1
|
Terry D, Peck B, Baker E, Schmitz D. Self-efficacy, grit, and rural career aspirations among early career nurses: a repeated cross-sectional study. BMC Nurs 2024; 23:50. [PMID: 38233912 PMCID: PMC10795393 DOI: 10.1186/s12912-024-01723-4] [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: 09/13/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Global nursing workforce shortage represents an impediment to the delivery of safe, evidence-based healthcare. Despite collective efforts, a consistent stream of nurses leaving the profession remains, particularly within the first five years of practice, which is exacerbated in rural communities. The aim of the study was to compare self-efficacy, grit, and rural career aspirations among nursing graduates between their second and fourth year of their nursing profession. METHODS As part of a longitudinal investigation, a repeated cross-sectional design was utilised. Participants included, 117 (response rate 52.2%) who completed an online questionnaire 18-24 months after graduating, and 32 participants (response rate of 21.0%) who agree to repeat the questionnaire 36-48 months after graduating. The questionnaire included demographic, employment, and measures examining general and occupational self-efficacy, grit, and rural career aspirations. RESULTS No differences between general and occupational self-efficacy or grit were identified between second- and fourth-year nurses. In addition, the importance placed on undertaking rural career also remains unchanged. However, a higher proportion of fourth year nurses were more likely to be in management or were considering leaving the profession. CONCLUSIONS This examination of early career nurses, now in their second and fourth-year post-graduation highlights self-efficacy, grit, and rural career aspirations remains stable between two- and four-years following graduation, while nursing in their fourth year were more likely to consider leaving the profession. Nursing retention is a 'Wicked Problem' that is unavoidably a complex amalgam of macro, meso and micro factors that we are yet to fully appreciate.
Collapse
Affiliation(s)
- Daniel Terry
- School of Nursing and Midwifery, University of Southern Queensland, 4305, Raceview LPO Raceview, QLD, PO BOX 4393, Australia.
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia.
- Institute of Health and Wellbeing, Federation University Australia, Victoria, Australia.
| | - Blake Peck
- School of Nursing and Midwifery, University of Southern Queensland, 4305, Raceview LPO Raceview, QLD, PO BOX 4393, Australia
- Institute of Health and Wellbeing, Federation University Australia, Victoria, Australia
| | - Ed Baker
- Center for Health Policy, Boise State University, Boise, ID, USA
| | - David Schmitz
- Department of Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
| |
Collapse
|
2
|
Lucas P, Jesus É, Almeida S, Araújo B. Relationship of the nursing practice environment with the quality of care and patients' safety in primary health care. BMC Nurs 2023; 22:413. [PMID: 37915013 PMCID: PMC10621276 DOI: 10.1186/s12912-023-01571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Nursing practice environment has impact on the quality of nursing care and on patients' and nurses' outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients' outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal. METHODS We conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing. RESULTS Nurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients' safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients' safety. CONCLUSIONS The perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses' outcomes, improving the quality of nursing care to patients in the Primary Health Care units.
Collapse
Affiliation(s)
- Pedro Lucas
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho, Porto, 1327, 4169-005, Portugal.
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1600-096, Portugal.
| | - Élvio Jesus
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho, Porto, 1327, 4169-005, Portugal
| | - Sofia Almeida
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho, Porto, 1327, 4169-005, Portugal
| | - Beatriz Araújo
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho, Porto, 1327, 4169-005, Portugal
| |
Collapse
|
3
|
Kaya S, Banaz Goncuoglu M, Mete B, Asilkan Z, Mete AH, Akturan S, Tuncer N, Yukselir Alasirt F, Toka O, Gunes T, Gumus R. Patient Safety Culture: Effects on Errors, Incident Reporting, and Patient Safety Grade. J Patient Saf 2023; 19:439-446. [PMID: 37729641 DOI: 10.1097/pts.0000000000001152] [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: 09/22/2023]
Abstract
OBJECTIVES This study mainly examines the effects of patient safety culture dimensions on 4 outcomes (self-reported errors, witnessing errors, incident reporting, and patient safety grade). METHODS The data were collected using the Turkish version of the Safety Attitudes Questionnaire, which consists of 6 dimensions (teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions). Of 1679 personnel working in 6 hospitals in Ankara, 860 were randomly selected. The data were analyzed using descriptive statistics, the Spearman correlation coefficient, and binary logistic regression analyses. RESULTS The response rate was 62.7%. When the overall patient safety culture score increased by 1 point; the probability of witnessing an error was 2 times lower (P < 0.001), the probability of incident reporting was 4.22 times higher (P < 0.001), and the probability of assessing the patient safety grade as excellent was 29.86 times higher (P < 0.001). The teamwork climate was negatively related to making errors and witnessing errors (P < 0.001). The safety climate and working conditions were positively related to incident reporting and patient safety grade (P < 0.001). Job satisfaction was negatively related to incident reporting (P < 0.001). Perceptions of management were positively related to making errors and patient safety grade (P < 0.001). CONCLUSIONS The patient safety culture scores were positively correlated with incident reporting and patient safety grade but negatively correlated with the occurrence of errors. Each dimension of the patient safety culture, except stress recognition, affected different outcomes. Therefore, managers should focus on different dimensions of patient safety culture to improve different outcomes.
Collapse
Affiliation(s)
- Sıdıka Kaya
- From the Department of Health Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara
| | | | - Buse Mete
- Department of Health Management, Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya
| | - Zeliha Asilkan
- Medical Documentation And Secretarial Program, Department of Medical Services and Techniques, Vocational School of Health Services, Izmir University of Economics, Izmir
| | - Anı Hande Mete
- Department of Health Management, Faculty of Health Sciences, Istanbul University - Cerrahpasa, Istanbul
| | - Saadet Akturan
- Department of General Surgery, Yıldırım Beyazıt University Yenimahalle Training and Research Hospital, Ankara
| | - Nursel Tuncer
- Department of Health Management, Faculty of Health Sciences, Hitit University, Corum
| | - Fatma Yukselir Alasirt
- Department of Health Management, Faculty of Health Sciences, Kırklareli University, Kırklareli
| | - Onur Toka
- Department of Statistics, Faculty of Science, Hacettepe University
| | | | - Rana Gumus
- Oncology Hospital, Hacettepe University, Ankara, Turkey
| |
Collapse
|
4
|
Tocco Tussardi I, Cazzoletti L, Zanolin ME, Comini A, Visentin D, Torri E, Tardivo S, Moretti F. Patient Safety Subcultures among Nursing Home Staff in Italy: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:1962. [PMID: 37444796 DOI: 10.3390/healthcare11131962] [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: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Nursing home (NH) residents are vulnerable subjects and highly susceptible to adverse events. Knowledge of patient safety culture (PSC) is essential for an organization to ensure patient safety. However, research on PSC in NHs, and its variability among staff, is still scarce. This study aimed to explore whether and how PSC differed among NH staff (Managers, Nurses, Direct Care Staff, Support Staff, Administrative Staff and Other Providers) in the Autonomous Province of Trento, Italy. This study employed a cross-sectional design and collected data from 1145 NH providers using the Nursing Home Survey on Patient Safety Culture (NHSPSC). Data were analyzed using linear mixed models, with each of the 12 NHSPSC domains as a response variable. The majority of the respondents (61.6%) were Direct Care Staff members. 'Feedback and Communication about Incidents' and 'Overall Perceptions of Resident Safety' were the domains with the highest proportions of positive answers (PPAs). For most staff categories, 'Staffing' was the domain with the lowest PPA. Support Staff showed significantly lower scores in the majority of domains (8/12). Shorter job tenure, fewer weekly working hours, working mostly during the day and working in highly specialized areas were associated with higher scores in several domains. Interventions to improve PSC must consider the differences between professional groups. Further research is needed to explore the relationship between job-related features and perceptions of patient safety among NH workers.
Collapse
Affiliation(s)
- Ilaria Tocco Tussardi
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, 37134 Verona, Italy
| | - Maria Elisabetta Zanolin
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, 37134 Verona, Italy
| | - Annarita Comini
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Donatella Visentin
- Department of Prevention, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Emanuele Torri
- Clinical Governance Service, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Francesca Moretti
- Department of Neurosciences, Biomedicine and Movement, University of Verona, 37134 Verona, Italy
| |
Collapse
|
5
|
Viksveen P, Røhne M, Grut L, Cappelen K, Wiig S, Ree E. Psychometric properties of the full and short version Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument: a cross-sectional study assessing patient safety culture in Norwegian homecare services. BMJ Open 2022; 12:e052293. [PMID: 35459662 PMCID: PMC9036422 DOI: 10.1136/bmjopen-2021-052293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Measure patient safety culture in homecare services; test the psychometric properties of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument; and propose a short-version Homecare Services Survey on Patient Safety Culture instrument for use in homecare services. DESIGN Cross-sectional survey with psychometric testing. SETTING Twenty-seven publicly funded homecare units in eight municipalities (six counties) in Norway. PARTICIPANTS Five-hundred and forty health personnel working in homecare services. INTERVENTIONS Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: Patient safety culture assessed using the NHSOPSC instrument. Secondary: Overall perception of service users' safety, service safety and overall care. METHODS Psychometric testing of the NHSOPSC instrument using factor analysis and optimal test assembly with generalised partial credit model to develop a short-version instrument proposal. RESULTS Most healthcare personnel rated patient safety culture in homecare services positively. A 19-item short-version instrument for assessing patient safety culture had high internal consistency, and was considered to have sufficient concurrent and convergent validity. It explained a greater proportion of variance (59%) than the full version (50%). Short-version factors included safety improvement actions, teamwork, information flow and management support. CONCLUSION This study provides a first proposal for a short-version Homecare Services Survey on Patient Safety Culture instrument to assess patient safety culture within homecare services. It needs further improvement, but provides a starting point for developing an improved valid and reliable short-version instrument as part of assessment of patient safety and quality improvement processes.
Collapse
Affiliation(s)
- Petter Viksveen
- SHARE-Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Mette Røhne
- SINTEF Digital, Health, SINTEF, Oslo, Norway
| | - Lisbet Grut
- SINTEF Digital, Health, SINTEF, Oslo, Norway
| | - Kathrine Cappelen
- Center for Caring Research South, University of South-Eastern Norway Faculty of Health and Social Sciences, Porsgrunn, Norway
| | - Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eline Ree
- SHARE-Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
6
|
Abt M, Lequin P, Bobo ML, Vispo Cid Perrottet T, Pasquier J, Ortoleva Bucher C. The scope of nursing practice in a psychiatric unit: A time and motion study. J Psychiatr Ment Health Nurs 2022; 29:297-306. [PMID: 34310817 PMCID: PMC9290684 DOI: 10.1111/jpm.12790] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: The evaluation of nurse care practices poses many challenges, including the identification of all the aspects of the care given. Few studies have looked at the scope of nursing practice in psychiatry. However, the evaluation of care practices in the mental health field poses many challenges, including the identification of all aspects of care. WHAT THE DOCUMENT ADDS TO EXISTING KNOWLEDGE?: Findings demonstrated that mental health nurses do not invest in all domains of their scope of practice in the same way and the time spent with patients is low. Several factors contributed to this, including the increasing complexity of care, stagnant staffing levels, and a culture of care that continues to be influenced by the medical model. Current models of care still retain the stigma of this past, prioritizing medically delegated tasks rather than promoting a holistic approach to care. Although the professional identity of nurses is evolving and asserting itself, the paradigm shift in practice is still incomplete. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to describe concretely what is actually expected of nurses, to help them allocate their time effectively and to identify opportunities for improvement. The field of practice of nurses is put under stress by a demanding work environment subject to many pressures and constraints. Changing practices so that nurses can use the full scope of nursing practice requires strong nursing leadership and action on education and the organization of care, particularly on clinical assessment. ABSTRACT: Introduction The evaluation of nursing care practices poses many challenges, including identifying all the aspects of the care given. However, few studies have examined the scope of nursing practice in psychiatry. Aim The aim of this study was to describe the intensity of nursing activities on a psychiatric unit based on the adaptation of Déry and D'Amour's (2017, Perspect Infirm Rev Off Ordre Infirm Qué, 14, 51) Scope of Nursing Practice Model. Method This 56-day descriptive observational study used the time and motion method to follow eight nurses. Results 500 h of observations were carried out. The greatest lengths of time were allocated to communication and coordination of care activities and to "non-healthcare" domains. Less time was devoted to activities related to clinical evaluation and therapeutic education. Discussion Findings demonstrated that MHNs do not perform all the possible functions in the domains of their scope of practice in the same way, and time spent with patients was short. Several factors contributed to this, including the fact that nurses are working in increasingly demanding care settings that keep them under constant pressure.
Collapse
Affiliation(s)
- Maryline Abt
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
| | - Pierre Lequin
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie-Louise Bobo
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
| |
Collapse
|
7
|
Wong SY, Fu ACL, Han J, Lin J, Lau MC. Effectiveness of customised safety intervention programmes to increase the safety culture of hospital staff. BMJ Open Qual 2021; 10:bmjoq-2020-000962. [PMID: 34625426 PMCID: PMC8504354 DOI: 10.1136/bmjoq-2020-000962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/22/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to investigate the effectiveness of customised safety interventions in improving the safety cultures of both clinical and non-clinical hospital staff. This was assessed using the Safety Attitude Questionnaire-Chinese at baseline, 2 years and 4 years after the implementation of safety interventions with a high response rate ranging from 80.5% to 87.2% and excellent internal consistency (Cronbach’s alpha=0.93). The baseline survey revealed a relatively low positive attitude response in the Safety Climate (SC) domain. Both SC and Working Conditions (WC) domains were shown to have increased positive attitude responses in the second survey, while only the Management Perception domain had gained 3.8% in the last survey. In addition, safety dimensions related to collaboration with doctors and service delays due to communication breakdown were significantly improved after customised intervention was applied. Safety dimensions related to safety training, reporting and safety awareness had a high positive response in the initial survey; however, the effect was difficult to sustain subsequently. Multilevel analysis further illustrated that non-clinical staff were shown to have a more positive attitude than clinical staff, while female staff had a higher positive attitude percentage in job satisfaction than male staff. The results showed some improvements in various safety domains and dimensions, but also revealed inconsistent changes in subsequent surveys. The change in positive safety culture over the years and its sustainability need to be further explored. It is suggested that hospital management should continuously monitor and evaluate their strategies while delivering multifaceted interventions to be more specifically focused and to motivate staff to be enthusiastic in sustaining patient safety culture.
Collapse
Affiliation(s)
- Shiu Yee Wong
- Physiotherapy Department, Shatin Hospital, Hospital Authority, Hong Kong
| | - Allan Chak Lun Fu
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jia Han
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Jianhua Lin
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Rehabilitation Therapy, Tongji University School of Medicine, Shanghai, China
| | - Mun Cheung Lau
- Sports Medicine and Rehabilitation Centre, Chinese University of Hong Kong, New Territories, Hong Kong.,School of Health Sciences, Caritas Institute of Higher Education, Kowloon, Hong Kong
| |
Collapse
|
8
|
Fish JA, Sharplin G, Wang L, An Y, Fan X, Eckert M. Cross-cultural differences in nurse burnout and the relationship with patient safety: An East-West comparative study. J Adv Nurs 2021; 78:1001-1011. [PMID: 34435692 DOI: 10.1111/jan.15024] [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: 04/16/2021] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 11/27/2022]
Abstract
AIMS To compare levels of nurse burnout across eastern and western cultures, as well as examine the influence of burnout on patient safety cross-culturally. DESIGN Comparative cross-sectional study. METHODS Survey data were collected from nurses between August and October 2017 in Australia (n = 730) and between April and October 2019 in China (n = 1107). Variables included burnout (emotional exhaustion, depersonalization, personal accomplishment), nurse leadership and support, staffing and resource adequacy, and perceived patient safety. Data were analysed separately for each jurisdiction using bootstrapped hierarchical regressions, which tested the relationships between burnout indicators and patient safety, controlling for support resources. RESULTS Emotional exhaustion and depersonalization scores were significantly higher in the Australian sample compared with the Chinese sample. Australian participants reported significantly lower patient safety grades than Chinese participants and were less likely to agree that support resources were present in their current job. Separate regressions indicated that patient safety was significantly associated with staffing and resource adequacy, nurse leadership and support, and depersonalization among Australian participants (30% of variance explained in the final regression model), while staffing and resource adequacy, nurse leadership and support, personal accomplishment and emotional exhaustion predicted patient safety for Chinese participants (22% of variance explained in the final model). CONCLUSION Australian nurses are at greater risk of burnout than Chinese nurses. Burnout dimensions are differentially associated with patient safety across cultures. Culturally relevant interventions may be more optimal than universal approaches for improving burnout and patient safety in nursing. IMPACT This study increased understanding of cross-cultural differences in nurse burnout and the relationship with patient safety. Australian nurses were at greater risk of burnout than Chinese nurses. Emotional exhaustion, depersonalization and personal accomplishment influenced patient safety distinctively across the countries. These findings inform interventions designed to reduce nurse burnout and improve patient safety internationally.
Collapse
Affiliation(s)
- Jennifer A Fish
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lyu Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Yan An
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Lee SE, Dahinten VS. Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157746. [PMID: 34360039 PMCID: PMC8345389 DOI: 10.3390/ijerph18157746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 01/15/2023]
Abstract
Studies have demonstrated associations between safety culture and patient safety based on the perceptions of healthcare professionals, but limited attention has been given to the perceptions of nurses. Moreover, most studies have used regression modeling, an approach that limits researchers’ ability to identify the most important predictors of patient safety due to intercorrelations among predictors in the model. Therefore, the purpose of this study was to examine the effects of seven dimensions of safety culture on nurse-rated patient safety and identify the relative importance of these dimensions for predicting patient safety. This correlational study used data from the Agency for Healthcare Research and Quality’s 2018 Hospital Survey on Patient Safety Culture. Data from 13,031 nurses working in surgical areas of 443 hospitals in the United States were examined using logistic regression and dominance analysis. Staffing adequacy was the strongest predictor of patient safety, followed by hospital management support for patient safety and organizational learning/continuous improvement. However, dominance analysis showed that hospital management support for patient safety was the most important predictor rather than staffing adequacy. Nurse managers and hospital administrators should role model a culture of safety and demonstrate their valuing of patient safety by providing sufficient resources, listening to and valuing staff suggestions regarding patient safety, and providing feedback about organizational changes to improve patient safety.
Collapse
Affiliation(s)
- Seung Eun Lee
- Mo-Im KIM Nursing Research Institute, College of Nursing, Yonsei University, Seoul 03722, Korea
- Correspondence:
| | - V. Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| |
Collapse
|
10
|
Hospital staffing patterns and safety culture perceptions: The mediating role of perceived teamwork and perceived handoffs. Health Care Manage Rev 2021; 46:227-236. [PMID: 31702706 DOI: 10.1097/hmr.0000000000000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As hospitals are under increasing pressure to improve quality and safety, safety culture has become a focal issue for high-risk organizations, including hospitals. Prior research has examined how structural characteristics directly impact safety culture. However, and based on Donabedian's structure-process-outcome quality model, there is a need to understand the processes that intermediate the relationship between structural characteristics and safety culture perceptions. PURPOSE The processes by which registered nurse (RN) and hospitalist staffing may affect safety culture perceptions were examined in this study. Specifically, this study investigates the processes of perceived teamwork across units and perceived handoffs. METHODOLOGY Data sources for this research included Hospital Survey on Patient Safety Culture from the Agency for Healthcare Research and Quality, the American Hospital Association's Annual Survey Data, the American Hospital Association Information Technology supplement, and the Area Health Resource File. Two separate mediation models for each process were used. Propensity weights were assigned to each hospital in the sample ( N = 207) to adjust for potential nonresponse bias of hospitals that did not assess employee's safety culture perceptions. RESULTS Results suggest that RN staffing influences safety culture perceptions, but hospitalist staffing does not. In addition, RN staffing has an indirect effect on safety culture perceptions through better processes. PRACTICE IMPLICATIONS Our study sheds light on how staffing affects safety culture perceptions. Specifically, our findings suggest that positive perceptions of teamwork across units and handoffs are integral in the relationship between RN staffing and safety culture perceptions. Hospital managers should, therefore, invest resources in staff recruitment and retention. In addition, a targeted focus on perceived teamwork and handoffs may allow hospital managers to improve safety culture perceptions.
Collapse
|
11
|
Michel O, Garcia Manjon AJ, Pasquier J, Ortoleva Bucher C. How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit. J Adv Nurs 2021; 77:4459-4470. [PMID: 34133039 PMCID: PMC8518809 DOI: 10.1111/jan.14935] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Aim To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward. Design A single‐centre observational descriptive study. Method Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre‐registered list of 42 activities classified into 13 dimensions. Results A total of 507.5 work hours were observed. Less than one third of registered nurses’ work time was spent with patients. They allocated the most time to the dimensions of ‘communication and care coordination’ and ‘care planning’, whereas ‘optimizing the quality and safety of care’, ‘integrating and supervising staff’ and ‘client education’ were allocated the least time. Conclusion This study provided a reliable description of nurses’ time use at work. It highlighted suboptimal use of the full scope of nursing practice. Impact Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses’ skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses’ knowledge.
Collapse
Affiliation(s)
- Olivia Michel
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Health Sciences (HEdS-FR), University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| |
Collapse
|
12
|
Granados-Plaza M, Gea-Caballero V, Martí-Ejarque MDM, Ferré-Grau C. Association of Nursing Practice Environment on reported adverse events in private management hospitals: A cross-sectional study. J Clin Nurs 2021; 30:2990-3000. [PMID: 33893681 DOI: 10.1111/jocn.15806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine the relationships between nurses' perceptions of their practice environment, other working conditions and reported adverse events in two private management hospitals. BACKGROUND Patient safety is influenced by knowledge, available resources and the context in which nursing care is provided. In this sense, it has been found that certain work environments (e.g., workload, nurse turnover level, patient-to-nurse ratio, nurse staffing, nurse manager ability) influence patient outcomes. The association between nursing practice environment and reported adverse events has not been explored in private management hospitals. DESIGN A cross-sectional study. The STROBE was selected as the checklist in this study. METHODS A total of 219 nurses were included in the study. This study was conducted from June 2018-June 2019 in Spain. Data were collected through questionnaires focusing on work conditions, reported adverse events (falls, medication errors, catheter-related sepsis and pressure ulcer) and Practice Environment Scale of the Nursing Work Index. Binary logistic regression analysis was performed to determine the factors influencing the occurrence of errors. RESULTS Nurses reported poor perception of the professional environment, and 62.1% reported having made at least one error in the previous year. Manager support and leadership and nurse-physician relations were the most favourable aspects of work environment. Medical-surgical units, rotating in the same shift and favourable work environment, were associated with more reporting of adverse events. CONCLUSION The factors of nursing practice (hospital area workload, staff rotating and perception of work environment) associated with reporting adverse events can be worked upon from the organisation and provided an opportunity for safety culture improvement and safer healthcare services. RELEVANCE TO CLINICAL PRACTICE Improving the nurse work environment may reduce adverse patient events in private management hospitals.
Collapse
Affiliation(s)
- Montse Granados-Plaza
- Grupo Hospitalario Quirónsalud, Hospital Universitari General de Catalunya, Barcelona, Spain.,Doctoral School, Universitat Rovira i Virgili, Tarragona, Spain
| | - Vicente Gea-Caballero
- Nursing School La Fe, Research Group GREIACC, Health Research Institute La Fe, Adscript Center of University of Valencia, Valencia, Spain
| | - Maria Del Mar Martí-Ejarque
- Grupo Hospitalario Quirónsalud, Hospital Universitari Sagrat Cor, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Carme Ferré-Grau
- Doctorate Programme coordinator Nursing and Health, Research Group Advanced Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| |
Collapse
|
13
|
van der Mark CJEM, Vermeulen H, Hendriks PHJ, Oostveen CJV. Measuring perceived adequacy of staffing to incorporate nurses' judgement into hospital capacity management: a scoping review. BMJ Open 2021; 11:e045245. [PMID: 33879488 PMCID: PMC8061817 DOI: 10.1136/bmjopen-2020-045245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Matching demand and supply in nursing work continues to generate debate. Current approaches focus on objective measures, such as nurses per occupied bed or patient classification. However, staff numbers do not tell the whole staffing story. The subjective measure of nurses' perceived adequacy of staffing (PAS) has the potential to enhance nurse staffing methods in a way that goes beyond traditional workload measurement or workforce planning methods. OBJECTIVES To detect outcomes associated with nurses' PAS and the factors that influence PAS and to review the psychometric properties of instruments used to measure PAS in a hospital setting. DESIGN AND METHODS A scoping review was performed to identify outcomes associated with PAS, factors influencing PAS and instruments measuring PAS. A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Business Source Complete and Embase databases identified 2609 potentially relevant articles. Data were independently extracted, analysed and synthesised. The quality of studies describing influencing factors or outcomes of PAS and psychometric properties of instruments measuring PAS were assessed following the National Institute for Health and Care Excellence quality appraisal checklist and the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. RESULTS Sixty-three studies were included, describing 60 outcomes of PAS, 79 factors influencing PAS and 21 instruments measuring PAS. In general, positive PAS was related to positive outcomes for the patient, nurse and organisation, supporting the relevance of PAS as a staffing measure. We identified a variety of factors that influence PAS, including demand for care, nurse supply and organisation of care delivery. Associations between these factors and PAS were inconsistent. The quality of studies investigating the development and evaluation of instruments measuring PAS was moderate. CONCLUSIONS Measuring the PAS may enhance nurse staffing methods in a hospital setting. Further work is needed to refine and psychometrically evaluate instruments for measuring PAS.
Collapse
Affiliation(s)
- Carmen J E M van der Mark
- Department of Capacity Management, Rijnstate Hospital, Arnhem, The Netherlands
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboudumc, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboudumc, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Paul H J Hendriks
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Catharina J van Oostveen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp and Haarlem, The Netherlands
| |
Collapse
|
14
|
Alshammari F, Alshammari HF, Alsaedi B, Zreiq R, Algahtan FD. Data on healthcare perceptions about system risk factors associated with patient safety from the Ministry of Health hospitals in Hail Region of Saudi Arabia. Bioinformation 2021; 17:274-282. [PMID: 34393446 PMCID: PMC8340706 DOI: 10.6026/97320630017274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 11/26/2022] Open
Abstract
Patient protection has become one of the key elements of the quality of health care systems in Saudi Arabia. Medical errors that threaten patient safety are mediated by several factors including system risk factors. Hence, we used a self-structured questionnaire
to assess and rank the system factors according to the perceptions of nurses working in the hospitals of the ministry of health in Hail, KSA. Eight out of twelve factors tested were perceived as threatening factors of the patient safety that are; 'Shortage of medical
staff', 'Poor design of the hospital structure', 'Long working hours', 'Overcrowding of patients','Poor coordination between hospital departments, 'Punitive and blaming environment, 'Lack of clinical practice standards' and, 'Poor financial incentives'. Thus, considering
the negative impact of the identified threatening system factors in this study on patient safety, urgent planning and managing appropriate corrective actions should be designed to improve patient safety issues.
Collapse
Affiliation(s)
- Fares Alshammari
- Department of Health Informatics, College of Public Health and Health Informatics, University of Ha'il, Ha'il, Saudi Arabia
| | - Hamoud Fahad Alshammari
- Department of Health administration, College of Public Health and Health Informatics, University of Ha'il, Ha'il, Saudi Arabia
| | - Bandar Alsaedi
- Department of Health administration, College of Public Health and Health Informatics, University of Ha'il, Ha'il, Saudi Arabia
| | - Rafat Zreiq
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Ha'il, Saudi Arabia.,Molecular Diagnostic and Personalised Therapeutics Unit, University of Ha'il, Ha'il,Saudi Arabia
| | - Fahad D Algahtan
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Ha'il, Saudi Arabia.,Molecular Diagnostic and Personalised Therapeutics Unit, University of Ha'il, Ha'il,Saudi Arabia
| |
Collapse
|
15
|
Al-Faouri I, Obaidat DM, AbuAlRub RF. Missed nursing care, staffing levels, job satisfaction, and intent to leave among Jordanian nurses. Nurs Forum 2020; 56:273-283. [PMID: 33345335 DOI: 10.1111/nuf.12537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/16/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Patient safety is an important outcome for nurses who provide patient care within an environment that may increase the incidence of errors or impose them to omit care; these errors mostly happen because of staff shortage. The purpose of this study is to identify the types and reasons of "missed nursing care" among Jordanian nurses, and to examine the relationships between "missed nursing care", staffing, intent to leave, and job satisfaction. A cross-sectional descriptive design was used. A convenience sample of 300 nurses completed the Arabic version of MISSCARE which included items to measure types and reasons for "missed nursing care", staffing adequacy, job satisfaction, and intent to leave. The results of this study indicated that Labor resources were the most common cause of "missed nursing care". The results also showed that a low number of nurses per shift were associated with a high level of "missed nursing care". Nurse managers need to tackle staffing problems that may increase the rate of missed care and result in negative outcomes on the patients, nurses, as well as organizations. Nurse administrators could conduct evidence-based staffing plans to manage nurse to patient ratio to decrease missed care and enhance satisfaction.
Collapse
Affiliation(s)
- Ibrahim Al-Faouri
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Dana M Obaidat
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Raeda F AbuAlRub
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
16
|
Ahlstedt C, Eriksson Lindvall C, Holmström IK, Muntlin Å. Flourishing at work: Nurses' motivation through daily communication - An ethnographic approach. Nurs Health Sci 2020; 22:1169-1176. [PMID: 33104296 PMCID: PMC7756815 DOI: 10.1111/nhs.12789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/11/2020] [Accepted: 10/24/2020] [Indexed: 01/10/2023]
Abstract
Shortage and turnover of registered nurses are worldwide challenges, and work motivation is one factor in retaining staff in the healthcare sector. The aim of this study was to explore registered nurses' motivation expressed in daily communication, using the basic needs in self‐determination theory as a framework. A secondary analysis of ethnographic data, collected through participant observations, informal interviews during observations, and individual interviews, was used. A total sample of all registered nurses employed at a hospital unit in Sweden (n = 10) participated. The data were analyzed thematically through the lens of the basic needs in self‐determination theory: autonomy, competence, and relatedness. Self‐regulation of learning, the possibilities to discuss work‐related challenges with colleagues, and having registered nurses lead dialogues with physicians were factors connected to autonomy. Having a registered nurse and physician solve problems together was a factor connected to competence. A sense of belonging and security in a permissive climate between registered nurses was connected to relatedness. This paper has implications for increased awareness of the three basic motivational needs, which could be used in the development of attractive workplaces.
Collapse
Affiliation(s)
- Carina Ahlstedt
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | | | - Inger K Holmström
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Åsa Muntlin
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
17
|
Olley R, Edwards I, Avery M, Cooper H. Systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals. AUST HEALTH REV 2020; 43:288-293. [PMID: 29661270 DOI: 10.1071/ah16252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/01/2017] [Indexed: 11/23/2022]
Abstract
Objective The purpose of this systematic review was to evaluate and summarise available research on nurse staffing methods and relate these to outcomes under three overarching themes of: (1) management of clinical risk, quality and safety; (2) development of a new or innovative staffing methodology; and (3) equity of nursing workload. Methods The PRISMA method was used. Relevant articles were located by searching via the Griffith University Library electronic catalogue, including articles on PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline. Only English language publications published between 1 January 2010 and 30 April 2016 focusing on methodologies in acute hospital in-patient units were included in the present review. Results Two of the four staffing methods were found to have evidenced-based articles from empirical studies within the parameters set for inclusion. Of the four staffing methodologies searched, supply and demand returned 10 studies and staffing ratios returned 11. Conclusions There is a need to develop an evidence-based nurse-sensitive outcomes measure upon which staffing for safety, quality and workplace equity, as well as an instrument that reliability and validly projects nurse staffing requirements in a variety of clinical settings. Nurse-sensitive indicators reflect elements of patient care that are directly affected by nursing practice In addition, these measures must take into account patient satisfaction, workload and staffing, clinical risks and other measures of the quality and safety of care and nurses' work satisfaction. i. What is known about the topic? Nurse staffing is a controversial topic that has significant patient safety, quality of care, human resources and financial implications. In acute care services, nursing accounts for approximately 70% of salaries and wages paid by health services budgets, and evidence as to the efficacy and effectiveness of any staffing methodology is required because it has workforce and industrial relations implications. Although there is significant literature available on the topic, there is a paucity of empirical evidence supporting claims of increased patient safety in the acute hospital setting, but some evidence exists relating to equity of workload for nurses. What does this paper add? This paper provides a contemporary qualitative analysis of empirical evidence using PRISMA methodology to conduct a systematic review of the available literature. It demonstrates a significant research gap to support claims of increased patient safety in the acute hospital setting. The paper calls for greatly improved datasets upon which research can be undertaken to determine any associations between mandated patient to nurse ratios and other staffing methodologies and patient safety and quality of care. What are the implications for practitioners? There is insufficient contemporary research to support staffing methodologies for appropriate staffing, balanced workloads and quality, safe care. Such research would include the establishment of nurse-sensitive patient outcomes measures, and more robust datasets are needed for empirical analysis to produce such evidence.
Collapse
Affiliation(s)
- Richard Olley
- Health Services Management, School of Medicine, Griffith University, PO Box 3370, South Brisbane, Qld 4101, Australia.
| | - Ian Edwards
- Health Services Management, School of Medicine, Griffith University, PO Box 3370, South Brisbane, Qld 4101, Australia.
| | - Mark Avery
- Health Services Management, School of Medicine, Griffith University, PO Box 3370, South Brisbane, Qld 4101, Australia.
| | - Helen Cooper
- Health Services Management, School of Medicine, Griffith University, PO Box 3370, South Brisbane, Qld 4101, Australia.
| |
Collapse
|
18
|
Douglas JA, Bourgeois S, Moxham L. Early career registered nurses: How they stay. Collegian 2020. [DOI: 10.1016/j.colegn.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
19
|
Lee SE, Dahinten VS. The Enabling, Enacting, and Elaborating Factors of Safety Culture Associated With Patient Safety: A Multilevel Analysis. J Nurs Scholarsh 2020; 52:544-552. [PMID: 32573867 DOI: 10.1111/jnu.12585] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Worldwide, 1 in 10 hospital patients is harmed while receiving care. Despite evidence that a culture of safety is associated with greater patient safety, these effects and the processes by which safety culture impacts patient safety are not yet clearly understood. Therefore, the purpose of this study was to examine the effects of various safety culture factors on nurses' perceptions of patient safety using an innovative theoretical model. DESIGN This descriptive, correlational study drew on deidentified, publicly available data from the 2018 Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. The study sample included 34,514 nurses who provided direct care to patients in medical and surgical units in 535 hospitals in the United States. METHODS Multilevel linear regression was used to examine the effects of 11 safety culture factors on nurses' overall perceptions of patient safety. The 11 safety culture factors were grouped as enabling, enacting, and elaborating processes, and entered in separate blocks. FINDINGS All 11 safety culture factors were associated with nurse-perceived patient safety, and all but two of the 11 factors uniquely predicted nurse-perceived patient safety. Staffing adequacy was the strongest predictor of nurse-perceived patient safety, followed by hospital management support for patient safety (both enabling processes), and continuous organizational learning and improvement (an elaborating process). CONCLUSIONS Hospital administrators and managers play a key role in promoting a safety culture and patient safety in healthcare organizations through enabling and elaborating processes. CLINICAL RELEVANCE Organizational efforts should be made to provide sufficient staffing and hospital-wide support for patient safety. However, all staff, administrators, and managers have a role to play in patient safety.
Collapse
Affiliation(s)
- Seung Eun Lee
- Lambda Alpha-at-Large, Assistant Professor, College of Nursing, Yonsei University, Seoul, South Korea
| | - V Susan Dahinten
- Associate Professor, School of Nursing, University of British Columbia, Vancouver, Canada
| |
Collapse
|
20
|
Between a rock and a hard place: Registered nurses' accounts of their work situation in cancer care in Swedish acute care hospitals. Eur J Oncol Nurs 2020; 47:101778. [PMID: 32563048 DOI: 10.1016/j.ejon.2020.101778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Hospital organizational features related to registered nurses' (RNs') practice environment are often studied using quantitative measures. These are however unable to capture nuances of experiences of the practice environment from the perspective of individual RNs. The aim of this study is therefore to investigate individual RNs' experiences of their work situation in cancer care in Swedish acute care hospitals. METHODS This study is based on a qualitative framework analysis of data derived from an open-ended question by 200 RNs working in specialized or general cancer care hospital units, who responded to the Swedish RN4CAST survey on nurse work environment. Antonovsky's salutogenic concepts "meaningfulness", "comprehensibility", and "manageability" were applied post-analysis to support interpretation of results. RESULTS RNs describe a tension between expectations to uphold safe, high quality care, and working in an environment where they are unable to influence conditions for care delivery. A lacking sense of agency, on individual and collective levels, points to organizational factors impeding RNs' use of their competence in clinical decision-making and in governing practice within their professional scope. CONCLUSIONS RNs in this study appear to experience work situations which, while often described as meaningful, generally appear neither comprehensible nor manageable. The lack of an individual and collective sense of agency found here could potentially erode RNs' sense of meaningfulness and readiness to invest in their work.
Collapse
|
21
|
Al-Mugheed K, Bayraktar N. Patient safety attitudes among critical care nurses: A case study in North Cyprus. Int J Health Plann Manage 2020; 35:910-921. [PMID: 32329530 DOI: 10.1002/hpm.2976] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Patient safety has become a crucial priority in quality healthcare. Adverse events and serious errors involving critically ill patients are common and can be potentially life-threatening. Thus, this study aimed to examine patient safety attitudes among critical care nurses. METHODS This cross-sectional study was conducted in two hospitals in North Cyprus. Eighty nurses working in critical care units participated in the study. Following ethical approval, data were collected between September and October 2018, using the Demographic Characteristics Questionnaire and Safety Attitudes Questionnaire. FINDINGS Nurses' overall scores regarding patient safety attitudes were found to be negative. The highest positive rate was for safety climate, followed by perception of management, teamwork, working conditions, job satisfaction, and stress recognition, respectively. There were significant differences among working conditions, perception of management, and stress recognition based on participants' positions and event reporting. CONCLUSION Our findings indicate safety culture needs to be improved in the hospitals included in the study. Healthcare managers and decision-makers should foster patient safety culture through in-service education, management support, institutional regulations, and updated guidelines.
Collapse
Affiliation(s)
- Khalid Al-Mugheed
- Surgical Nursing Department, Near East University Faculty of Nursing, Nicosia, Cyprus
| | - Nurhan Bayraktar
- Surgical Nursing Department, Near East University Faculty of Nursing, Nicosia, Cyprus
| |
Collapse
|
22
|
Griffiths P, Saville C, Ball JE, Chable R, Dimech A, Jones J, Jeffrey Y, Pattison N, Saucedo AR, Sinden N, Monks T. The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08160] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe Safer Nursing Care Tool is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The Safer Nursing Care Tool is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing the staffing levels needed for safe and quality patient care.ObjectivesTo determine whether or not the Safer Nursing Care Tool corresponds to professional judgement, to assess a range of options for using the Safer Nursing Care Tool and to model the costs and consequences of various ward staffing policies based on Safer Nursing Care Tool acuity/dependency measure.DesignThis was an observational study on medical/surgical wards in four NHS hospital trusts using regression, computer simulations and economic modelling. We compared the effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff re-deployed/hired to meet fluctuations in demand.SettingMedical/surgical wards in four NHS hospital trusts.Main outcome measuresThe main outcome measures were professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient-day and cost per life saved.Data sourcesThe data sources were hospital administrative systems, staff reports and national reference costs.ResultsIn total, 81 wards participated (85% response rate), with data linking Safer Nursing Care Tool ratings and staffing levels for 26,362 wards × days (96% response rate). According to Safer Nursing Care Tool measures, 26% of all ward-days were understaffed by ≥ 15%. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the Safer Nursing Care Tool to set establishments, on average 60 days of observation would be needed for a 95% confidence interval spanning 1 whole-time equivalent either side of the mean. Staffing levels below the daily requirement estimated using the Safer Nursing Care Tool were associated with lower odds of nurses reporting ‘enough staff for quality’ and more reports of missed nursing care. However, the relationship was effectively linear, with staffing above the recommended level associated with further improvements. In simulation experiments, ‘flexible (low)’ establishments led to high rates of understaffing and adverse outcomes, even when temporary staff were readily available. Cost savings were small when high temporary staff availability was assumed. ‘High’ establishments were associated with substantial reductions in understaffing and improved outcomes but higher costs, although, under most assumptions, the cost per life saved was considerably less than £30,000.LimitationsThis was an observational study. Outcomes of staffing establishments are simulated.ConclusionsUnderstanding the effect on wards of variability of workload is important when planning staffing levels. The Safer Nursing Care Tool correlates with professional judgement but does not identify optimal staffing levels. Employing more permanent staff than recommended by the Safer Nursing Care Tool guidelines, meeting demand most days, could be cost-effective. Apparent cost savings from ‘flexible (low)’ establishments are achieved largely by below-adequate staffing. Cost savings are eroded under the conditions of high temporary staff availability that are required to make such policies function.Future workResearch is needed to identify cut-off points for required staffing. Prospective studies measuring patient outcomes and comparing the results of different systems are feasible.Trial registrationCurrent Controlled Trials ISRCTN12307968.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 16. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane E Ball
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Rosemary Chable
- Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Dimech
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Yvonne Jeffrey
- Nursing & Patient Services, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Natalie Pattison
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | | | - Nicola Sinden
- Nursing Directorate, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Thomas Monks
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| |
Collapse
|
23
|
Neves TMA, Parreira PMSD, Graveto JMGN, Freitas MJBDSD, Rodrigues VJL. Nurse managers' perceptions of nurse staffing and nursing care quality: A cross-sectional study. J Nurs Manag 2020; 28:625-633. [PMID: 31999385 DOI: 10.1111/jonm.12966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 01/16/2020] [Accepted: 01/26/2020] [Indexed: 11/27/2022]
Abstract
AIM To verify the association between the nurse staffing and the quality of nursing care, mediated by the care process, based on a hypothetical model, in Portuguese public hospitals. BACKGROUND Nurse staffing influences health outcomes. Understaffing is associated with an increased risk for adverse events (AEs) and a reduction in the quality of care. METHOD A cross-sectional study was conducted using a sample of 55 Portuguese nurse managers. A path model was developed to analyse potential causal mediation effects on care quality. RESULTS Nurse staffing (number and competencies) and teamwork indirectly influence the quality of care. This process is mediated by the response capacity, the use of new techniques and work methods and patient's surveillance capacity. The AEs occurrence also has a mediating role, being negatively associated with the quality of care. CONCLUSIONS Optimizing nursing care safety and quality requires an adequate nurse staffing level, both in terms of number and competencies, as well as teamwork. Process components seem to play a mediating role in these relations. IMPLICATIONS FOR NURSING MANAGEMENT These results deserve the attention of nursing management for investment in the nursing staff and in the care process, to improve quality and create value in health care.
Collapse
|
24
|
Baris VK, Seren Intepeler S. Cross-cultural adaptation and psychometric evaluation of the Turkish version of the Self-Efficacy for Preventing Falls-Nurse. J Nurs Manag 2019; 27:1791-1800. [PMID: 31532040 DOI: 10.1111/jonm.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/10/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to test the psychometric properties of the Turkish version of the Self-Efficacy for Preventing Falls-Nurse. BACKGROUND Patient falls have negative effects on patients and health care services. Nurses' self-efficacy for preventing falls can affect their performance in interventions to prevent falls. METHODS The sample of this methodological study included 326 nurses who work at a university, a training and a public hospital in Turkey. The construct validity of the scale was assessed using the exploratory factor analysis, the confirmatory factor analysis and the known-group technique. The reliability of the scale was assessed through internal consistency approaches and test-retest reliability. RESULTS Two factors were extracted through the exploratory factor analysis, and the factors explained 68.69% of total variance. The confirmatory factor analysis showed a significantly good fit for a two-factor structure. Satisfactory evidence was found for test-retest reliability and internal consistency reliability. CONCLUSION The Turkish version of the Self-Efficacy for Preventing Falls-Nurse is a reliable and valid scale for assessing nurses' self-efficacy for preventing falls. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can assess nurses' self-efficacy for preventing falls by using the Turkish version of the Self-Efficacy for Preventing Falls-Nurse. Moreover, they can identify where to focus on improving nurses' self-efficacy by analysing scores of subscales and items.
Collapse
Affiliation(s)
- Veysel Karani Baris
- Nursing Faculty, Nursing Management Department, Dokuz Eylul University, Izmir, Turkey
| | - Seyda Seren Intepeler
- Nursing Faculty, Nursing Management Department, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
25
|
Abuosi AA, Akologo A, Anaba EA. Determinants of patient safety culture among healthcare providers in the Upper East Region of Ghana. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519876756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Aaron A Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | - Alexander Akologo
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | - Emmanuel A Anaba
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| |
Collapse
|
26
|
Wang Y, Han H, Qiu L, Liu C, Wang Y, Liu W. Development of a patient safety culture scale for maternal and child health institutions in China: a cross-sectional validation study. BMJ Open 2019; 9:e025607. [PMID: 31501095 PMCID: PMC6738693 DOI: 10.1136/bmjopen-2018-025607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aimed to develop a patient safety culture (PSC) scale for maternal and child healthcare (MCH) institutions in China. METHODS A theoretical framework of PSC for MCH institutions was proposed through in-depth interviews with MCH workers and patients and Delphi expert consultations. The reliability and validity of the PSC scale were tested in a cross-sectional survey of 1256 MCH workers from 14 MCH institutions in Zhejiang province of China. The study sample was randomly split into half for exploratory and confirmatory factor analyses, respectively. Test-retest reliability was assessed through a repeated survey of 63 voluntary participants 2 weeks apart. RESULTS The exploratory factor analysis extracted 10 components: patient engagement in patient safety (six items), managerial response to patient safety risks (four items), perceived management support (five items), staff empowerment (four items), staffing and workloads (four items), reporting of adverse events (three items), defensive medical practice (three items), work commitment (three items), training (two items) and transfer and handoff (three items). A good model fit was found in the confirmatory factor analysis: χ2/df=1.822, standardised root mean residual=0.048, root mean square error of approximation=0.038, comparative fit index=0.921, Tucker-Lewis index=0.907. The PSC scale had a Cronbach's α coefficient of 0.89 (0.59-0.90 for dimensional scales) and a test-retest reliability of 0.81 (0.63-0.87 for dimensional reliability), respectively. The intracluster correlation coefficients confirmed a hierarchical nature of the data: individual health workers nested within MCH institutions. CONCLUSION The PSC scale for MCH institutions has acceptable reliability and validity. Further studies are needed to establish benchmarking in a national representative sample through a multilevel modelling approach.
Collapse
Affiliation(s)
- Yuanyuan Wang
- Department of Obstetrics and Gynecology and Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Hui Han
- School of Public Health, Peking University, Beijing, China
| | - Liqian Qiu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Yan Wang
- School of Public Health, Peking University, Beijing, China
| | - Weiwei Liu
- Second Outpatient Department, Peking University Third Hospital, Beijing, China
| |
Collapse
|
27
|
Ree E, Wiig S. Employees' perceptions of patient safety culture in Norwegian nursing homes and home care services. BMC Health Serv Res 2019; 19:607. [PMID: 31464630 PMCID: PMC6716833 DOI: 10.1186/s12913-019-4456-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most health care services are provided in the primary health care sector, and an increasing number of elderly is in need of these services. Nonetheless, the research on patient safety culture in home care services and nursing homes remains scarce. This study describes staff perceptions of patient safety culture in Norwegian home care services and nursing homes, and assesses how various patient safety culture dimensions contribute to explaining overall perceptions of patient safety. METHODS Cross-sectional surveys were conducted among healthcare professionals in Norwegian home care services (N = 139) and nursing homes (N = 165) in 2018, response rates being 67.5% and 65%, respectively. A Norwegian version of the international recognized Nursing Home Survey on Patient Safety Culture was used. Descriptive statistics and t-tests were used to explore staff perceptions of patient safety culture. We used multiple regression analyses to explore the degree to which patient safety culture dimensions could explain overall perceptions of patient safety. RESULTS The number of patient safety dimensions having an average score of more than 60% positive responses was seven out of 10 in nursing homes, and nine out of 10 in home care. Staffing had the lowest scores in both health care services. Home care services scored significantly higher than nursing homes on teamwork (eta squared = .053), while nursing homes scored somewhat higher on handover (eta squared = .027). In home care, total explained variance of overall perceptions of patient safety was 45%, with teamwork, staffing, and handoffs as significant predictors. The explained variance in nursing homes was 42.7%, with staffing and communication openness as significant predictors. CONCLUSIONS There are differences in perceptions of patient safety culture between nursing homes and home care services. Staffing is important for patient safety perceptions in both health care services. In home care, teamwork seems to be a significant contributing factor to patient safety, and building sound teams with mutual trust and collaboration should therefore be an essential part of managers' work with patient safety. In nursing homes, the main focus when building a good patient safety culture should be on open communication, ensuring that staff's ideas and suggestions are valued.
Collapse
Affiliation(s)
- Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway.
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| |
Collapse
|
28
|
Karlsson AC, Gunningberg L, Bäckström J, Pöder U. Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword. J Nurs Manag 2019; 27:1359-1365. [PMID: 31211908 DOI: 10.1111/jonm.12816] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/15/2019] [Accepted: 06/13/2019] [Indexed: 12/01/2022]
Abstract
AIM To describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these. BACKGROUND Nurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment. METHOD Descriptive design with 25 qualitative interviews. RESULTS Five categories were identified: RNs feel satisfied when providing person-centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal. CONCLUSION Registered nurses' job satisfaction could be described as a double-edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety. IMPLICATIONS FOR NURSING MANAGEMENT Our findings suggest that nursing leadership can increase RNs' intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.
Collapse
Affiliation(s)
- Ann-Christin Karlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Josefin Bäckström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ulrika Pöder
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
29
|
Sandelin A, Kalman S, Gustafsson BÅ. Prerequisites for safe intraoperative nursing care and teamwork—Operating theatre nurses’ perspectives: A qualitative interview study. J Clin Nurs 2019; 28:2635-2643. [DOI: 10.1111/jocn.14850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/21/2018] [Accepted: 01/20/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Annika Sandelin
- Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Research, Development and Educational Unit, Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Sigridur Kalman
- Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Division for Anaesthesia and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Birgitta Åkesdotter Gustafsson
- Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Research, Development and Educational Unit, Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
30
|
Lim ML, Ang SY. A time–motion observation study to measure and analyse clinical nursing workload in an acute care hospital in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819834569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Internationally, there are concerns about rising nursing workforce shortages, which could be attributed to both recruitment and retention issues. As the population rapidly ages in Singapore, there is an increase in demand for more trained nurses to staff new facilities. Given the problem that Singapore is facing, there is a need for other solutions besides increasing recruitment rate. A time-motion study of nurses’ workload can assist us in determining how and what nurses spend their time on during their working shift. Work processes can then be studied to allow for improvements and implementation of strategies to ease nurses’ workload. Results of the current study demonstrated four main processes (preparing and clearing requisites, documentation, care coordination, transportation) that can be improved upon. Some of these processes do not require dedicated nursing skills; and can potentially be performed for other staff members. Results also demonstrated that nurses spent significantly less time on patient care activities as compared to nurses in United States; with as much as 31% of the nurses’ time being spent on documentation. Future studies can target on the effectiveness of strategies to improve the efficiency and quality of nursing care.
Collapse
Affiliation(s)
- Mei Ling Lim
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore
| |
Collapse
|
31
|
Norman RM, Iversen HH, Sjetne IS. Development, adaptation and psychometric assessment of the extended brisbane practice environment measure for nursing homes (B-PEM-NH) for use in the Norwegian setting. Geriatr Nurs 2018; 40:302-313. [PMID: 30553554 DOI: 10.1016/j.gerinurse.2018.11.007] [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: 10/17/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022]
Abstract
Care workers' work environment is known to be associated with patient and nurse outcomes. To our knowledge no questionnaire is available for assessing this environment for all care workers in the Norwegian nursing-home setting. This paper describes the development, adaptation and assessment of such a questionnaire: the extended Norwegian version of the Brisbane Practice Environment Measure for Nursing Homes (B-PEM-NH). This version was developed and assessed using semistructured interviews, a reference group meeting, translation, adaptation, and pretesting, and psychometric assessment including exploratory and confirmatory factor analyses, and retest. We tested hypotheses to assess relations to other variables. The final factor solution comprised 41 items and 9 factors: interpersonal leadership, professional development, resources, professional leadership, input and acknowledgement, patient and next-of-kin focus, multidisciplinary collaboration, language misunderstandings, and feeling unsafe. The assessment showed that the B-PEM-NH had good psychometric properties, suggesting that the questionnaire is suitable for application in similar settings.
Collapse
Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway; University of Oslo, Faculty of Medicine, Institute of Health and Society, Department of Health Management and Health Economics, PO Box 1130 Blindern, 0318 Oslo, Norway.
| | | | | |
Collapse
|
32
|
Burton CR, Rycroft-Malone J, Williams L, Davies S, McBride A, Hall B, Rowlands AM, Jones A, Fisher D, Jones M, Caulfield M. NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPolicy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.ObjectivesThe review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.DesignA realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.ParticipantsNHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.ResultsWorkforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.LimitationsThe evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.Conclusions and recommendationsThe synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.Study registrationThis study is registered as PROSPERO CRD42016038132.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Christopher R Burton
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Jo Rycroft-Malone
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Siân Davies
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Anne McBride
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Beth Hall
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | | | - Adrian Jones
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Denise Fisher
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Margaret Jones
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Maria Caulfield
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| |
Collapse
|
33
|
Dorigan GH, Guirardello EDB. Effect of the practice environment of nurses on job outcomes and safety climate. Rev Lat Am Enfermagem 2018; 26:e3056. [PMID: 30379243 PMCID: PMC6206827 DOI: 10.1590/1518-8345.2633.3056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/01/2018] [Indexed: 12/02/2022] Open
Abstract
Objective: to propose and analyze a theoretical model to measure the effect of nurses’
perceptions about the practice environment on safety climate, job
satisfaction, intention to stay employed and in the profession, and burnout
syndrome. Method: correlational study with probabilistic sample of 465 nurses. In the
theoretical model, the dimensions of the nursing practice environment were
considered as independent variables and job satisfaction, safety climate,
intention to stay employed and in the profession, and burnout were
considered the outcome variables. Structural Equation Modeling was the
method used in the analysis. Results: small adjustments were made in the model and the dimensions of practice
environment predicted job satisfaction (R2 = 43%), safety climate
(R2 = 42%) and burnout (R2 = 36%), as well as the
intention to stay in the job (R2 = 22%) and in the profession
(R2 = 17%). Conclusion: the practice environment showed a strong impact on job satisfaction, safety
climate and burnout, with a moderate impact on the intention to stay in the
institution and in the profession. The findings can be used to manage care
in health institutions, focusing on promoting nurse retention and improving
the safety climate.
Collapse
|
34
|
Al-Maaitah R, AbuAlRub RF, Al Blooshi S. Practice environment as perceived by nurses in acute care hospitals in Sharjah and North Emirates. Nurs Forum 2018; 53:213-222. [PMID: 29364526 DOI: 10.1111/nuf.12245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To explore nurses' perceptions of their practice environment in acute care hospitals in Sharjah and North Emirates in the United Arab Emirates (UAE). BACKGROUND The health of the environment in which registered nurses' work is critical to nursing outcomes. The interest to examine the practice environment extended to the Gulf area which has a complex healthcare system including the UAE. METHODS The study used an exploratory descriptive design with a qualitative part using two focus group interviews. The sample size was 450 nurses selected through a random sampling method. A self-administered questionnaire including the Practice Environment Scale of Nursing Work Index (PES-NWI) was used. In addition, semi-structured interviews for two focus groups were done. RESULTS The results showed that UAE practicing nurses reported favorable perceptions of most aspects of their practice environment. Unfavorable perceptions were only reported for Staffing and Resource Adequacy. The analysis of focus group discussions resulted in different emerged themes such as Lack of Recognition and Career Promotion, and Nurses' Workload due to Paper and Administrative Work. CONCLUSIONS The findings of this study suggest that strategic interventions are needed to secure adequate staff and resources and implement an effective system for evaluation of performance.
Collapse
|
35
|
Yule S, Gupta A, Gazarian D, Geraghty A, Smink DS, Beard J, Sundt T, Youngson G, McIlhenny C, Paterson-Brown S. Construct and criterion validity testing of the Non-Technical Skills for Surgeons (NOTSS) behaviour assessment tool using videos of simulated operations. Br J Surg 2018; 105:719-727. [DOI: 10.1002/bjs.10779] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/06/2017] [Accepted: 11/04/2017] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Surgeons' non-technical skills are an important part of surgical performance and surgical education. The most widely adopted assessment tool is the Non-Technical Skills for Surgeons (NOTSS) behaviour rating system. Psychometric analysis of this tool to date has focused on inter-rater reliability and feasibility rather than validation.
Methods
NOTSS assessments were collected from two groups of consultant/attending surgeons in the UK and USA, who rated behaviours of the lead surgeon during a video-based simulated crisis scenario after either online or classroom instruction. The process of validation consisted of assessing construct validity, scale reliability and concurrent criterion validity, and undertaking a sensitivity analysis. Central to this was confirmatory factor analysis to evaluate the structure of the NOTSS taxonomy.
Results
Some 255 consultant surgeons participated in the study. The four-category NOTSS model was found to have robust construct validity evidence, and a superior fit compared with alternative models. Logistic regression and sensitivity analysis revealed that, after adjusting for technical skills, for every 1-point increase in NOTSS score of the lead surgeon, the odds of having a higher versus lower patient safety score was 2·29 times. The same pattern of results was obtained for a broad mix of surgical specialties (UK) as well as a single discipline (cardiothoracic, USA).
Conclusion
The NOTSS tool can be applied in research and education settings to measure non-technical skills in a valid and efficient manner.
Collapse
Affiliation(s)
- S Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - A Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - D Gazarian
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Geraghty
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - D S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - J Beard
- Faculty of Medicine, University of Sheffield, Sheffield, UK
| | - T Sundt
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G Youngson
- Department of Paediatric Surgery, Royal Aberdeen Children's Hospital, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - C McIlhenny
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - S Paterson-Brown
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
36
|
Swiger PA, Loan LA, Raju D, Breckenridge-Sproat ST, Miltner RS, Patrician PA. Relationships between Army nursing practice environments and patient outcomes. Res Nurs Health 2018; 41:131-144. [PMID: 29355993 DOI: 10.1002/nur.21855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/07/2017] [Indexed: 11/08/2022]
Abstract
Favorable nursing practice environments have been associated with lower patient mortality, failure to rescue, nurse-administered medication errors, infections, patient complaints, and patient falls. Favorable environments have also been associated with higher nurse-reported care quality and patient satisfaction in civilian hospitals. However, limited information exists on the relationship between favorable nursing practice environments and positive outcomes in military facilities. Using 4 years of secondary data collected from 45 units in 10 Army hospitals, generalized estimating equations were used to test the associations between nurses' scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI) and patient outcomes of falls with and without injury, medication administration errors with and without harm, and patient experience. Four significant associations were found between the PES-NWI subscales and the patient outcomes under study. The Staffing and Resource Adequacy subscale was significantly associated with patient falls, the Collegial Nurse Physician Relations subscale was significantly associated with the rate of nurse-administered medication errors, and the Nursing Foundations for Quality Care and Collegial Nurse Physician Relations subscales were both significantly associated with patient experience with nursing care. As in civilian hospitals, favorable nursing practice environment was associated with improved patient outcomes within these military nursing units.
Collapse
Affiliation(s)
- Pauline A Swiger
- US Army Nurse Corps, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Lori A Loan
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Dheeraj Raju
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | | | - Rebecca S Miltner
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Patricia A Patrician
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| |
Collapse
|
37
|
Lee SE, Scott LD, Dahinten VS, Vincent C, Lopez KD, Park CG. Safety Culture, Patient Safety, and Quality of Care Outcomes: A Literature Review. West J Nurs Res 2017; 41:279-304. [DOI: 10.1177/0193945917747416] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This integrative literature review was conducted to examine the relationships between safety culture and patient safety and quality of care outcomes in hospital settings and to identify directions for future research. Using a search of six electronic databases, 17 studies that met the study criteria were selected for review. This review revealed semantic inconsistencies, infrequent use of a theory or theoretical framework, limited discussions of validity of instruments used, and significant methodological variations. Most notably, this review identified a large array of nonsignificant and inconsistent relationships between safety culture and patient safety and quality of care outcomes. To improve understanding of the relationships, investigators should consider using a theoretical framework and valid measures of the key concepts. Researchers should also give more attention to selecting appropriate sampling and data collection methods, units of analysis, levels of data measurement and aggregation, and statistical analyses.
Collapse
|
38
|
Jangland E, Teodorsson T, Molander K, Muntlin Athlin Å. Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework. J Clin Nurs 2017; 27:2311-2321. [DOI: 10.1111/jocn.14095] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | | | - Karin Molander
- Department of Surgery; Sundsvall Hospital; Sundsvall Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine; Uppsala University Hospital; Uppsala Sweden
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- Department of Public Health and Caring Sciences/Health Services Research; Uppsala University; Uppsala Sweden
- Adelaide Nursing School; University of Adelaide; Adelaide SA Australia
| |
Collapse
|
39
|
Andersson H, Lindholm M, Pettersson M, Jonasson LL. Nurses' competencies in home healthcare: an interview study. BMC Nurs 2017; 16:65. [PMID: 29176934 PMCID: PMC5693583 DOI: 10.1186/s12912-017-0264-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/10/2017] [Indexed: 12/02/2022] Open
Abstract
Background Nurses working in Home healthcare (HHC) are facing major challenges since more advanced care and treatment are increasingly being carried out in patients’ homes. The aim of this study has been to explore how nurses experience their competencies in HHC situations. Methods This study has a qualitative and explorative design. Ten nurses were interviewed and data was analyzed using content analysis. Results The themes “Being a capable nurse”, “Being a useful nurse” and “Being a subordinate and dependent nurse” were identified. Nurses want to be capable of taking care of patients, to develop their competencies and to perform their duties in the way required. They also want their work to be useful and to provide good and safe HHC. Finally, nurses want to improve HHC care by applying their competencies. Simultaneously, they are subordinate and dependent in relation to their manager and also dependent upon their manager’s interest in encouraging nurses’ competence development. Conclusions Nurses in HHC are responsible for many seriously ill patients and they want to contribute to good and safe patient care. To maintain patient safety, reduce the risk for burnout and staff turnover as well as to contribute to a sustainable development of the work, strategies for transferring competencies between nurses and efforts for competence development are needed.
Collapse
Affiliation(s)
- Henrik Andersson
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Maria Lindholm
- Centre for Adult Education, Härryda municipality, SE-435 80 Mölnlycke, Sweden
| | | | - Lise-Lotte Jonasson
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| |
Collapse
|
40
|
Swiger PA, Patrician PA, Miltner RS(S, Raju D, Breckenridge-Sproat S, Loan LA. The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use. Int J Nurs Stud 2017. [DOI: 10.1016/j.ijnurstu.2017.06.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
41
|
Källberg AS, Ehrenberg A, Florin J, Östergren J, Göransson KE. Physicians’ and nurses’ perceptions of patient safety risks in the emergency department. Int Emerg Nurs 2017; 33:14-19. [DOI: 10.1016/j.ienj.2017.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/29/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
|
42
|
Cucolo DF, Perroca MG. Assessment of the nursing care product (APROCENF): a reliability and construct validity study. Rev Lat Am Enfermagem 2017; 25:e2860. [PMID: 28403337 PMCID: PMC5396485 DOI: 10.1590/1518-8345.1495.2860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives to verify the reliability and construct validity estimates of the "Assessment of nursing care product" scale (APROCENF) and its applicability. Methods this validation study included a sample of 40 (inter-rater reliability) and 172 (construct validity) assessments performed by nurses at the end of the work shift at nine inpatient services of a teaching hospital in the Brazilian Southeast. The data were collected between February and September/2014 with interruptions. Cronbach's alpha and Spearman's correlation coefficients were calculated, as well as the intraclass correlation and the weighted kappa index (inter-rater reliability). Exploratory factor analysis was used with principal component extraction and varimax rotation (construct validity). Results the internal consistency revealed an alpha coefficient of 0.85, item-item correlation ranging between 0.13 and 0.61 and item-total correlation between 0.43 and 0.69. Inter-rater equivalence was obtained and all items evidenced significant factor loadings. Conclusion this research evidenced the reliability and construct validity of the scale to assess the nursing care product. Its application in nursing practice permits identifying improvements needed in the production process, contributing to management and care decisions.
Collapse
Affiliation(s)
- Danielle Fabiana Cucolo
- PhD, Professor, Departamento de Enfermagem, Universidade Federal de São
Carlos, São Carlos, SP, Brazil
| | - Márcia Galan Perroca
- PhD, Adjunct Professor, Faculdade de Medicina de São José do Rio Preto,
São José do Rio Preto, SP, Brazil
| |
Collapse
|
43
|
Dirik HF, Intepeler SS. The work environment and empowerment as predictors of patient safety culture in Turkey. J Nurs Manag 2017; 25:256-265. [DOI: 10.1111/jonm.12458] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/30/2022]
|
44
|
Hamaideh SH. Mental health nurses' perceptions of patient safety culture in psychiatric settings. Int Nurs Rev 2016; 64:476-485. [PMID: 27966218 DOI: 10.1111/inr.12345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mental health nurses have a crucial role in preventing medical incidents and in promoting safety culture because they provide and coordinate most of patients' care. Therefore, they are able to enhance patients' outcomes and reduce nurses' injuries. AIMS The aims of this study were to assess the perception of mental health nurses about patients' safety culture and to detect the factors which may affect patients' safety culture at psychiatric hospitals. METHODS A predictive correlational design was employed to collect data about patient safety culture and safety outcomes from 224 mental health nurses working in psychiatric hospitals using Hospital Survey on Patient Safety Culture. RESULTS Positive scores to patients' safety culture dimensions ranged between 13.4% and 81.2%. Two-thirds of mental health nurses perceived safety as excellent/very good, 20.5% perceived it as acceptable and 10.8% perceived it as poor/failing. Overall perception of safety correlated significantly with four dimensions and explained 32.6% of the variance. Frequency of events reported correlated significantly with six dimensions and explained 23.1% of the variance. CONCLUSION Of the 12 dimensions of patients' safety culture, only one was strong, six within acceptable range and five were weak and need improvement. IMPLICATIONS FOR NURSING AND HEALTH POLICY Healthcare managers and policy-makers should encourage educational interventions and help to establish a reporting system that focus on improving systems, not on blaming individuals and encourage open communication among mental healthcare workers.
Collapse
Affiliation(s)
- S H Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| |
Collapse
|
45
|
Kawasaki Y, Kojima Y, Akamatsu R. Barriers to accurately measuring patients' dietary intake in hospitals using the visual estimation method. Int J Health Care Qual Assur 2016; 29:835-45. [PMID: 27671419 DOI: 10.1108/ijhcqa-04-2016-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Visual estimation, an easy-to-perform technique, is commonly used in hospitals to assess dietary intake in patients. The authors performed a qualitative study where the authors interviewed nurses and dietitians about their perceptions of barriers to accurately measuring patients' dietary intake in hospitals using the visual estimation method. The paper aims to discuss these issues. Design/methodology/approach Ten dietitians and ten clinical nurses responded to 30-minute individual interviews in Tokyo, Japan, in September 2014. Each interview was conducted using a common protocol of open-ended questions focusing on the challenges of the visual estimation method and barriers to accurately measuring patients' dietary intake as part of their routine work. The tape-recorded interviews were transcribed and analyzed based on grounded theory. Findings Five main categories emerged: hospitals, meals, colleagues, raters, and patients. Various individual barriers such as skill, attitude, knowledge, and others that had not been considered in previous studies also emerged. External barriers that were out of the raters' control, such as shortage of time, human resources, financial ability, and others, emerged from the "hospitals" category. Research limitations/implications Research participants were all females and many of them had less than ten years of experience. Practical implications In addition to standardizing the visual estimation process, medical staff need to overcome various other internal and external barriers to accurate measurements. Originality/value This is the first study to articulate some important barriers that influence reliability and validity when measuring patients' dietary intake by visual estimation methods in typical clinical settings.
Collapse
Affiliation(s)
- Yui Kawasaki
- Graduate School of Humanities and Sciences, Ochanomizu Joshi Daigaku , Tokyo, Japan
| | - Yui Kojima
- Graduate School of Humanities and Sciences, Ochanomizu Joshi Daigaku , Tokyo, Japan
| | - Rie Akamatsu
- Natural Science Division, Ochanomizu Joshi Daigaku , Tokyo, Japan
| |
Collapse
|
46
|
Lavander P, Meriläinen M, Turkki L. Working time use and division of labour among nurses and health-care workers in hospitals - a systematic review. J Nurs Manag 2016; 24:1027-1040. [DOI: 10.1111/jonm.12423] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Päivi Lavander
- Research Unit of Nursing Science and Health Management; Faculty of Medicine; University of Oulu; Finland
- Oulu University Hospital, the Northern Ostrobothnia District; Finland
| | - Merja Meriläinen
- Oulu University Hospital, the Northern Ostrobothnia District; Finland
| | - Leena Turkki
- Research Unit of Nursing Science and Health Management; Faculty of Medicine; University of Oulu; Finland
| |
Collapse
|
47
|
Smeds-Alenius L, Tishelman C, Lindqvist R, Runesdotter S, McHugh MD. RN assessments of excellent quality of care and patient safety are associated with significantly lower odds of 30-day inpatient mortality: A national cross-sectional study of acute-care hospitals. Int J Nurs Stud 2016; 61:117-24. [PMID: 27348357 PMCID: PMC5072172 DOI: 10.1016/j.ijnurstu.2016.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality and safety in health care has been increasingly in focus during the past 10-15 years. Stakeholders actively discuss ways to measure safety and quality of care to improve the health care system as a whole. Defining and measuring quality and safety, however, is complicated. One underutilized resource worthy of further exploration is the use of registered nurses (RNs) as informants of overall quality of care and patient safety. However, research is still scarce or lacking regarding RN assessments of patient safety and quality of care and their relationship to objective patient outcomes. OBJECTIVE To investigate relationships between RN assessed quality of care and patient safety and 30-day inpatient mortality post-surgery in acute-care hospitals. DESIGN This is a national cross-sectional study. DATA SOURCES A survey (n=>10,000 RNs); hospital organizational data (n=67); hospital discharge registry data (n>200,000 surgical patients). DATA COLLECTION AND ANALYSIS RN data derives from a national sample of RNs working directly with inpatient care in surgical/medical wards in acute-care hospitals in Sweden in 2010. Patient data are from the same hospitals in 2009-2010. Adjusted multivariate logistic regression models were used to estimate relationships between RN assessments and 30-day inpatient mortality. RESULTS Patients cared for in hospitals where a high proportion of RNs reported excellent quality of care (the highest third of hospitals) had 23% lower odds of 30-day inpatient mortality compared to patients cared for in hospitals in the lowest third (OR 0.77, CI 0.65-0.91). Similarly, patients in hospitals where a high proportion of RNs reported excellent patient safety (highest third) had is 26% lower odds of death (OR 0.74, CI 0.60-0.91). CONCLUSIONS RN assessed excellent patient safety and quality of care are related to significant reductions in odds of 30-day inpatient mortality, suggesting that positive RN reports of quality and safety can be valid indicators of these key variables.
Collapse
Affiliation(s)
- Lisa Smeds-Alenius
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
| | - Carol Tishelman
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
| | - Rikard Lindqvist
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
| | - Sara Runesdotter
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
| | | |
Collapse
|
48
|
Jangland E, Nyberg B, Yngman-Uhlin P. ‘It's a matter of patient safety’: understanding challenges in everyday clinical practice for achieving good care on the surgical ward - a qualitative study. Scand J Caring Sci 2016; 31:323-331. [DOI: 10.1111/scs.12350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/12/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences; Uppsala University and Department of Surgery; Uppsala University Hospital; Uppsala Sweden
| | - Berit Nyberg
- Department of Surgery; Uppsala University Hospital; Uppsala Sweden
| | - Pia Yngman-Uhlin
- Research & Development Unit in Local Health Care and Department of Medicine and Health Sciences; Linköping University; Linköping Sweden
| |
Collapse
|
49
|
The daily relationships between staffing, safety perceptions and personality in hospital nursing: A longitudinal on-line diary study. Int J Nurs Stud 2016; 59:27-37. [DOI: 10.1016/j.ijnurstu.2016.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 11/19/2022]
|
50
|
Brasaitė I, Kaunonen M, Martinkėnas A, Mockienė V, Suominen T. Health care professionals' skills regarding patient safety. MEDICINA-LITHUANIA 2016; 52:250-256. [PMID: 27697239 DOI: 10.1016/j.medici.2016.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/17/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The importance of patient safety is growing worldwide, and every day, health care professionals face various challenges in how to provide safe care for their patients. Patient safety skills are one of the main tools to ensure safe practice. This study looks to describe health care professionals' skills regarding patient safety. MATERIALS AND METHODS Data were collected using the skill scale of the Patient Safety Attitudes, Skills and Knowledge (PS-ASK) instrument from different health care professionals (n=1082: physicians, head nurses, nurses and nurse assistants) working in hospitals for adult patients in three regional multi-profile hospitals in the western part of Lithuania. RESULTS Overall, the results of this study show that based on their own evaluations, health care professionals were competent regarding their safety skills. In particular, they were competent in the sub-scale areas of error analysis (mean=3.09) and in avoiding threats to patient safety (mean=3.31), but only somewhat competent in using decision support technology (mean=2.00). Demographic and other work related background factors were only slightly associated with these patient safety skills areas. Especially, it was noted that nurse assistants may need more support from managers and colleagues in developing their patient safety skills competence. CONCLUSIONS This study has served to investigate the general skills of health care professionals in regard to patient safety. It provides new knowledge about the topic in the context of the Baltic countries and can thus be used in the future development of health care services.
Collapse
Affiliation(s)
- Indrė Brasaitė
- School of Health Sciences, University of Tampere, Tampere, Finland; Faculty of Health Sciences, Klaipėda University, Klaipėda, Lithuania.
| | - Marja Kaunonen
- School of Health Sciences, University of Tampere, Tampere, Finland; Pirkanmaa Hospital District, Tampere, Finland
| | | | - Vida Mockienė
- Faculty of Health Sciences, Klaipėda University, Klaipėda, Lithuania
| | - Tarja Suominen
- School of Health Sciences, University of Tampere, Tampere, Finland
| |
Collapse
|