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Reyes Ramos MJ, Costa Abós S. Patient Safety Culture: Nurses' Perspective in the Hospital Setting. Healthcare (Basel) 2024; 12:1010. [PMID: 38786420 PMCID: PMC11121312 DOI: 10.3390/healthcare12101010] [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: 03/26/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: Patient safety culture (PSC) encompasses the values, attitudes, norms, beliefs, practices, perceptions, competencies, policies, and behaviours of professionals that determine organisational commitment to quality and patient safety. Few studies use mixed methods to analyse patient safety culture, and none offer the richness of using a mixed methodology to develop their theoretical model. This study aims to identify the factors nurses believe contextualise and influence PSC in relation to existing theoretical frameworks. (2) Methods: This study employed a sequential explanatory mixed-methods design combined with the Pillar Integration Process for data integration. (3) Results: In the final data integration process, 26 factors affecting nurses' PSC were identified. Factors nurses related to PSC not being assessed with the tool used in phase 1 were notification system, flow of patients, patient involvement, resources and infrastructure, and service characteristics. (4) Conclusions: This mixed-methods study provides an opportunity to identify the weaknesses and strengths of currently developed theoretical frameworks related to PSC and offers content for its improvement. Even though multiple studies aim to assess PSC using existing quantitative method tools, the development of this study offers a glimpse of some aspects relevant to nurses' PSC not included in the theoretical framework of the said tools, such as patient involvement, the flow of patients, and service infrastructure.
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Affiliation(s)
- Maria José Reyes Ramos
- Facultat d’Infermeria, Universitat de Barcelona, 08907 Barcelona, Spain
- Fundació Sanitària Mollet, 08100 Mollet del Vallès, Spain
| | - Silvia Costa Abós
- Facultat d’Infermeria, Universitat de Barcelona, 08907 Barcelona, Spain
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Maddineshat M, Safi-Keykaleh M, Ghaleiha A, Sadeghian E. Speaking Up: Exploring Mental Health Care Workers' Patient Safety Concerns. J Psychosoc Nurs Ment Health Serv 2024:1-9. [PMID: 38709102 DOI: 10.3928/02793695-20240424-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
PURPOSE To explore the perspectives and experiences of mental health care workers (MHCWs) when speaking up about patient safety concerns. METHOD A qualitative study was performed at Farshchian (Sina) Hospital in Iran, involving the purposive sampling of MHCWs from three inpatient psychiatric wards. From July to October 2022, semi-structured interviews were conducted with 23 participants. Data were analyzed using conventional content analysis. RESULTS Three major patient safety themes were identified: (a) Voicing Concerns for Daily Safety (subthemes: daily safety check-ins and speaking up to prevent patient harm); (b) Speaking Up to Save Future Lives (subthemes: whistleblowing, leadership, and being open to communication); and (c) Hesitating to Speak Up (sub-themes: ineffectiveness of raising one's voice and whispering). CONCLUSION MHCWs have various concerns about speaking up or staying silent. Failure to communicate can result in adverse events and missed opportunities to address patient safety. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Austen K, Hutchinson M, Hurley J. Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review. J Clin Nurs 2024. [PMID: 38685802 DOI: 10.1111/jocn.17199] [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: 12/19/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
AIM To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people. DESIGN Scoping review. METHODS The updated Joann Briggs Institute scoping review methodological guidelines were followed. DATA SOURCES CINAHL, PubMed, PsycINFO, and Scopus were searched. RESULTS A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention. CONCLUSION There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care. IMPACT Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people. REPORTING METHOD The PRISMA-ScR (Tricco et al., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in this review.
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Affiliation(s)
- Katrina Austen
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Ibrahim El-Sayed AA, Ramadan Asal MG, Farghaly Abdelaliem SM, Alsenany SA, Elsayed BK. The moderating role of just culture between nursing practice environment and oncology nurses' silent behaviors toward patient safety: A multicentered study. Eur J Oncol Nurs 2024; 69:102516. [PMID: 38402719 DOI: 10.1016/j.ejon.2024.102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Patient safety is a critical part of healthcare delivery that must be prioritized to guarantee optimal patient outcomes. Oncology nursing is a specialized area of nursing that demands great focus on patient safety because of the high-risk nature of this patient group. Nurses play an important role in ensuring that patients receive safe and effective care. However, the nursing practice environment can have a substantial impact on how nurses respond to patient safety problems. A just culture can promote open communication and identify potential safety issues, whereas a culture of silence can have a negative impact on patient outcomes. OBJECTIVE Firstly, assess the relationship between the nursing practice environment and oncology nurses' silent behavior towards patient safety. Secondly, the interaction effect of just culture as a moderator in this relationship. METHOD A cross-sectional, correctional research design was employed. Data was collected from 303 nurses working at the oncology departments of five hospitals in Egypt using three questionnaires. Data was analyzed using SPSS-PROCESS Macro (v4.2). RESULTS There was a moderate, negative, and significant correlation between the nurse practice environment and silent behavior of nurses towards patient safety. The interaction effect of just culture with nurse practice environment strengthens this relationship, thus enhancing errors reporting. CONCLUSIONS This study emphasized on the importance of creating a just culture that facilitates open communication and eliminating the potential hazards result from nurses' silence. Thus, oncology nurses must be encouraged to report issues related to patient safety.
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Affiliation(s)
| | | | - Sally Mohammed Farghaly Abdelaliem
- Associate Professor of Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University Riyadh, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Samira Ahmed Alsenany
- Associate Professor, Community Health Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Boshra Karem Elsayed
- Nursing Administration Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt.
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Lee SE, Seo JK, Squires A. Voice, silence, perceived impact, psychological safety, and burnout among nurses: A structural equation modeling analysis. Int J Nurs Stud 2024; 151:104669. [PMID: 38160639 DOI: 10.1016/j.ijnurstu.2023.104669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/14/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context. OBJECTIVE This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence. DESIGN A cross-sectional, correlational study design was employed. SETTINGS Study data were collected in 34 general hospitals in South Korea. PARTICIPANTS A total of 1255 registered nurses providing direct care to patients were included in this study. METHODS Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %. RESULTS The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (β = -0.10, 95 % confidence interval [-0.143, -0.059]) and silence (β = -0.04, 95 % confidence interval [-0.058, -0.014]), and psychological safety also decreased burnout through voice (β = -0.04, 95 % confidence interval [-0.057, -0.016]) and silence (β = -0.07, 95 % confidence interval [-0.101, -0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant. CONCLUSIONS It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ. REGISTRATION Not applicable. TWEETABLE ABSTRACT Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.
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Affiliation(s)
- Seung Eun Lee
- College of Nursing, Yonsei University, Seoul, South Korea.
| | - Ja-Kyung Seo
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, USA
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Tedone AM, Lanz JJ. Staying silent during a crisis: How workplace factors influence safety decisions in U.S. nurses. Soc Sci Med 2024; 341:116548. [PMID: 38171213 DOI: 10.1016/j.socscimed.2023.116548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/16/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE It is critical for healthcare organizations to promote upward communication of safety information to ensure safety issues experienced on the work floor are promptly identified and addressed, especially during crisis events. OBJECTIVE This study investigates mechanisms through which workplace factors affect nurses' motivation to speak up about safety issues, and ultimately their safety behaviors, in a pandemic work environment. METHOD The work experiences of 152 frontline U.S. nurses were captured across three time-points during the height of a global pandemic. RESULTS Findings indicate that nurses who experienced a greater frequency of pandemic-related demands and/or perceived a greater social risk associated with voicing concerns were more likely to remain silent about safety issues due to job-related constraints or a fear of negatively impacting their reputation, respectively. As a consequence, nurses were more likely to bypass safety protocols while completing work tasks, especially those who had a lower risk propensity. CONCLUSION These findings advance the literature on workplace safety by investigating factors that affect employee communication and ultimately safety workarounds in nurses within the context of a global pandemic.
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Affiliation(s)
| | - Julie J Lanz
- Department of Psychology, University of Nebraska at Kearney, USA
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Rodriguez R, Hambley C, Wisner K. Taking the Fear Out of Peer Feedback: A Brain-Friendly Peer Feedback Program. J Nurs Adm 2024; 54:40-46. [PMID: 38117151 DOI: 10.1097/nna.0000000000001375] [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: 12/21/2023]
Abstract
ABSTRACT Effective peer feedback is critical for the self-regulation of nursing practice and safe, high-quality care, yet peer feedback conversations can be challenging and anxiety provoking. As current literature revealed no consistent approach, taskforce members designed and implemented an innovative and standardized peer feedback program using brain science to support nurses' skills in speaking up. The new program resulted in an increase in nurses' self-reported willingness to provide peer feedback, and improvements in safety culture and nurse-sensitive quality outcomes.
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Affiliation(s)
- Rebecca Rodriguez
- Author Affiliations: Clinical Excellence Specialist (Rodriguez) and Magnet® Program Director (Dr Wisner), Magnet Program Department, Salinas Valley Health; and Organizational Psychologist (Dr Hambley), Brain-Based Strategies Consulting, Monterey, California
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Pinho M, Ferreira P, Gomes S. Healthcare professionals' voice as a road to burnout and work engagement? The role of relational outcomes: An exploratory study of European countries. J Health Organ Manag 2023; ahead-of-print. [PMID: 38061881 DOI: 10.1108/jhom-06-2023-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE Healthcare professionals are key in healthcare organisations but are subject to long working hours and may have to make complex life-and-death decisions. As frontline agents dealing with human lives, giving them a voice is paramount. This study explores the impact of employee voice (assessed based on employee perceptions on how much they are consulted and how much influence they have on task-related decisions) on health professionals' work engagement and burnout when mediated by relational outcomes (perceived organisational support, workplace trust, workplace recognition and meaningful work). DESIGN/METHODOLOGY/APPROACH A sample of 3,266 health professionals retrieved from the European Working Condition Survey was used. The quantitative analysis was performed using the partial least square structural equation modelling and multiple regression analyses. FINDINGS The results indicate that employee voice has a direct positive impact on work engagement, but employee voice's direct effects on burnout still need to be confirmed. Relational outcomes are found to mediate the relationship between employee voice and burnout (decreasing it) and between employee voice and work engagement (increasing it). PRACTICAL IMPLICATIONS Practices of employee voice in the workplace are fundamental to promoting health professionals' well-being. Trust, recognition, support and the feeling of doing meaningful work increase the influence of employee voice, especially in reducing the levels of burnout. ORIGINALITY/VALUE This is the first study that assesses, at a European level, the importance that 'giving health professionals a voice' has on crucial employee outcomes: work engagement, burnout and relational outcomes.
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Affiliation(s)
- Micaela Pinho
- DEG, Research on Economics, Management and Information Technologies (REMIT), Portucalense Institute for Legal Reseach (IJP), University Portucalense, Oporto, Portugal
- Agueda School of Technology and Management, University of Aveiro, Aveiro, Portugal
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Bagot KL, McInnes E, Mannion R, McMullan RD, Urwin R, Churruca K, Hibbert P, Westbrook JI. Middle manager responses to hospital co-workers' unprofessional behaviours within the context of a professional accountability culture change program: a qualitative analysis. BMC Health Serv Res 2023; 23:1012. [PMID: 37726731 PMCID: PMC10510259 DOI: 10.1186/s12913-023-09968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The critical role that middle managers play in enacting organisational culture change designed to address unprofessional co-worker behaviours has gone largely unexplored. We aimed to explore middle managers' perspectives on i) whether they speak up when they or their team members experience unprofessional behaviours (UBs); ii) how concerns are handled; iii) the outcomes; and iv) the role of a professional accountability culture change program (known as Ethos) in driving change. METHODS Qualitative, constructivist approach. Five metropolitan hospitals in Australia which had implemented Ethos. Purposive sampling was used to invite middle-level managers from medicine, nursing, and non-clinical support services. Semi-structured interviews conducted remotely. Inductive, reflexive thematic and descriptive thematic analyses undertaken using NVivo. RESULTS Thirty interviews (approximately 60 min; August 2020 to May 2021): Nursing (n = 12), Support Services (n = 10), and Medical (n = 8) staff, working in public (n = 18) and private (n = 12) hospitals. One-third (n = 10) had a formal role in Ethos. All middle managers (hearers) had experienced the raising of UBs by their team (speakers). Themes representing reasons for ongoing UBs were: staying silent but active; history and hierarchy; and double-edged swords. The Ethos program was valued as a confidential, informal, non-punitive system but required improvements in profile and effectiveness. Participants described four response stages: i) determining if reports were genuine; ii) taking action depending on the speaker's preference, behaviour factors (type, frequency, impact), if the person was known/unknown; iii) exploring for additional information; and iv) addressing either indirectly (e.g., change rosters) or directly (e.g., become a speaker). CONCLUSIONS Addressing UBs requires an organisational-level approach beyond supporting staff to speak up, to include those hearing and addressing UBs. We propose a new hearer's model that details middle managers' processes after a concern is raised, identifying where action can be taken to minimise avoidant behaviours to improve hospital culture, staff and patient safety.
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Affiliation(s)
- K L Bagot
- Nursing Research Institute -St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Fitzroy, VIC, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia
| | - E McInnes
- Nursing Research Institute -St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Fitzroy, VIC, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - R Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - R D McMullan
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - R Urwin
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - K Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - P Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - J I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
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Barlow M, Morse KJ, Watson B, Maccallum F. Identification of the barriers and enablers for receiving a speaking up message: a content analysis approach. Adv Simul (Lond) 2023; 8:17. [PMID: 37415244 DOI: 10.1186/s41077-023-00256-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Within healthcare, the barriers and enablers that influence clinicians' ability to speak up are well researched. However, despite the receiver of the message being identified as a key barrier to a speaker voicing a concern, there have been very few receiver-focused studies. As a result, little is known about the barriers and enablers that influence message reception. Understanding these can help inform speaking up training and ultimately enhance patient safety through more effective clinical communication. OBJECTIVES To identify enabling or inhibiting factors that influence the receiver's reception and response to a speaking up message, and if the identified barriers and enablers are related to speaker or receiver characteristics. DESIGN AND METHODS Twenty-two interdisciplinary simulations were video recorded and transcribed. Simulation participants formed the patient discharge team and were receivers of a speaking up message, delivered by a nurse at the patient's bedside. How the message was delivered (verbose or abrupt wording), was manipulated and counterbalanced across the simulations. Within the post simulation debriefs, barriers and enablers of being a receiver of a message were explored using content analysis. SETTING/PARTICIPANTS This study took place in a large Australian tertiary healthcare setting. Participants were qualified clinicians of varying disciplines and specialties. RESULTS A total of 261 barriers and 285 enablers were coded. Results showed that how the message was delivered (differing tone, phases, and manner) influenced what receivers identified as barriers and enablers. Additionally, the receiver's own cognitive processes, such as making positive attributions of the speaker and attempting to build rapport and collegiality, better enabled message reception and response. Receiver behaviour was negatively impacted by listening to fix, rather than understand, and not knowing in the moment how to manage their own reactions and appropriately frame a response. CONCLUSION The debriefings identified key barriers and enablers to receiving a speaking up message that differ from those previously identified for senders of the speaking up message. Current speaking up programs are predominately speaker centric. This study identified that both speaker and receiver behaviour influenced message reception. Therefore, training must place equal attention on both the speaker and receiver and be inclusive of experiential conversational rehearsal of both positive and challenging encounters.
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Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, QLD, Australia.
- School of Psychology, University of Queensland, St. Lucia, QLD, Australia.
| | - Kate J Morse
- College of Nursing & Health Professions, Drexel University, 245 N 15Th Street, Mail Stop 501, 4Th Floor, Room 4606, Philadelphia, PA, 19102, USA
| | - Bernadette Watson
- School of Psychology, University of Queensland, St. Lucia, QLD, Australia
- Department of English and Communication, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St. Lucia, QLD, Australia
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Turner N, Deng C, Granger S, Dueck PM. How does subjective invulnerability impact young workers' safety voice? JOURNAL OF SAFETY RESEARCH 2023; 85:129-139. [PMID: 37330862 DOI: 10.1016/j.jsr.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/07/2022] [Accepted: 01/26/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Young workers are at risk of workplace injuries for numerous reasons. One contentious yet untested theory is that subjective invulnerability to danger-a sense of indestructability in the face of physical hazards-can affect some young workers' reactions to workplace hazards. This study contends that subjective invulnerability can affect these reactions in two ways: (a) perceptions of physical hazards at work generate less fear of injury among those who perceive themselves as more invulnerable and/or; (b) fear of injury does not motivate speaking up about safety concerns (safety voice) among those who perceive themselves as more invulnerable. METHOD This paper tests a moderated mediation model in which higher perceptions of physical hazards at work are related to higher safety voice intentions via higher fear of injury, but that subjective invulnerability reduces the extent to which: (a) perceptions of physical hazards at work are associated with fear of injury and/or; (b) fear of injury is associated with safety voice. This model is tested in two studies of young workers (Study 1 on-line experiment: N = 114, M age = 20.67, SD = 1.79; range = 18-24 years; Study 2 field study using three waves of data collected at monthly intervals: N = 80, M age = 17.13, SD = 1.08, range = 15-20 years). RESULTS Contrary to expectations, the results showed that young workers who feel more invulnerable to danger are more likely to speak up about safety when experiencing higher fear of injury, and that perceptions of physical hazards-safety voice relationship is mediated by fear of injury for those who perceive themselves to be more invulnerable to danger. Conclusions/Practical Applications: Rather than subjective invulnerability silencing safety voice as predicted, the current data suggest that subjective invulnerability may serve to accelerate how fear of injury motivates safety voice.
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Affiliation(s)
- Nick Turner
- Haskayne School of Business, University of Calgary, Canada.
| | - Connie Deng
- Haskayne School of Business, University of Calgary, Canada
| | - Steve Granger
- John Molson School of Business, Concordia University, Canada
| | - Paul M Dueck
- Asper School of Business, University of Manitoba, Canada
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Lin MW, Papaconstantinou HT, White BAA. Moving beyond teamwork in the operating room to facilitating mutual professional respect. Proc (Bayl Univ Med Cent) 2022; 36:45-53. [PMID: 36578613 PMCID: PMC9762787 DOI: 10.1080/08998280.2022.2148987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Psychological safety enables the interpersonal risk-taking necessary for providing safer patient care in the operating room (OR). Limited studies look at psychological safety in the OR from the perspectives of each highly specialized team member. Therefore, we investigated each member's perspective on the factors that influence psychological safety in the OR. Interviews were conducted with operative team members of a level 1 trauma center in central Texas. The interviews were transcribed, de-identified, and coded by two investigators independently, and thematic analysis was performed. Responses were collected from 21 participants representing all surgical team roles (attending surgeons, attending anesthesiologists, circulating nurses, nurse anesthetists, scrub techs, and residents). Circulating nurse responses were redacted for confidentiality (n = 1). Six major themes influencing psychological safety in the OR were identified. Psychological safety is essential to better, safer patient care. Establishing a climate of mutual respect and suspended judgment in an OR safe for learning will lay the foundation for achieving psychological safety in the OR. Team exercises in building rapport and mutual understanding are important starting points.
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Affiliation(s)
- Melody W. Lin
- Department of Surgery, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | | | - Bobbie Ann Adair White
- Department of Surgery, Baylor Scott & White Medical Center – Temple, Temple, Texas,Department of Health Professions Education, MGH Institute of Health Professions, Boston, Massachusetts,Corresponding author: Bobbie Ann Adair White, EdD, MA, Health Professions Education, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA02129 (e-mail: , )
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Solera-Gómez S, Benedito-Monleón A, LLinares-Insa LI, Sancho-Cantus D, Navarro-Illana E. Educational Needs in Oncology Nursing: A Scoping Review. Healthcare (Basel) 2022; 10:2494. [PMID: 36554019 PMCID: PMC9778242 DOI: 10.3390/healthcare10122494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Care in oncology requires both technical and psychosocial skills by nursing staff, so continuous learning is necessary. Evidence suggests there are some educational gaps in oncology nursing staff, and continuing educational interventions have been effective in overcoming these deficiencies. Aim: to determine the basic educational lines that a continuous training program should have for oncology nurses. A bibliographic review study was carried out in two phases from October 2020 to January 2021. In a first phase, the main databases were analyzed: PubMed, Web of Science, Dialnet and Medline, following the PRISMA methodology; and subsequently, an analysis of the most important thematic nuclei that a training program in cancer nursing should contain. The DAFO matrix and the Hanlon prioritization method were used. Four competencies that every oncology nurse should have were described: communication, coping, self-direction of learning and technical health. The thematic contents that a training program should contain were then determined, and aspects such as stress prevention and burnout, adequate communication with patient and family, and continuous educational and technical skills were considered. The results found suggest that there are deficiencies in the education of nursing staff. Continuing education programs are effective in supplementing them. They should develop the four skills described in the results section.
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Affiliation(s)
| | | | | | - David Sancho-Cantus
- Faculty of Medicine and Health Sciences, Department of Nursing, Catholic University of Valencia, 46600 Valencia, Valencia, Spain
| | - Esther Navarro-Illana
- Faculty of Medicine and Health Sciences, Department of Nursing, Catholic University of Valencia, 46600 Valencia, Valencia, Spain
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Kee K, de Jong D. Factors influencing newly graduated registered nurses' voice behavior: An interview study. J Nurs Manag 2022; 30:3189-3199. [PMID: 35862097 PMCID: PMC10087583 DOI: 10.1111/jonm.13742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 06/23/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
AIM To gain insight into the factors that affect newly graduated registered nurses' voice behavior. BACKGROUND Employees with little work experience may experience difficulties with speaking up. Given that a lack of voice can negatively affect the delivery of safe client care and lower nurses' job satisfaction, it is important to understand which factors facilitate and hinder newly graduated nurses' voice behavior. METHODS A qualitative descriptive study was conducted using semi-structured interviews with 17 newly graduated registered nurses working in inpatient hospital settings. RESULTS In total, seven factors emerged from our data, which were grouped in four, overarching themes. Whether newly graduated nurses speak up depends on (1) their levels of self-confidence; (2) whether they feel encouraged and welcome to speak up; (3) their relationship with the voice target; and (4) the content of their voice message. CONCLUSION Factors that affect newly graduated nurses' voice behavior are multifaceted, but mostly center around time spent in and relationships at the workplace. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers and colleagues can build an environment that fosters newly graduated nurses' voice behavior. Specifically, induction programs, assigning mentors and offering additional training can support newly graduated nurses in developing voice behavior.
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Affiliation(s)
- Karin Kee
- Department of Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Demi de Jong
- Department of Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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15
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Niederhauser A, Schwappach DLB. Speaking up or remaining silent about patient safety concerns in rehabilitation: A cross‐sectional survey to assess staff experiences and perceptions. Health Sci Rep 2022; 5:e631. [PMID: 35509405 PMCID: PMC9059171 DOI: 10.1002/hsr2.631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/04/2022] [Accepted: 04/17/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - David L. B. Schwappach
- Swiss Patient Safety Foundation Zurich Switzerland
- Institute of Social and Preventive Medicine (ISPM) University Bern Bern Switzerland
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16
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Montgomery A, Lainidi O. Understanding the Link Between Burnout and Sub-Optimal Care: Why Should Healthcare Education Be Interested in Employee Silence? Front Psychiatry 2022; 13:818393. [PMID: 35432023 PMCID: PMC9008194 DOI: 10.3389/fpsyt.2022.818393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
Evidence on the association of burnout with objective indicators of performance is scarce in healthcare. In parallel, healthcare professionals ameliorate the short-term impact of burnout by prioritizing some tasks over others. The phenomenon of employee silence can help us understand the evolution of how culture is molded toward the prioritization of some tasks over others, and how this contributes to burnout. Silence in healthcare has been associated with concealing errors, reduced patient safety, and covering up errors made by others. Conversely, there is evidence that in organizations where employees are encouraged to speak up about concerns, and where concerns are responded to appropriately, better patient outcomes such as improved patient safety and patient experience occur. Interventions to promote "speaking-up" in healthcare have not been successful and are rooted in a professional culture that does not promote speaking out. In this paper, we review the evidence that exists within healthcare to argue why healthcare education should be interested in employee silence, and how silence is a key factor in understanding how burnout develops and impacts quality of care. The following key questions have been addressed; how employee silence evolves during medical education, how is silence maintained after graduation, and how can leadership style contribute to silence in healthcare. The impact of withholding information on healthcare professional burnout, patient safety and quality of care is significant. The paper concludes with a suggested future research agenda and additional recommendations.
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17
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Thompson B, Madan CR, Patel R. Investigating cognitive factors and diagnostic error in a presentation of complicated multisystem disease. Diagnosis (Berl) 2021; 9:199-206. [PMID: 34851562 DOI: 10.1515/dx-2021-0072] [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: 05/29/2021] [Accepted: 10/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To use a case review approach for investigating the types of cognitive error identifiable following a complicated patient admission with a multisystem disorder in an acute care setting where diagnosis was difficult and delayed. METHODS A case notes review was undertaken to explore the cognitive factors associated with diagnostic error in the case of an 18-year-old male presenting acutely unwell with myalgia, anorexia and vomiting. Each clinical interaction was analysed and identified cognitive factors were categorised using a framework developed by Graber et al. RESULTS Cognitive factors resulting in diagnostic errors most frequently occurred within the first five days of hospital admission. The most common were premature closure; failure to order or follow up an appropriate test; over-reliance on someone else's findings or opinion; over-estimating or underestimating usefulness or salience of a finding, and; ineffective, incomplete or faulty history and physical examination. Cognitive factors were particularly frequent around transitions of care and patient transfers from one clinical area to another. The presence of senior staff did not necessarily mitigate against diagnostic error from cognitive factors demonstrated by junior staff or diagnostic errors made out-of-hours. CONCLUSIONS Cognitive factors are a significant cause of diagnostic error within the first five days after admission, especially around transitions of care between different clinical settings and providers. Medical education interventions need to ensure clinical reasoning training supports individuals and teams to develop effective strategies for mitigating cognitive factors when faced with uncertainty over complex patients presenting with non-specific symptoms in order to reduce diagnostic error.
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Affiliation(s)
- Ben Thompson
- Critical Care Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Rakesh Patel
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
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18
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Guttman OT, Lazzara EH, Keebler JR, Webster KLW, Gisick LM, Baker AL. Dissecting Communication Barriers in Healthcare: A Path to Enhancing Communication Resiliency, Reliability, and Patient Safety. J Patient Saf 2021; 17:e1465-e1471. [PMID: 30418425 DOI: 10.1097/pts.0000000000000541] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Suboptimal exchange of information can have tragic consequences to patient's safety and survival. To this end, the Joint Commission lists communication error among the most common attributable causes of sentinel events. The risk management literature further supports this finding, ascribing communication error as a major factor (70%) in adverse events. Despite numerous strategies to improve patient safety, which are rooted in other high reliability industries (e.g., commercial aviation and naval aviation), communication remains an adaptive challenge that has proven difficult to overcome in the sociotechnical landscape that defines healthcare. Attributing a breakdown in information exchange to simply a generic "communication error" without further specification is ineffective and a gross oversimplification of a complex phenomenon. Further dissection of the communication error using root cause analysis, a failure modes and effects analysis, or through an event reporting system is needed. Generalizing rather than categorizing is an oversimplification that clouds clear pattern recognition and thereby prevents focused interventions to improve process reliability. We propose that being more precise when describing communication error is a valid mechanism to learn from these errors. We assert that by deconstructing communication in healthcare into its elemental parts, a more effective organizational learning strategy emerges to enable more focused patient safety improvement efforts. After defining the barriers to effective communication, we then map evidence-based recovery strategies and tools specific to each barrier as a tactic to enhance the reliability and validity of information exchange within healthcare.
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Affiliation(s)
| | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Kristen L W Webster
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Logan M Gisick
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Anthony L Baker
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
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19
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Patient Safety Silence and Safety Nursing Activities: Mediating Effects of Moral Sensitivity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111499. [PMID: 34770014 PMCID: PMC8583696 DOI: 10.3390/ijerph182111499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022]
Abstract
Among the factors that threaten patient safety and quality of care due to the diversification and complication of hospital environments, nurses play a pivotal role regarding patient safety in the clinical setting. This study investigates the mediating effects of moral sensitivity on the relationship between nurses’ patient safety silence and safety nursing activities and contributes to developing strategies. Nurses (n = 120) employed for at least one year in two university hospitals in Korea between 1 September and 30 October 2020 participated in the study. Data were analyzed using t-test, Pearson’s correlation coefficients, and multiple regression using the SPSS/WIN 22.0 program. Additionally, the mediating effects were analyzed using Baron and Kenny’s method and bootstrapping. Safety nursing activities were significantly negatively correlated with patient safety silence and significantly positively correlated with moral sensitivity. Patient safety silence was significantly negatively correlated with moral sensitivity. Moral sensitivity partially mediated the relationship between patient safety silence and safety nursing activities. There is a need to develop and implement individualized ethical programs that enhance moral sensitivity in nurses to promote patient safety nursing activities.
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20
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Richard A, Pfeiffer Y, Schwappach DDL. Development and Psychometric Evaluation of the Speaking Up About Patient Safety Questionnaire. J Patient Saf 2021; 17:e599-e606. [PMID: 28858000 DOI: 10.1097/pts.0000000000000415] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Speaking up about safety concerns by staff is important to prevent medical errors. Knowledge about healthcare workers' speaking up behaviors and perceived speaking up climate is useful for healthcare organizations (HCOs) to identify areas for improvement. The aim of this study was to develop a short questionnaire allowing HCOs to assess different aspects of speaking up among healthcare staff. METHODS Healthcare workers (n = 523) from 2 Swiss hospitals completed a questionnaire covering various aspects of speak up-related behaviors and climate. Psychometric testing included descriptive statistics, correlations, reliabilities (Cronbach α), principal component analysis, and t tests for assessing differences in hierarchical groups. RESULTS Principal component analysis confirmed the structure of 3 speaking up behavior-related scales, that is, frequency of perceived concerns (concern scale, α = 0.73), withholding voice (silence scale, α = 0.76), and speaking up (speak up scale, α = 0.85). Concerning speak up climate, principal component analysis revealed 3 scales (psychological safety, α = 0.84; encouraging environment, α = 0.74; resignation, α = 0.73). The final survey instrument also included items covering speaking up barriers and a vignette to assess simulated behavior. A higher hierarchical level was mostly associated with a more positive speak up-related behavior and climate. CONCLUSIONS Patient safety concerns, speaking up, and withholding voice were frequently reported. With this questionnaire, we present a tool to systematically assess and evaluate important aspects of speaking up in HCOs. This allows for identifying areas for improvement, and because it is a short survey, to monitor changes in speaking up-for example, before and after an improvement project.
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21
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Gyberg A, Henoch I, Lepp M, Ulin K. Framing healthcare professionals in written adverse events: A discourse analysis. Nurs Inq 2021; 29:e12461. [PMID: 34553446 DOI: 10.1111/nin.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/27/2022]
Abstract
Healthcare professionals have a major responsibility to protect patients from harm. Despite vast efforts to decrease the number of adverse events, the progression of patient safety has internationally been acknowledged as slow. From a social construction perspective, it has been argued that the understanding of patient safety is contextual based on historical and structural rules, and that this meaning construction points out different directions of possible patient safety actions. By focusing on fact construction and its productive and limiting effect on how something can be understood, we explored the discourses about healthcare professionals in 29 written reports of adverse events as reported by patients, relatives, and healthcare professionals. Through the analysis, a discourse about the healthcare professionals as experts was found. The expert role most dominantly included an understanding that adverse events were identified through physical signs and that patient safety could be prevented by more strictly following routines and work procedures. We drew upon the conclusion that these regimes of truth brought power to the expert discourse, to the point that it became difficult for patients and relatives to engage in patient safety actions on their terms.
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Affiliation(s)
- Anna Gyberg
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingela Henoch
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Angered Hospital, Gothenburg, Sweden
| | - Margret Lepp
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Østfold University College, Halden, Norway.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Kerstin Ulin
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Grailey KE, Murray E, Reader T, Brett SJ. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. BMC Health Serv Res 2021; 21:773. [PMID: 34353319 PMCID: PMC8344175 DOI: 10.1186/s12913-021-06740-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. METHODS We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. RESULTS We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. DISCUSSION This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual's psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified.
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Affiliation(s)
- K. E. Grailey
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - E. Murray
- Said Business School, University of Oxford, Oxford, UK
| | - T. Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - S. J. Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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23
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Remtulla R, Hagana A, Houbby N, Ruparell K, Aojula N, Menon A, Thavarajasingam SG, Meyer E. Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC Health Serv Res 2021; 21:269. [PMID: 33761958 PMCID: PMC7988250 DOI: 10.1186/s12913-021-06232-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological safety is the concept by which individuals feel comfortable expressing themselves in a work environment, without fear of embarrassment or criticism from others. Psychological safety in healthcare is associated with improved patient safety outcomes, enhanced physician engagement and fostering a creative learning environment. Therefore, it is important to establish the key levers which can act as facilitators or barriers to establishing psychological safety. Existing literature on psychological safety in healthcare teams has focused on secondary care, primarily from an individual profession perspective. In light of the increased focus on multidisciplinary work in primary care and the need for team-based studies, given that psychological safety is a team-based construct, this study sought to investigate the facilitators and barriers to psychological safety in primary care multidisciplinary teams. METHODS A mono-method qualitative research design was chosen for this study. Healthcare professionals from four primary care teams (n = 20) were recruited using snowball sampling. Data collection was through semi-structured interviews. Thematic analysis was used to generate findings. RESULTS Three meta themes surfaced: shared beliefs, facilitators and barriers to psychological safety. The shared beliefs offered insights into the teams' background functioning, providing important context to the facilitators and barriers of psychological safety specific to each team. Four barriers to psychological safety were identified: hierarchy, perceived lack of knowledge, personality and authoritarian leadership. Eight facilitators surfaced: leader and leader inclusiveness, open culture, vocal personality, support in silos, boundary spanner, chairing meetings, strong interpersonal relationships and small groups. CONCLUSION This study emphasises that factors influencing psychological safety can be individualistic, team-based or organisational. Although previous literature has largely focused on the role of leaders in promoting psychological safety, safe environments can be created by all team members. Members can facilitate psychological safety in instances where positive leadership behaviours are lacking - for example, strengthening interpersonal relationships, finding support in silos or rotating the chairperson in team meetings. It is anticipated that these findings will encourage practices to reflect on their team dynamics and adopt strategies to ensure every member's voice is heard.
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Affiliation(s)
- Ridhaa Remtulla
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Arwa Hagana
- Imperial College London, School of Medicine, London, UK
| | - Nour Houbby
- Imperial College London, School of Medicine, London, UK
| | | | | | - Anannya Menon
- Imperial College London, School of Medicine, London, UK
| | | | - Edgar Meyer
- Leeds University Business School, University of Leeds, Leeds, UK
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24
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Lee SE, Choi J, Lee H, Sang S, Lee H, Hong HC. Factors Influencing Nurses' Willingness to Speak Up Regarding Patient Safety in East Asia: A Systematic Review. Risk Manag Healthc Policy 2021; 14:1053-1063. [PMID: 33737846 PMCID: PMC7966392 DOI: 10.2147/rmhp.s297349] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/04/2021] [Indexed: 11/23/2022] Open
Abstract
Speaking up for patient safety among health care professionals is important because it can contribute to the prevention of adverse patient events, such as medication errors, infections, wrong-site surgical procedures, and other sentinel events. This systematic review identified factors that facilitate or inhibit nurses' willingness to speak up regarding patient safety in East Asian hospitals. Following the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four databases, including PubMed, CINAHL, PsycInfo, and Web of Science, were searched. Nine studies were analyzed in this review, including five qualitative and four quantitative studies published between 2014 and 2019. Quality of included studies were evaluated using the Mixed-Method Appraisal Tool. Data synthesis was based upon qualitative-led synthesis adopting two existing multilevel frameworks on safety voice and employee voice signals. Four studies were conducted in Japan, three in South Korea, one in Hong Kong, and one in Taiwan. We organized factors influencing East Asian nurses' willingness to speak up regarding patient safety according to the following four contexts: individual (motivation toward patient safety, organizational commitment, perceived effectiveness and importance of speaking up, and assertive personality), team (positive relationship and team trust, team culture, and mentoring), organizational (hospital administrative support and organizational culture) and sociocultural (hierarchy and power differential and collectivistic culture). However, due to the limited number of studies conducted in East Asian hospitals, further studies with larger cohort samples of nurses in various East Asian countries should be conducted to deepen our understanding of nurses' willingness to voice their concerns for patient safety.
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Affiliation(s)
- Seung Eun Lee
- Mo-Im Kim Nursing Research Institute, Seoul, South Korea.,College of Nursing, Yonsei University, Seoul, South Korea
| | - JiYeon Choi
- Mo-Im Kim Nursing Research Institute, Seoul, South Korea.,College of Nursing, Yonsei University, Seoul, South Korea
| | - Hyunjie Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Somin Sang
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Haesun Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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25
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Seelandt JC, Walker K, Kolbe M. "A debriefer must be neutral" and other debriefing myths: a systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing. Adv Simul (Lond) 2021; 6:7. [PMID: 33663598 PMCID: PMC7931165 DOI: 10.1186/s41077-021-00161-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly. METHODS We interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding. RESULTS In total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units. CONCLUSION The debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.
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Affiliation(s)
- Julia Carolin Seelandt
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Katie Walker
- New York City, Health + Hospitals Simulation Center, 1400 Pelham Parkway South, Building 4, 2nd Floor, Bronx, NY 10461 USA
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
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26
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O'Donovan R, De Brún A, McAuliffe E. Healthcare Professionals Experience of Psychological Safety, Voice, and Silence. Front Psychol 2021; 12:626689. [PMID: 33679547 PMCID: PMC7933795 DOI: 10.3389/fpsyg.2021.626689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Healthcare professionals who feel psychologically safe believe it is safe to take interpersonal risks such as voicing concerns, asking questions and giving feedback. Psychological safety is a complex phenomenon which is influenced by organizational, team and individual level factors. However, it has primarily been assessed as a team-level phenomenon. This study focused on understanding healthcare professionals' individual experiences of psychological safety. We aim to gain a fuller understanding of the influence team leaders, interpersonal relationships and individual characteristics have on individuals' psychological safety and their decisions to engage in voice or silence behavior. Thirty-four interviews were conducted with healthcare professionals from across five teams working within an acute, suburban hospital. Hybrid inductive-deductive thematic analysis focused on identifying themes which captured the complexities of individuals' varied experiences of psychological safety. The themes identified were: "Personal Characteristics," "Past Experiences," "Individual Perceptions of Being Valued," and "Judged Appropriateness of Issues/Concerns." These themes are explored within the context of motivating and inhibiting factors associated with the influence of leadership, interpersonal relationships and individual characteristics on experiences of psychological safety and voice behavior. These results extend existing theoretical frameworks guiding our understanding of psychological safety by accounting for the variation in individuals' experiences and studying these significant influences on voice behavior. Important considerations for the development of interventions to enhance psychological safety are discussed.
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Affiliation(s)
- Róisín O'Donovan
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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27
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Jones A, Blake J, Adams M, Kelly D, Mannion R, Maben J. Interventions promoting employee "speaking-up" within healthcare workplaces: A systematic narrative review of the international literature. Health Policy 2021; 125:375-384. [PMID: 33526279 DOI: 10.1016/j.healthpol.2020.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/11/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Healthcare systems worldwide increasingly value the contribution of employee voice in ensuring the quality of patient care. Although employees' concerns are often dealt with satisfactorily, considerable evidence suggests that some employees may feel unable to speak-up, and even when they do their concerns may be ignored. As a result, in addition to trans-national and national policies, workplace interventions that support employees to speak-up about their concerns have recently increased. METHODS A systematic narrative review, informed by complex systems perspectives addresses the question: "What workplace strategies and/or interventions have been implemented to promote speaking-up by employees"? RESULTS Thirty-four studies were included in the review. Most studies reported inconclusive results. Researchers explanations for the successful implementation, or otherwise, of speak-up interventions were synthesised into two narrative themes (Braithwaite et al., 2018 (a)) hierarchical, interdisciplinary and cultural relationships and (Francis, 2015 (b)) psychological safety. CONCLUSIONS We strengthen the existing evidence base by providing an in-depth critique of the complex system factors influencing the implementation of speak-up interventions within the healthcare workforce. Although many of the studies were locally unique, there were international similarities in workplace cultures and norms that created contexts inimical to speaking-up interventions. Changing communication behaviours and creating a climate that supports speaking-up is immensely challenging. Interventions can be usurped in practice by complex, emergent and contextual issues, such as pre-existing socio-cultural relationships and workplace hierarchies.
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Affiliation(s)
- Aled Jones
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, CF24 0XB, UK.
| | - Joanne Blake
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, CF24 0XB, UK.
| | - Mary Adams
- King's Improvement Science, Health Service & Population Research Department, King's College London, UK.
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, CF24 0XB, UK.
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, UK.
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Long J, Jowsey T, Garden A, Henderson K, Weller J. The flip side of speaking up: a new model to facilitate positive responses to speaking up in the operating theatre. Br J Anaesth 2020; 125:1099-1106. [PMID: 32943191 DOI: 10.1016/j.bja.2020.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Speaking up is important for patient safety, but only if the concern raised is acknowledged and responded to appropriately. While the power to change the course of events rests with those in charge, research has focussed on supporting those in subordinate positions to speak up. We propose responsibility also rests with senior clinical staff to respond appropriately. We explored the perceptions of senior staff on being spoken up to in the operating theatre (OT), and factors moderating their response. METHODS We undertook interviews and focus groups of fully qualified surgeons, anaesthetists, nurses, and anaesthetic technicians working in OTs across New Zealand. We used grounded theory to analyse and interpret the data. RESULTS With data from 79 participants, we conceptualise three phases in the speaking up interaction: 1) the content of the speaker's message and the tone of delivery; 2) the message interpreted through the receiver's filters, including beliefs on personal fallibility and leadership, respect for the speaker, understanding the challenges of speaking up, and personal cultural and professional norms around communication; and 3) the receiver's subsequent response and its effects on the speaker, the observing OT staff, and patient care. CONCLUSIONS The speaking up interaction can be high stakes for the whole OT team. The receiver response can strengthen team cohesion and function, or cause distress and tension. Our grounded theory uncovers multiple influences on this interaction, with potential for re-framing and optimising the speaker/receiver interaction to improve team function and patient safety.
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Affiliation(s)
- Jennifer Long
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Alexander Garden
- Department of Anaesthesia, Capital and Coast Health, Wellington, New Zealand
| | - Kaylene Henderson
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Auckland, New Zealand.
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Towbin AJ, Smith RL, Smith EA, Brown J, Care MM, Calvo-Garcia MA, Coley BD, Dillman JR, England D, Gramke M, Howard B, Koch BL, Kraus SJ, Leopard AC, Li Y, Merrow AC, O’Brien S, Schmitz JA, Sharp SE, Szabados A, Vogelsang TA, Walton K, Wieland CA, Wiesman BA. RESPECT: Radiology Employees Striving for Productive and Effective Communication. Radiographics 2020; 40:2068-2079. [DOI: 10.1148/rg.2020200041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander J. Towbin
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
| | - Rachel L. Smith
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
| | - Ethan A. Smith
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
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O'Donovan R, McAuliffe E. Exploring psychological safety in healthcare teams to inform the development of interventions: combining observational, survey and interview data. BMC Health Serv Res 2020; 20:810. [PMID: 32867762 PMCID: PMC7456753 DOI: 10.1186/s12913-020-05646-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychological safety allows healthcare professionals to take the interpersonal risks needed to engage in effective teamwork and to maintain patient safety. In order to improve psychological safety in healthcare teams, an in-depth understanding of the complex and nuanced nature of psychological safety is needed. Psychological safety concepts, including voice, silence, learning behaviour, support and familiarity, informed the current study's investigation of psychological safety. This study aims to use a mixed-methods approach to develop an in-depth understanding of psychological safety within healthcare teams and to build on this understanding to inform the development of future interventions to improve it. METHODS Survey, observational and interview data are triangulated in order to develop an in- depth understanding of psychological safety within four healthcare teams, working within one case study hospital. The teams taking part included one multidisciplinary and three unidisciplinary teams. Observational and survey data were collected during and immediately following team meetings. Individual interviews were conducted with 31 individuals across the four teams. Thematic analysis was used to analyse these interviews. RESULTS Survey results indicated a high level of psychological safety. However, observations and interviews captured examples of silence and situations where participants felt less psychologically safe. Findings from across all three data sources are discussed in relation to voice and silence, learning, familiarity and support. CONCLUSION The results of this study provide a detailed description and in-depth understanding of psychological safety within four healthcare teams. Based on this, recommendations are made for future research and the development of interventions to improve psychological safety.
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Affiliation(s)
- Róisín O'Donovan
- Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland.
| | - Eilish McAuliffe
- Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
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He S, Lai D, Mott S, Little A, Grock A, Haas MRC, Chan TM. Remote e-Work and Distance Learning for Academic Medicine: Best Practices and Opportunities for the Future. J Grad Med Educ 2020; 12:256-263. [PMID: 32595840 PMCID: PMC7301927 DOI: 10.4300/jgme-d-20-00242.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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O’donovan R, Mcauliffe E. A systematic review of factors that enable psychological safety in healthcare teams. Int J Qual Health Care 2020; 32:240-250. [DOI: 10.1093/intqhc/mzaa025] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
The current systematic review will identify enablers of psychological safety within the literature in order to produce a comprehensive list of factors that enable psychological safety specific to healthcare teams.
Data sources
A keyword search strategy was developed and used to search the following electronic databases PsycINFO, ABI/INFORM, Academic search complete and PubMed and grey literature databases OpenGrey, OCLC WorldCAT and Espace.
Study selection
Peer-reviewed studies relevant to enablers of psychological safety in healthcare setting that were published between 1999 and 2019 were eligible for inclusion. Covidence, an online specialized systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers.
Data extraction
Thirty-six relevant studies were identified for full review and data extraction. A data extraction template was developed and included sections for the study methodology and the specific enablers identified within each study.
Results of data synthesis
Identified studies were reviewed using a narrative synthesis. Within the 36 articles reviewed, 13 enablers from across organizational, team and individual levels were identified. These enablers were grouped according to five broader themes: priority for patient safety, improvement or learning orientation, support, familiarity with colleagues, status, hierarchy and inclusiveness and individual differences.
Conclusion
This systematic review of psychological safety literature identifies a list of enablers of psychological safety within healthcare teams. This list can be used as a first step in developing observational measures and interventions to improve psychological safety in healthcare teams.
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Affiliation(s)
- Róisín O’donovan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
| | - Eilish Mcauliffe
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
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Yang R, Pepper GA, Wang H, Liu T, Wu D, Jiang Y. The mediating role of power distance and face-saving on nurses' fear of medication error reporting: A cross-sectional survey. Int J Nurs Stud 2020; 105:103494. [PMID: 32203755 DOI: 10.1016/j.ijnurstu.2019.103494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/22/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The fear of social and professional consequences is a significant barrier to medication error reporting among nurses. Although some studies have identified cultural factors as playing a significant role in medication error reporting, little is known about the mechanisms by which these cultural characteristics influence the relationship between patient safety emphasis and the fear of medication error reporting. OBJECTIVES (1) Identify nurses' perceptions of patient safety emphasis, face-saving, power distance, and fear of medication error reporting; and (2) explore face-saving and power distance as the underlying mechanisms for cultural factors in the relationship between nurses' perceptions of safety emphasis and the fear of medication error reporting. DESIGN A cross-sectional, descriptive, and correlational design. SETTINGS Three tertiary teaching hospitals located in China, including one children's hospital and two adult hospitals. PARTICIPANTS We recruited a total of 569 female registered nurses with at least one year of work experience. Most of the participants (73.8%) were junior nurses with mid-associate or associate degrees (55.4%). METHODS Participants completed four questionnaires, including Safety Emphasis subscales from the Safety Climate Scale, Face-Saving Scale, the Index of Hierarchy of Authority, and the Nurses' Fear of Medication Error Reporting. RESULTS The average scores of safety emphasis, face-saving, power distance, and the fear of medication error reporting were 20.27 (SD=2.36), 14.63 (SD=3.57), 17.36 (SD=3.49), and 18.92 (SD=4.20), respectively. There were no demographic characteristics associated with these variables, except education (B=-0.16, p = 0.013) and work experience (B=-0.14, p = 0.019), which were related to power distance. Face-saving and power distance were significant mediators that explained the effect of safety emphasis on nurses' fear of medication error reporting. The overall indirect effect for both mediators was statistically significant (β=-0.27, p<0.05). When we compared the specific mediators' indirect effects, face-saving was a more powerful mediator than power distance (β=-0.24 vs. β=-0.04). These mediation effects remained after we adjusted for the effects of education and work experience on power distance. CONCLUSIONS When nurses have a common cultural background, they tend to perceive similar barriers to medication error reporting. For this study, face-saving and power distance are the two most important cultural factors because they significantly influence the relationship between safety emphasis and the fear of medication error reporting among Chinese nurses. It may not be possible to develop a work culture that minimizes fears of medication error reporting without first addressing face-saving needs and power differences.
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Affiliation(s)
- Rumei Yang
- Nanjing Medical University, School of Nursing, 101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, China; University of Utah, College of Nursing, 10 2000 E, Salt Lake City, UT, United States.
| | - Ginette A Pepper
- University of Utah, College of Nursing, 10 2000 E, Salt Lake City, UT, United States
| | - Haocen Wang
- University of Wisconsin-Madison, School of Nursing, Madison, WI, United States
| | - Tingting Liu
- University of Arkansas Eleanor Mann School of Nursing, Fayetteville, AR, United States
| | - Dongmei Wu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Yinfen Jiang
- The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Jin Chang District, Suzhou, Jiangsu Province 215000, China.
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Silverio SA, Cope LC, Bracken L, Bellis J, Peak M, Kaehne A. The implementation of a Technician Enhanced Administration of Medications [TEAM] model: An evaluative study of impact on working practices in a children's hospital. Res Social Adm Pharm 2020; 16:1768-1774. [PMID: 32035869 DOI: 10.1016/j.sapharm.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children are frequently prescribed unlicensed and off-label medicines meaning dosing and administration of medicines to children is often based on poor quality guidance. In UK hospitals, nursing staff are often responsible for administering medications. Medication Errors [MEs] are problematic for health services, though are poorly reported and therefore difficult to quantify with confidence. In the UK, children's medicines require administration by at least two members of ward staff, known as a 'second check' system, thought to reduce Medication Administration Errors [MAEs]. OBJECTIVES To assess the impact on working practices of the introduction of a new way of working, using Technician Enhanced Administration of Medications [TEAM] on two specialist wards within a children's' hospital. To evidence any potential impact of a TEAM ward-based pharmacy technician [PhT] on the reporting of MEs. METHODS A TEAM PhT was employed on two wards within the children's hospital and trained in medicines administration. Firstly, an observational pre-and-post cohort design was used to identify the effect of TEAM on MEs. We analysed the hospital's official reporting system for incidents and 'near misses', as well as the personal incident log of the TEAM PhT. Secondly, after implementation, we interviewed staff about their perceptions of TEAM and its impact on working practices. RESULTS We affirm MEs are considerably under-reported in hospital settings, but TEAM PhTs can readily identify them. Further, placing TEAM PhTs on wards may create opportunities for inter-professional knowledge exchange and increase nurses' awareness of potential MAEs, although this requires facilitation. CONCLUSIONS TEAM PhT roles may be beneficial for pharmacy technicians' motivation, job satisfaction, and career development. Hospitals will need to consider the balance between resources invested in TEAM PhTs and the level of impact on reporting MEs. Health economic analyses could provide evidence to fully endorse integration of TEAM PhTs for all hospital settings.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Louise C Cope
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jennifer Bellis
- Pharmacy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Axel Kaehne
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
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Levine KJ, Carmody M, Silk KJ. The influence of organizational culture, climate and commitment on speaking up about medical errors. J Nurs Manag 2019; 28:130-138. [PMID: 31733166 DOI: 10.1111/jonm.12906] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/15/2019] [Accepted: 11/13/2019] [Indexed: 12/01/2022]
Abstract
AIM Speaking up about medical errors is an essential behaviour for nurses in pursuit of their goal of maintaining patient safety. This study was designed to understand how a hospital's culture and climate can impact a nurse's active behaviour in this important health care activity. BACKGROUND Research shows that while medical errors happen frequently, there is great variability on whether these errors are reported. As such, organizational culture, climate and commitment as well as employee perceptions associated with the reporting process were investigated to determine their impact on participants' intentions to speak up about medical errors. METHODS Focus groups and one-on-one interviews were used to collect these data and were analysed using content analysis. RESULTS/KEY ISSUES Nurses in the hospital perceive and understand both the benefits and barriers to reporting medical errors. Commonly reported benefits include patient safety, promoting education and awareness, and the improvement of internal processes or systems. Barriers include an inefficient reporting system and organizational influences such as perceived consequences and unequal status/position of the individual who made the error and the person reporting the error. Participants are aware that the organization believes that the responsibility to report medical errors falls to everyone. CONCLUSIONS Results indicate that the organization's existing culture does not facilitate the reporting of medical errors and that the organizational climate interferes with the reporting process. Lastly, organizational commitment is not related to the perception of importance given to the reporting of medical errors by the hospital. IMPLICATIONS FOR NURSING MANAGEMENT Nurses and nurse managers are an essential part of any hospital. In their role, they can effect change on the organization's culture and climate, but often do not realize the connection between organizational culture and patient safety. Results indicate that promoting organizational commitment to speaking up through the creation of a positive organizational culture can both promote speaking up about medical errors and increase patient safety.
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Affiliation(s)
- Kenneth J Levine
- Department of Communication, Michigan State University, East Lansing, Michigan
| | - Molly Carmody
- Department of Communication, Michigan State University, East Lansing, Michigan
| | - Kami J Silk
- Department of Communication, University of Delaware, Newark, Delaware
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36
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Schwappach DLB, Niederhauser A. Speaking up about patient safety in psychiatric hospitals - a cross-sectional survey study among healthcare staff. Int J Ment Health Nurs 2019; 28:1363-1373. [PMID: 31609065 PMCID: PMC6919932 DOI: 10.1111/inm.12664] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 12/02/2022]
Abstract
Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up-related behaviour and climate for the first time in psychiatric hospitals. A cross-sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up-related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up-related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%-65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13-25% of HCWs, and speaking up was reported by 53%-72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self-reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure.
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Affiliation(s)
- David L B Schwappach
- Swiss Patient Safety Foundation, Zürich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University Bern, Bern, Switzerland
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Voogt JJ, Taris TW, van Rensen ELJ, Schneider MME, Noordegraaf M, van der Schaaf MF. Speaking up, support, control and work engagement of medical residents. A structural equation modelling analysis. MEDICAL EDUCATION 2019; 53:1111-1120. [PMID: 31568600 PMCID: PMC6856833 DOI: 10.1111/medu.13951] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/03/2019] [Accepted: 07/18/2019] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Medical residents can play key roles in improving health care quality by speaking up and giving suggestions for improvements. However, previous research on speaking up by medical residents has shown that speaking up is difficult for residents. This study explored: (i) whether two main aspects of medical residents' work context (job control and supervisor support) are associated with speaking up by medical residents, and (ii) whether these associations differ between in-hospital and out-of-hospital settings. METHODS Speaking up was operationalised and measured as voice behaviour. Structural equation modelling using a cross-sectional survey design was used to identify and test factors pertaining to speaking up and to compare hospital settings. RESULTS A total of 499 medical residents in the Netherlands participated in the study. Correlational analysis showed significant positive associations between each of support and control, and voice behaviour. The authors assumed that the associations between support and control, and voice behaviour would be partially mediated by engagement. This partial mediation model fitted the data best, but showed no association between support and voice. However, multi-group analysis showed that for residents in hospital settings, support is associated with voice behaviour. For residents outside hospital settings, control is more important. Engagement mediated the effects of control and support outside hospital settings, but not within the hospital. CONCLUSIONS This study shows that in order to enable medical residents to share their suggestions for improvement, it is beneficial to invest in supportive supervision and to increase their sense of control. Boosting medical residents' support would be most effective in hospital settings, whereas in other health care organisations it would be more effective to focus on job control.
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Affiliation(s)
- Judith J Voogt
- Executive BoardUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
- Utrecht School of GovernanceUtrecht UniversityUtrechtthe Netherlands
| | - Toon W Taris
- Department of PsychologyUtrecht UniversityUtrechtthe Netherlands
| | | | - Margriet M E Schneider
- Executive BoardUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Mirko Noordegraaf
- Utrecht School of GovernanceUtrecht UniversityUtrechtthe Netherlands
| | - Marieke F van der Schaaf
- Centre for Research and Development of EducationUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
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Schwappach D, Sendlhofer G, Kamolz LP, Köle W, Brunner G. Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety. PLoS One 2019; 14:e0222461. [PMID: 31514203 PMCID: PMC6742486 DOI: 10.1371/journal.pone.0222461] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Speaking up behavior is a manifestation the culture of safety in an organization; however, withholding voice is commonly observed. Within one academic teaching hospital, it was the aim to assess students' speaking up behaviors and perceived culture in order to stimulation of the academic development in terms of patient safety. METHODS Survey amongst medical students using a validated questionnaire. Data were analysed using descriptive statistics. RESULTS 326 individuals completed the questionnaire (response rate 24%). 37% of responders were in their 5th- 6th clinical term, 32% were in their 7th-8th term and 31% were in the 9th-12th term. 69% of students had a specific safety concern in the past four weeks, 48% had observed an error and 68% noticed the violation of a patient safety rule. Though students perceived specific patient safety concerns, 56% did not speak up in a critical situation. All predefined barriers seemed to play an important role in inhibiting students' voicing concerns. The scores on the psychological safety scale were overall moderately favourable. Students felt little encouraged by colleagues and, in particular, by supervisors to speak up. CONCLUSION Speaking up behaviour of students was assessed for the first time in an Austrian academic teaching hospital. The higher the term the more frequent students reported perceived patient safety concerns or rule violations and withholding voice. These results suggest the need to adapt the curriculum concept of the faculty in order to address patient safety as a relevant topic.
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Affiliation(s)
- David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Wolfgang Köle
- Department of General Otorhinolaryngology, Medical University of Graz, Graz, Austria
- Medical Directorate, University Hospital Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Sharp L, Rannus K, Olofsson A, Kelly D, Oldenmenger WH. Patient safety culture among European cancer nurses-An exploratory, cross-sectional survey comparing data from Estonia, Germany, Netherlands, and United Kingdom. J Adv Nurs 2019; 75:3535-3543. [PMID: 31441110 PMCID: PMC6899826 DOI: 10.1111/jan.14177] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/10/2019] [Accepted: 08/06/2019] [Indexed: 01/20/2023]
Abstract
Aim To explore the differences in perceived patient safety culture in cancer nurses working in Estonia, Germany, the Netherlands, and the United Kingdom. Design An exploratory cross‐sectional survey. Methods In 2018, 393 cancer nurses completed the 12 dimensions of the Hospital Survey on Patient Safety Culture. Results The mean score for the overall patient safety grade was 61.3. The highest rated dimension was “teamwork within units” while “staffing” was the lowest in all four countries. Nurses in the Netherlands and in the United Kingdom, scored higher on “communication openness”, the “frequency of events reported”, and “non‐punitive response to errors”, than nurses from Estonia or Germany. We found statistically significant differences between the countries for the association between five of the 12 dimensions with the overall patient safety grade: overall perception of patient safety, communication openness, staffing, handoffs and transitions and non‐punitive response to errors. Conclusion Patient safety culture, as reported by cancer nurses, varies between European countries and contextual factors, such as recognition of the nursing role and education have an impact on it. Cancer nurses’ role in promoting patient safety is a key concern and requires better recognition on a European and global level. Impact Cancer Nursing Societies in any country can use these data as an indication on how to improve patient care in their country. Recognition of cancer nursing as a distinct specialty in nursing will help to improve patient safety.
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Affiliation(s)
- Lena Sharp
- Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden.,Division of Innovative Care Research, Department of Learning Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Kristi Rannus
- North Estonia Medical Centre, Tallinn, Estonia.,Tallinn Health Care College, Tallinn, Estonia
| | - Anna Olofsson
- Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Wales, UK
| | - Wendy H Oldenmenger
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Chang WY, Hsu CT, Yu PY. Confidence is the plant of slow growth: a moderated mediation model for predicting voice behavior among power distance orientation and team-based self-esteem in Taiwanese nurses. Psychol Res Behav Manag 2019; 12:609-617. [PMID: 31496845 PMCID: PMC6689124 DOI: 10.2147/prbm.s209931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background According to the social identity theory and Chinese cultural influences, power distance orientation may play an important role in this relationship, and thus the examined model investigates the mediating role of team-based self-esteem relations between voice behavior and team trust. Purpose This study explores how voice behavior in the nursing workplace correlates to changes in team-based self-esteem and trust. We also examine the power distance orientation level in this process to test for any moderated mediation in these linkages. Patients and methods Employing convenient sampling of 247 registered nurses from a medical center in northern Taiwan. Nurses received envelopes including self-report questionnaires from the researchers, which were immediately sealed after interviews. Results Structural equation modeling indicates all model fits are acceptable, suggesting that team-based self-esteem has partial mediation between team trust and voice behavior. Power distance orientation also moderates the indirect effect of team trust upon self-esteem, such that the relationship is stronger among those who have a high power distance orientation. Conclusion This study highlights the usefulness of continued research into how nurses display promoting behavior through team-based self-esteem with a distinct level of power distance orientation under differing sources of team trust from peers, managers, and organizations, as well as how nurses, especially fresh graduates and those who underwent a job transfer, shape their social identity through psychological factors in the sense-making process.
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Affiliation(s)
- Wen Ying Chang
- Department of Counseling and Industrial-Organizational Psychology, Ming Chuan University, Taoyuan District, Taiwan.,Taipei Veterans General Hospital, Taoyuan Branch Registered Nurse, Taoyuan District, Taiwan
| | - Chin-Tien Hsu
- Department of Counseling and Industrial-Organizational Psychology, Ming Chuan University, Taoyuan District, Taiwan
| | - Pei Yun Yu
- Department of Counseling and Industrial-Organizational Psychology, Ming Chuan University, Taoyuan District, Taiwan.,Tri-Service General Hospital Nurse Anesthetist, Taipei, Taiwan
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Bochatay N, Bajwa NM, Blondon KS, Junod Perron N, Cullati S, Nendaz MR. Exploring group boundaries and conflicts: a social identity theory perspective. MEDICAL EDUCATION 2019; 53:799-807. [PMID: 30989682 DOI: 10.1111/medu.13881] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/21/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT In the clinical environment, health care professionals self-categorise into different groups towards which they develop positive attitudes, whereas they view other groups less favourably. Social identity theory purports that these attitudes influence group processes and may foster conflicts that impede collaborative practice, although this relationship is poorly understood. This study used concepts from social identity theory to examine the interplay between group processes and conflicts, as well as the consequences of these conflicts, with the goal of identifying educational strategies to favour teamwork. METHODS Semi-structured interviews with 82 randomly selected physicians and nursing professionals working at a Swiss academic medical centre explored participants' experiences of conflicts. Data analysis was informed by social identity theory and focused on interviews where group processes were highlighted by participants. The analysis sought to uncover how group processes were intertwined with conflicts and how they affected health care professionals. RESULTS A total of 42 participants out of the initial pool of 82 interviews shared 52 stories of conflicts involving group processes. Most of these stories were shared by physicians and involved groups of physicians at different hierarchical levels. Conflicts and group processes were linked in two ways: (i) through processes of group membership when individuals struggled to join a relevant group, and (ii) through intergroup boundaries, such as when participants perceived that power differentials disadvantaged their own groups. Conflicts could lead to difficult experiences for clinicians who questioned their abilities, became disillusioned with their professional ideals and developed negative perceptions of other groups. CONCLUSIONS This study suggests that conflicts involving group processes may lead to stronger intergroup boundaries, challenging current educational efforts to favour teamwork in health care. Taking steps to create more inclusive groups and to encourage perspective taking may help manage intergroup conflict.
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Affiliation(s)
- Naike Bochatay
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Nadia M Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics at the Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Primary Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Pun J, Chan EA, Man M, Eggins S, Slade D. Pre- and post evaluations of the effects of the Connect, Ask, Respond and Empathise (CARE) protocol on nursing handover: A case study of a bilingual hospital in Hong Kong. J Clin Nurs 2019; 28:3001-3011. [PMID: 30938014 DOI: 10.1111/jocn.14871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/15/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate (a) the perceived effects of the training provided to nurses under a standardised Connect, Ask, Respond and Empathise (CARE) protocol; (b) the ability to enhance the effectiveness of the ISBAR checklist; (c) any increase in nurses' spoken interactions and/or improved comprehension of the patient conditions upon the transfer of responsibility. BACKGROUND Nursing handover is a pivotal act of communication with effects on both patient safety and risk management. Previous studies of critical incidents have highlighted ineffective communication, including a lack of interaction and incomplete and unstructured handovers, as a major contributor to patient harm. DESIGN A pre- and post evaluation study involving a questionnaire survey before and after the 3-hours training. METHODS Forty-nine randomly selected bilingual nurses with no previous professional development experience in handover communication were trained according to the CARE protocol, and their perceptions of nursing handovers were assessed before and after training using questionnaire. The STROBE checklist is used (See File S1). RESULTS Training of the CARE protocol improved key areas of the handover process. All participating nurses exhibited significant improvements in their perceptions of effective handover from before to after training. Particularly, improvements were observed in the interactive frequency and quality and completeness of the presented patient information per handover. CONCLUSIONS The nurses reported a deeper understanding of their perceptions of handover after a patient-centred intervention, a better quality of interactions (e.g., querying and checking by incoming nurses), a greater focus when managing handovers and a more complete and comprehensive transfer of information between nurses. RELEVANCE TO CLINICAL PRACTICE CARE protocol-based training yielded significant improvements in nursing handover practice.
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Affiliation(s)
- Jack Pun
- Department of English, The City University of Hong Kong, Hong Kong SAR, China
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Manbo Man
- Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Suanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
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Schwappach D, Sendlhofer G, Häsler L, Gombotz V, Leitgeb K, Hoffmann M, Jantscher L, Brunner G. Speaking up behaviors and safety climate in an Austrian university hospital. Int J Qual Health Care 2019; 30:701-707. [PMID: 29701770 DOI: 10.1093/intqhc/mzy089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/09/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To analyze speaking up behavior and safety climate with a validated questionnaire for the first time in an Austrian university hospital. Design Survey amongst healthcare workers (HCW). Data were analyzed using descriptive statistics, Cronbach's alpha was calculated as a measure of internal consistencies of scales. Analysis of variance and t-tests were used. Setting The survey was conducted in 2017. Participants About 2.149 HCW from three departments were asked to participate. Intervention To measure speaking up behavior and safety climate. Main Outcome Measure To explore psychological safety, encouraging environment and resignation towards speaking up. Results About 859 evaluable questionnaires were returned (response rate: 40%). More than 50% of responders perceived specific concerns about patient safety within the last 4 weeks and observed a potential error or noticed rule violations. For the different items, between 16% and 42% of HCW reported that they remained silent though concerns for safety. In contrast, between 96% and 98% answered that they did speak up in certain situations. The psychological safety for speaking up was lower for HCW with a managerial function (P < 0.001). HCW with managerial functions perceived the environment as less encouraging to speak up (P < 0.05) than HCW without managerial function. Conclusions We identified speaking up behaviors for the first time in an Austrian university hospital. Only moderately frequent concerns were in conflict with frequent speaking up behaviors. These results clearly show that a paradigm shift is needed to increase speaking up culture.
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Affiliation(s)
- David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lynn Häsler
- Swiss Patient Safety Foundation, Zurich, Switzerland
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Karina Leitgeb
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lydia Jantscher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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44
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Noort MC, Reader TW, Gillespie A. Walking the Plank: An Experimental Paradigm to Investigate Safety Voice. Front Psychol 2019; 10:668. [PMID: 31001165 PMCID: PMC6454216 DOI: 10.3389/fpsyg.2019.00668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/11/2019] [Indexed: 11/28/2022] Open
Abstract
The investigation of people raising or withholding safety concerns, termed safety voice, has relied on report-based methodologies, with few experiments. Generalisable findings have been limited because: the behavioural nature of safety voice is rarely operationalised; the reliance on memory and recall has well-established biases; and determining causality requires experimentation. Across three studies, we introduce, evaluate and make available the first experimental paradigm for studying safety voice: the “Walking the plank” paradigm. This paradigm presents participants with an apparent hazard (walking across a weak wooden plank) to elicit safety voice behaviours, and it addresses the methodological shortfalls of report-based methodologies. Study 1 (n = 129) demonstrated that the paradigm can elicit observable safety voice behaviours in a safe, controlled and randomised laboratory environment. Study 2 (n = 69) indicated it is possible to elicit safety silence for a single hazard when safety concerns are assessed and alternative ways to address the hazard are absent. Study 3 (n = 75) revealed that manipulating risk perceptions results in changes to safety voice behaviours. We propose a distinction between two independent dimensions (concerned-unconcerned and voice-silence) which yields a 2 × 2 safety voice typology. Demonstrating the need for experimental investigations of safety voice, the results found a consistent mismatch between self-reported and observed safety voice. The discussion examines insights on conceptualising and operationalising safety voice behaviours in relationship to safety concerns, and suggests new areas for research: replicating empirical studies, understanding the behavioural nature of safety voice, clarifying the personal relevance of physical harm, and integrating safety voice with other harm-prevention behaviours. Our article adds to the conceptual strength of the safety voice literature and provides a methodology and typology for experimentally examining people raising safety concerns.
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Affiliation(s)
- Mark C Noort
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
| | - Tom W Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
| | - Alex Gillespie
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
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45
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Schwappach D, Sendlhofer G. Speaking Up about Patient Safety in Perioperative Care: Differences between Academic and Nonacademic Hospitals in Austria and Switzerland. J INVEST SURG 2019; 33:730-738. [PMID: 30644786 DOI: 10.1080/08941939.2018.1554016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose of the Study: In perioperative care, communication about patient safety concerns is both difficult and valuable. Research into speaking up has mostly been conducted in single countries; the aim of this study was to compare speaking up-related climate and behaviors in academic and nonacademic hospitals. Materials and Methods: The study is based on two surveys conducted in Austria and Switzerland. The Swiss survey was conducted in five nonacademic hospitals, the Austrian survey in one university hospital. Results: 768 questionnaires were returned (nonacademic: n = 360; response rate: 37%; academic: n = 408; response rate: 32%). There were differences (p < 0.001) concerning speaking up episodes (at least one episode of speaking up in the past four weeks) between nonacademic hospitals (68%) and the academic hospital (96%). Withholding voice was reported by 32% of nonacademic and 43% of academic staff (p = 0.003). The speak up-related climate in the Swiss sample was more positive. Nurses compared to doctors scored higher on all items of the "resignation scale." Important differences emerged in ratings of a clinical scenario of missed hand disinfection: Nonacademic health-care workers perceived the risk of harm for patients higher compared to academic (5.3 vs. 2.5; p < 0.001). Responders higher in hierarchy felt better with speaking up in nonacademic hospitals. Conclusions: The study is one of the first to address differences in academic and nonacademic hospitals in speaking up behaviors and demonstrated differences. This analysis helps to put local data in perspective and to target further activities for improvement.
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Affiliation(s)
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, Landeskrankenhaus-Universitatsklinikum Graz, Graz, Austria.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Research Unit for Safety in Health, Medizinische Universitat Graz, Graz, Austria
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46
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Sendlhofer G, Pregartner G, Gombotz V, Leitgeb K, Tiefenbacher P, Jantscher L, Richter C, Hoffmann M, Kamolz LP, Brunner G. A new approach of assessing patient safety aspects in routine practice using the example of "doctors handwritten prescriptions". J Clin Nurs 2018; 28:1242-1250. [PMID: 30554434 PMCID: PMC7328776 DOI: 10.1111/jocn.14736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/15/2018] [Accepted: 12/04/2018] [Indexed: 11/27/2022]
Abstract
Aims and objectives To test the method of self‐ and external assessment as a feedback system to decrease illegibility and incorrectness of handwritten prescriptions and to reduce additional workload for nursing staff. Background Illegibility and incorrectness of handwritten prescriptions occur very often and are the most crucial factors affecting patient safety. Design Self‐ versus external assessment using a 15 items checklist. Methods Nurses randomly selected five fever charts of their wards. Each fever chart was self‐ as well as externally assessed. Nurses and doctors took part in the self‐assessment, and the external assessment was performed by external experts. According to a monitor suspension system, assessment results were considered “green,” “yellow” or “red.” After the first assessment and issuing feedback of the results “red” scored wards by the external assessment, additional trainings were performed. Thereafter, a second assessment was performed to rate eligibility and completeness of prescriptions. The research and reporting methodology followed squire 2.0. Results In total, 580 fever charts were self‐ as well as externally assessed (290 in each of the two assessment periods). Out of the 58 participating wards, 31 were surgical and 27 were non‐surgical wards. Averaging over all checklist items, surgical and non‐surgical wards improved only slightly over time. Linear regression models for ward means showed that there were significant improvements over time for non‐surgical wards. Conclusions This method directly involves those who commit errors and stimulate learning from errors. The approach of self‐ and external assessment was a useful instrument to detect inadequate prescriptions and to monitor improvements. Relevance to clinical practice Significant improvements were achieved regarding correctness and legibility of handwritten prescription and helped to decrease additional workload for nursing staff and thereby enhanced patient safety.
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Affiliation(s)
- Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Karina Leitgeb
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Peter Tiefenbacher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Lydia Jantscher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Christian Richter
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Lars P Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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47
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Slade D, Murray KA, Pun JKH, Eggins S. Nurses’ perceptions of mandatory bedside clinical handovers: An Australian hospital study. J Nurs Manag 2018; 27:161-171. [DOI: 10.1111/jonm.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
| | - Kristen A. Murray
- Department of English; The Hong Kong Polytechnic University; Hong Kong SAR China
| | - Jack K. H. Pun
- Department of English; City University of Hong Kong; Hong Kong SAR China
| | - Suzanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
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48
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Omura M, Stone TE, Maguire J, Levett-Jones T. Exploring Japanese nurses' perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour. NURSE EDUCATION TODAY 2018; 67:100-107. [PMID: 29852398 DOI: 10.1016/j.nedt.2018.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/10/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The hierarchical nature of healthcare environments presents a key risk factor for effective interprofessional communication. Power differentials evident in traditional healthcare cultures can make it difficult for healthcare professionals to raise concerns and be assertive when they have concerns about patient safety. This issue is of particular concern in Japan where inherent cultural and social norms discourage assertive communication. AIM The aim of this study was to (a) explore nurses' perceptions of the relevance and use of assertive communication in Japanese healthcare environments; and (b) identify the factors that facilitate or impede assertive communication by Japanese nurses. DESIGN A belief elicitation qualitative study informed by the Theory of Planned Behaviour was conducted and reported according to the COnsolidated criteria for REporting Qualitative research. SETTINGS AND PARTICIPANTS Twenty-three practicing Japanese registered nurses were recruited by snowball sampling from October 2016 to January 2017. METHODS Individual face-to-face semi-structured interviews were conducted and transcribed in Japanese and then translated into English. Two researchers independently conducted a directed content analysis informed by the Theory of Planned Behaviour. Participants' responses were labelled in order of frequency for behavioural beliefs about the consequences of assertive communication, sources of social pressure, and factors that facilitate or impede assertive communication in Japanese healthcare environments. FINDINGS Although person-centred care and patient advocacy were core values for many of the participants, strict hierarchies, age-based seniority, and concerns about offending a colleague or causing team disharmony impeded their use of assertive communication. Novice nurses were particularly reluctant to speak up because of their perception of having limited knowledge and experience. CONCLUSION This study identified Japanese nurses' behavioural, normative, and control beliefs in relation to assertive communication. The findings will be used to inform the development of a culturally appropriate assertiveness communication training program for Japanese nurses and nursing students.
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Affiliation(s)
- Mieko Omura
- Faculty of Health and Medicine, The University of Newcastle, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308, Australia.
| | - Teresa E Stone
- Faculty of Nursing, Chiang Mai University, 110 Intavaroros Road Sripum District, Muang, Chiang Mai 50200, Thailand.
| | - Jane Maguire
- Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia.
| | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia.
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49
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Schwappach DL. Speaking up about hand hygiene failures: A vignette survey study among healthcare professionals. Am J Infect Control 2018; 46:870-875. [PMID: 29650487 DOI: 10.1016/j.ajic.2018.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Speaking up by healthcare professionals (HCPs) is an important resource to reduce risks to patient safety. Due to complex tradeoffs, HCPs are often reluctant to voice their concerns. A survey investigated HCPs' likelihood to speak up. METHODS A cross-sectional survey study among HCPs in 5 Swiss hospitals addressed speaking-up behaviors, safety climate, and likelihood to speak up about poor hand hygiene practice described in a vignette. Likelihood to speak up was analyzed using a multilevel regression model. RESULTS Of surveyed HCPs (n = 1217), 56% reported that they would speak up to a colleague with poor hand hygiene practice. Nurses as compared to doctors rated the situation as more realistic (5.25 vs 4.32, P < .001), felt more discomfort with speaking up (4.00 vs 3.34, P < .001), and reported a slightly lower likelihood of speaking up (4.41 vs 4.77, P < .001). Clinical function (hierarchy) was strongly associated with speaking-up behavior (P < .001). Higher risk of harm to the patient (P < .001) and higher frequencies of past speaking-up behaviors (P = .006) were positively associated with the likelihood to speak up. Higher frequencies of past withholding voice (P = .013) and higher levels of resignation (P = .008) were both associated with a lower likelihood to speak up. CONCLUSIONS Infection control interventions should empower HCPs to speak up about non-adherence with prevention practices by addressing authority gradients and risk perceptions and by focusing on resignation.
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50
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Edrees HH, Ismail MNM, Kelly B, Goeschel CA, Berenholtz SM, Pronovost PJ, Al Obaidli AAK, Weaver SJ. Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates. Int J Qual Health Care 2018; 29:948-960. [PMID: 29186417 DOI: 10.1093/intqhc/mzx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. Design, setting, participants, intervention A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Main outcome measures Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. Results A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. Conclusions Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.
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Affiliation(s)
- Hanan H Edrees
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,National Guard Health Affairs, Quality and Patient Safety/King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Mohd Nasir Mohd Ismail
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
| | - Bernadette Kelly
- SEHA (Abu Dhabi Health Services Company), Das Tower, Sultan Bin Zayed St, Abu Dhabi, UAE
| | - Christine A Goeschel
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.,Medstar Health, 3007 Tilden St NW, Washington, DC 20008, USA
| | - Sean M Berenholtz
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Peter J Pronovost
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | | | - Sallie J Weaver
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
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