GA, USA
| | - Laryssa Frederick
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Jordan Kenney
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Douglas S Gardenhire
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
26
|
Rodríguez-Fernández M, Herrera J, de las Heras-Rosas C. Model of Organizational Commitment Applied to Health Management Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4496. [PMID: 33922667 PMCID: PMC8122969 DOI: 10.3390/ijerph18094496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022]
Abstract
In this paper, we try to build on the problems surrounding the management of human resources in health care organizations worldwide. After the analysis of the reviewed literature, we detected that the scientific community considers several recurring themes that need attention: stress, burnout, and turnover intention. Based on this, we developed a model of organizational commitment that aims to achieve performance and health quality, its main result the establishment of the appropriate management policies in order to avoid the abandonment of the organization through the search for commitment and job satisfaction. Amongst our main conclusions, we highlight the need to implement a human resources model for hospital administrators based on the relationships with "patients" not "clients" through the maintenance of a positive and strong atmosphere of staff participation. It is important to develop innovative practices related to clear job design that eliminate reasons for ambiguity and stress in executing the tasks of the healthcare system. Finally, we urge training programs in transformational leadership to promote the well-being and organizational commitment of employees.
Collapse
Affiliation(s)
| | - Juan Herrera
- Department of Economics and Business Administration, Universidad de Málaga, 29071 Málaga, Spain
| | | |
Collapse
|
27
|
Alyahya MS, Hijazi HH, Alolayyan MN, Ajayneh FJ, Khader YS, Al-Sheyab NA. The Association Between Cognitive Medical Errors and Their Contributing Organizational and Individual Factors. Risk Manag Healthc Policy 2021; 14:415-430. [PMID: 33568959 PMCID: PMC7868240 DOI: 10.2147/rmhp.s293110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Examining cognitive medical errors (MEs) and their contributing factors is vital in health systems research, as it provides baseline data that can be used to develop appropriate interventions to prevent and/or minimize errors. The primary aim of this study was to investigate the association between cognitive MEs and hospitals' organizational factors and the individual psychological and functional factors. METHODS This cross-sectional study was conducted in three main hospitals in Northern Jordan. A proportional sampling technique was employed to decide the number of participants from each hospital. Data from physicians and nurses (n=400) were collected using a self-administered questionnaire, which was developed based on pertinent literature review. Exploratory and confirmatory factor analyses were conducted to validate the study instrument. The relationships between the variables were analyzed through structural equation modeling (SEM) using AMOS. Multi-group analysis was also performed to examine the differences in the participants' perceptions towards the respective variables between the three selected hospitals. RESULTS Our results showed a non-significant negative association between MEs and hospital organizational factors. Also, the SEM analysis showed a positive significant correlation between MEs and psychological and functional factors, whereby excessive workload, complexity of tasks, stress, sleep deprivation, and fatigue were found to be predictors of MEs occurrence. In comparison to the results from the university hospital, the multi-group analysis results from the governmental public hospital and the private hospital showed a significant impact of psychological and functional factors on MEs. CONCLUSION To reduce the occurrence of MEs in hospitals, there is a need to enhance organizational safety culture. Efforts should be directed at both organizational and individual levels. Also, it is essential that health decision makers develop strategies to reduce work-related stress and improve healthcare staff well-being, as work stress may cause cognitive impairments among healthcare workers and hence threaten patients' safety.
Collapse
Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Heba H Hijazi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Main Naser Alolayyan
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Farah Jehad Ajayneh
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Yousef S Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Nihaya A Al-Sheyab
- Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, 22110, Jordan
| |
Collapse
|
28
|
Ta'an WF, Suliman MM, Al-Hammouri MM, Ta'an A. Prevalence of medical errors and barriers to report among nurses and nursing students in Jordan: A cross-sectional study. Nurs Forum 2020; 56:284-290. [PMID: 33336425 DOI: 10.1111/nuf.12542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/14/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medical errors (MEs) are serious but preventable threats to patient safety. Annually, 421 million hospitalizations take place worldwide, from those an estimation of around 43 million MEs occur. Low-middle income countries account for two-thirds of these MEs. AIM To examine the prevalence and contributing factors predicting MEs and its reporting among Jordanian nurses and nursing students. METHODS The study used a cross-sectional descriptive design. A total of 178 nursing students and 123 bedside nurses participated in this study. Study data were collected through a five-section newly developed survey. RESULTS MEs are highly prevalent in Jordanian hospitals. More than 70% of nurses and nursing students have no previous training in preventing and reporting MEs. The most prevalent type of MEs were related to changing positions for bedridden patients followed by medication errors, iatrogenic infections, and falls. Staff shortage was the main cause of MEs from participants' perspectives. CONCLUSION A central concern of these results is the need for providing effective programs on identifying and preventing MEs in health-care settings and integrate these programs into graduate nursing curriculums. Strategies should be implemented to establish electronic systems that are accessible, confidential, and a time-saver to enhance reporting MEs.
Collapse
Affiliation(s)
- Wafa'a F Ta'an
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad M Suliman
- Department of Community and Mental Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Mohammed M Al-Hammouri
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali Ta'an
- Forensic Medicine, Ministry of Health, Northern Jordan, Jordan
| |
Collapse
|
29
|
Cottell M, Wätterbjörk I, Hälleberg Nyman M. Medication-related incidents at 19 hospitals: A retrospective register study using incident reports. Nurs Open 2020; 7:1526-1535. [PMID: 32802373 PMCID: PMC7424444 DOI: 10.1002/nop2.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/18/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To examine (a) when medication incidents occur and which type is most frequent; (b) consequences for patients; (c) incident reporters' perceptions of causes; and (d) professional categories reporting the incidents. Design A descriptive multicentre register study. Methods This study included 775 medication incident reports from 19 Swedish hospitals during 2016-2017. From the 775 reports, 128 were chosen to establish the third aim. Incidents were classified and analysed statistically. Perceived causes of incidents were analysed using content analysis. Results Incidents occurred as often in prescribing as in administering. Wrong dose was the most common error, followed by missed dose and lack of prescription. Most incidents did not harm the patients. Errors in administering reached the patients more often than errors in prescribing. The most frequently perceived causes were shortcomings in knowledge, skills and abilities, followed by workload. Most medication incidents were reported by nurses.
Collapse
Affiliation(s)
- Maria Cottell
- Department of Patient SafetyÖrebro University HospitalÖrebroSweden
| | - Inger Wätterbjörk
- School of Health SciencesFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Maria Hälleberg Nyman
- School of Health SciencesFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| |
Collapse
|