Advanced Practice Nurses' Experiences on Patient Safety Culture in Hospital-Based Home Healthcare: A Qualitative Descriptive Study

Home Healthcare Among Aging Migrants: A Joanna Briggs Institute Scoping Review

Background/Objectives: The aging migrant population faces unique healthcare challenges due to linguistic, cultural, and systemic barriers. Home healthcare services play a crucial role in supporting aging migrants, yet accessibility and effectiveness remain inconsistent across different healthcare systems. This scoping review examines the experiences of aging migrants in home healthcare settings and explores the impact of these services on their health and well-being. This review aims to synthesize the existing literature on home healthcare experiences among aging migrants, highlighting the facilitators and barriers to effective service delivery and the implications for policy and practice. Method: A scoping review was conducted using the Joanna Briggs Institute (JBI) framework. A comprehensive search was performed across multiple databases, including CINAHL, Medline, and Scopus, for articles published between 2000 and 2024. Studies were selected based on predefined inclusion criteria focusing on home healthcare experiences among aging migrants. Data extraction and thematic analysis were conducted to identify key themes. Results: The review identified 35 studies across various geographical regions, highlighting four key themes: (1) Cultural and Linguistic Accessibility, (2) The Role of Informal Caregiving, (3) Structural and Systemic Challenges, and (4) Health Outcomes and Identity Preservation. The findings indicate that language barriers, cultural stigma, and systemic exclusion significantly hinder equitable access to home healthcare. Informal caregiving by family members remains a primary support mechanism, though it places considerable strain on caregivers. The lack of culturally competent healthcare services and inadequate policy frameworks exacerbate disparities in care. Conclusions: This review highlights the critical need for systemic reforms to improve healthcare accessibility for aging migrants. Policies must prioritize cultural competence training for healthcare providers, expand multilingual healthcare services, and integrate informal caregiving into formal support structures. Investment in community-driven healthcare initiatives and targeted outreach programs can help bridge existing service gaps. While home healthcare plays a vital role in supporting aging migrants, structural inequities and cultural barriers continue to hinder equitable access. Addressing these disparities requires comprehensive policy interventions, enhanced provider training, and culturally inclusive care models. Future research should explore innovative frameworks that incorporate culturally responsive practices to ensure effective and equitable home healthcare for aging migrant populations.

Contributions of Specialized Nurses to Medication Management for Older People in Home Care: A Mixed-Method Systematic Review

There is a growing international interest in defining the roles, responsibilities, and contributions of specialized nurses across various aspects of home care to establish them as effective members of multidisciplinary home care teams. This study aimed to identify and describe the contributions of specialized nurses to medication management for older people in home care. This systematic review was performed using a mixed method approach. A thorough search was conducted across PubMed (including MEDLINE), Scopus, CINAHL, ProQuest, and Embase, focusing on studies published in English over the last decade, from 2014 to 2024. The convergent synthesis was used to combine and analyze qualitative and quantitative evidence in parallel to address the review question. The initial search yielded 875 studies, which were then refined to 32 studies selected for data-based convergent synthesis. The findings of the review were organized into three categories: "specialized nurses' identities", "specialized nurses' roles and responsibilities", and "impact of specialized nurses' medication management in home care". Specialized nurses played key roles in enhancing medication safety, improving older adults' quality of life, and reducing emergency visits. Their support in medication management eased the home care burden and ensured timely interventions for better symptom control and healthcare outcomes. Specialized nurses bring vital expertise to home care multidisciplinary medication team, promoting safe medication practices and helping older adults manage chronic conditions effectively at home.

Dimensions and components of hospital-at-home care: a systematic review

BACKGROUND AND AIM

Hospital-at-home (HaH) care is known as a healthcare delivery approach providing acute care services at home as an alternative to traditional hospital care. This study aimed to explore the dimensions and components of HaH care.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The databases including ScienceDirect, Scopus, PubMed, the Cochrane library, the Web of Science Core Collection, and the Wiley online library were searched for articles on HaH care dimensions and components of from early 2000 to February 19, 2024. The inclusion criteria of the study included articles published in the English language, and and those pertaining to various dimensions and components of HaH care. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and data were analysed using the framework analysis method.

RESULTS

A total of 4078 articles were retrieved. After screening and quality assessment, 179 articles were included in the review, identifying 88 dimensions and components of HaH care across seven main categories: benefits, challenges and obstacles, facilitators, management-related factors, medical conditions, factors associated with patients and their families, and factors associated with caregivers. The common components included cost savings (n = 30), patient and family satisfaction (n = 23), reduction in re-admissions (n = 13), medication management (n = 12), communication, coordination, and cooperation among healthcare teams, patients, and families (n = 12), preferences of patients and families (n = 12), and education of patients, families, and healthcare teams (n = 10).

CONCLUSION

Based on the results, HaH includes many and diverse dimensions and components. So, healthcare policymakers and planners are urged to consider the dimensions and components of HaH care including benefits, challenges and obstacles, facilitators, management-related factors, medical conditions, factors associated with patients and their families, and factors associated with caregivers when developing models and programs to ensure effective outcomes following implementation.

An exploration of patient safety culture in NICUs: a convergent parallel mixed-method study

BACKGROUND

Safety culture, as a component that improves the quality of safety and health care for neonates, serves as foundation for providing professional and high-quality care by creating positive insight among employees. This study aimed to explore the safety culture concept in neonatal intensive care units (NICUs).

METHODS

This convergent parallel mixed-method study included Quantitative, Qualitative, and Integrated parts. In the Quantitative part, the psychometric properties of the Persian version of "Hospital Survey on Patient Safety Culture" were examined among physicians and nurses in NICUs. CFA was performed on the data obtained from 342 participants. The Qualitative section data were collected through in-depth and semi-structured interviews with 24 staff to understand the concept of safety culture. Data were analyzed through the Elo & Kyngäs approach. The interpretation of the results and the convergence of the data was done using the Onwuegbuzie and Teddlie method.

RESULTS

The initial CFA showed that the 12-dimensional model did not align well with indices. Subsequently, based on T-values, six heterogeneous items were eliminated. The revised 11-dimensional model consisting of 36 items showed an acceptable fit during the second CFA. In the qualitative part, five main categories of "Constructive interactions", "Management's commitment to neonatal safety", "Organizational supportive climate", "Professional development", and "Planning and implementation of neonatal developmental care" were obtained. The comparison of the results showed that the dimensions of the quantitative part, except for "Overall perceptions of patient safety", were also present in the qualitative part, but they were different in some aspects. New findings in the qualitative study such as "Striving for mutual empowerment", "Constructive criticism in teamwork", "Efficient supervision procedures", "Inexperienced staff' leading" and "Provision of care assistance equipment and facilities" were not found in the dimensions of the quantitative part. The main categories "Acquiring professional competence" and "Planning and implementation of neonatal developmental care" were not align with the dimensions identified in the quantitative study.

CONCLUSION

The findings shed light on previously unexplored aspects of the safety culture concept within the nursing profession, leading to a better understanding and evolution of this concept in Iranian NICUs. The new definition obtained in this study can enhance nursing knowledge on safe care and improve patient safety culture in the NICUs in Iran and globally.

Lessons for Strengthening a Resilient Health System from the View of Health Facilities During the COVID-19 Pandemic: A Qualitative Study

Background

Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe.

Methods

We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022.

Results

Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc.

Conclusion

Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.

Advanced practice nurses' experiences of patient safety: a focus group study

BACKGROUND

Patient harm from unsafe care is an increasingly global phenomenon leading to death or disability. Drawing on their expertise, Advanced Practice Nurses provide the opportunity to improve care quality and safety.

AIM

To explore Nurse Practitioners and Clinical Nurse Consultants' experiences in patient safety.

DESIGN

A qualitative design was used involving six audio-visually recorded focus group interviews. Participants working in an acute or community adult nursing speciality were involved.

METHODS

Twenty-eight Advanced Practice Nurses (female 82.1%, mean age 47.5 ± 10 years) were recruited by convenience and snowball sampling. After transcription of interview data, qualitative content analysis was conducted.

RESULTS

Six categories were identified: patient safety as the highest priority (1), special contribution to patient safety (2), patients/relatives role in safety (3), multidisciplinary team approach (4), government regulation in safety (5), and further needs to improve safety (6). Advanced Practice Nurses saw themselves as role models and leaders for other healthcare staff through their expertise and professional experience and thus able to see the bigger picture in health. They identified as change agents at the system-level due to their decision-making ability and multi-professional team connectivity.

CONCLUSIONS

This study emphasises the key position of extended nursing roles and the need for future development of patient safety strategies in hospitals and community care. As influential leaders, Advanced Practice Nurses are best placed to identify improvements. They play a central role in guiding the multi-professional team, the patient and their family, educating nursing staff, and identifying and addressing system-wide safety gaps to improve patient safety.

Prevalence and influencing factors of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer

Objectives

This study aims to not only investigate the prevalence of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer but also identify the contributing factors.

Materials and methods

A total of 245 elderly patients diagnosed with prostate cancer and undergoing radical prostatectomy at a tertiary care general hospital in Jinan were included in this study. To assess the patients, several questionnaires were used. These included the General Situation Questionnaire, General Alienation Scale, Social Impact Scale, Modified Memorial Anxiety Scale for Prostate Cancer, and Perceived Social Support Scale. Pearson correlation analysis was conducted to examine the relationships between variables, whereas multiple linear regression was used to identify the factors influencing social alienation among patients who underwent radical prostatectomy.

Results

Patients who underwent radical prostatectomy had a mean total score of 44.13 ± 7.24 on the Social Alienation Scale. The results of the Pearson correlation analysis indicated that social alienation showed an inverse association with social support (r = -0.627, p < 0.05) and positive associations with age, disease stigma, and anxiety (r = 0.325, 0.575, 0.421, all p's < 0.01) among patients who underwent radical prostatectomy. The findings from multiple linear regression analysis demonstrated that educational level, age, urinary incontinence, disease stigma, anxiety, and social support significantly influenced social alienation among elderly patients who underwent radical prostatectomy (p < 0.05).

Conclusions

Elderly patients who undergo radical prostatectomy often experience social alienation. This study found that social alienation was associated with factors such as educational level, age, urinary incontinence, social support, anxiety, and disease stigma. Consequently, healthcare providers should actively monitor the degree of social alienation in elderly patients after radical prostatectomy and provide suitable psychological care to facilitate positive social reintegration and alleviate their feelings of social alienation.

A systematic integrative review of specialized nurses' role to establish a culture of patient safety: A modelling perspective

AIMS

To understand specialized nurses' role in the culture of patient safety and their ability to promote and enforce it within healthcare.

DESIGN

A systematic integrative review using the approach of Whittemore and Knafl.

METHODS

Systematic literature search for qualitative, quantitative and mixed-methods studies, followed by data evaluation, quality assessment, analysis and research synthesis with a narrative perspective. Findings were contextualized within a 'framework for understanding the development of patient safety culture'.

DATA SOURCES

Searches were conducted in PubMed [including MEDLINE], Scopus, CINAHL, Web of Science and EMBASE from Jan 2013 until Sep 2023.

RESULTS

Sixteen studies published in English from six different countries were selected and used for research synthesis. Diverse enabling factors and enacting behaviours influencing specialized nurses' roles to promote patient safety culture were identified, mainly focusing on nurses' workload, professional experiences and organizational commitment. Patient safety outcomes focused on medication management, infection prevention, surveillance process in critical care, oversight on quality and safety of nurses' practice, patient care management, continuity of care, adherence to the treatment plan and implementation of a specialized therapeutic procedure.

CONCLUSION

Specialized nurses can make a significant contribution to promote patient safety culture and support organizational initiatives to prevent adverse events.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Stronger participation and leadership of specialized nurses in initiatives to improve patient safety culture requires appropriate investments and support by policy makers and managers in terms of resources and training.

IMPACT

There is a gap in existing literature on the contribution that specialized nurses can make in promoting patient safety culture. Review results highlight the importance of interprofessional collaboration and teamwork by involving specialized nurses. They inform healthcare policy makers about recognizing their roles and competencies in patient safety culture. Preferred reporting items for systematic reviews and meta-analysis. No patient or public contribution.