Interdisciplinary and interprofessional communication intervention: How psychological safety fosters communication and increases patient safety

Cultivating compassion in care: evaluating a compassion-training intervention and exploring barriers to compassionate care in postgraduate medical education in Pakistan: a mixed-methods study

BACKGROUND

Compassionate patient care is essential for improving patient outcomes and enhancing healthcare experience. However, in lower-middle-income countries (LMICs) like Pakistan, systemic barriers and a lack of structured curricula hinder its consistent delivery. This study evaluates a targeted compassion-training intervention for residents in a tertiary care hospital and explores barriers to its implementation. Given shared challenges like resource constraints, high patient loads, and gaps in formal training, these findings have broader implications for integrating structured compassion-based education across LMICs.

METHODS

This quasi-experimental mixed-methods study was conducted with first-year residents over a one-year period (November 2023 - October 2024). A 4-hour compassion-training session was delivered to develop compassion as a clinical competency. Quantitative data on satisfaction and self-reported compassion competence were collected using the Sinclair Compassion Questionnaire-Healthcare Provider Competence Self-Assessment (SCQ-HCPCSA) and analyzed via paired t-tests. Qualitative data from focused group discussions (FGDs) exploring barriers and facilitators underwent thematic analysis.

RESULTS

204 residents participated. Baseline compassion competence was 4.03 ± 0.54, with no demographic variations (p > 0.05). Participants rated sessions highly for interest (4.54 ± 0.65), relevance (4.50 ± 0.82), and interactivity (4.68 ± 0.61). Post-training, compassion competence significantly improved to 4.58 ± 0.47 (p < 0.001), with all SCQ-HCPCSA items showing significant improvements (p < 0.001). Qualitative findings revealed key barriers to practicing compassionate care, including time constraints, high workloads, and compassion fatigue, particularly in high-pressure specialties like surgery and intensive care. Institutional factors like documentation inefficiencies, financial pressures, and hierarchical workplace culture also limit compassionate care delivery. Culturally specific challenges emerged, including language barriers, differences in patient expectations, and perceptions of compassion as a transactional service in a largely out-of-pocket healthcare system. Facilitators of compassionate care included interdisciplinary collaboration, supportive senior staff, and effective communication strategies.

CONCLUSIONS

Targeted compassion-training interventions can enhance compassionate care among physicians. To ensure long-term impact, postgraduate medical education programs should formally integrate structured curricula, alongside institutional policy reforms that reduce administrative burdens and promote interdisciplinary collaboration. Future studies should explore long-term retention of training effects and assess scalability of similar curricula across diverse healthcare settings, particularly in other lower-middle-income countries.

TRIAL REGISTRATION

Not applicable.

Evaluating the outcomes of patient safety education programs in nursing education: a scoping review

PURPOSE

This study aimed to identify the trends in scholarly research related to patient safety education programs and outcome evaluations in the field of nursing education, focusing on providing a comprehensive overview of the current state of patient safety education and suggesting directions for future program development and evaluation.

METHODS

We conducted a scoping review using Arksey and O'Malley's 5-step framework and searched five databases; Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PubMed, Science Direct, and Research Information Sharing Service (RISS) for Korean literature.

RESULTS

Of the 1626 articles retrieved, we identified 27 articles published between 2006 and 2023. The articles' educational content focused on comprehensive patient safety education using instructional methods such as lectures, discussions, simulations, and online education. The effectiveness of the programs was evaluated primarily via knowledge, skills, and attitudes toward patient safety, and behavioral and results-related outcomes were rarely evaluated at Kirkpatrick's evaluation., The most commonly used tools were the Health Professional Education in Patient Safety Survey and the questionnaire developed by the World Health Organization Patient Safety Program. The evaluation was conducted using quantitative and qualitative methods, but follow-up tests were rarely conducted.

CONCLUSION

Our review findings suggest that patient safety education programs for nursing students and clinical nurses should apply diverse teaching methods and comprehensive evaluation strategies to enhance their overall effectiveness and ensure the practical application of safety practices. It is essential to diversify program evaluation metrics, such as experiential learning and interprofessional education, by expanding performance indicators at both learner and institutional levels for long-term repeated assessments.

Effect of Assertive Communication Training on the Confidence of New Graduate Nurses

BACKGROUND

New graduate nurses (NGNs) often face challenges during conflicts with health care providers, fellow nurses, and patients.

METHOD

A pilot educational session was created to address conflict challenges in communication. The session discussed assertive communication, communication tools to be used in practice, and video simulations with standardized clients.

RESULTS

A total of 17 NGNs in a transition to practice program completed the pretest, educational session, and posttest measuring confidence in managing conflicts. The NGNs rated their belief in their ability to be assertive in communication, and a significant improvement in confidence was seen from pre- to posttest. Specifically, NGNs reported an 18.03% increase in confidence when discussing difficult care decisions with health care providers and a 20.07% increase when discussing decisions with more experienced nurses. Posttest qualitative vignettes supported these quantitative findings, highlighting NGNs' growing confidence in advocating for patient care concerns.

CONCLUSION

Educational interventions similar to this one may benefit other transition to practice programs and prelicensure nursing programs. [J Contin Educ Nurs. 2025;56(2):71-77.].

Psychological safety in health professions education: insights and strategies from a global community of practice

Psychological safety is the belief that one will not be punished or humiliated for speaking up, sharing ideas, raising concerns, or making mistakes. There are various threats to psychological safety in health professions education (HPE). This commentary applies Clark's model of psychological safety (Inclusion Safety, Learner Safety, Contributor Safety, Challenger Safety) to five different HPE settings (classroom instructions, clinical training, simulation-based training, online instructions, interprofessional education). Setting-specific threats and strategies for enhancing psychological safety are discussed.

Validation of the Neuroception of Psychological Safety Scale (NPSS) Among Health and Social Care Workers in the UK

Psychological safety is essential for rest, recovery, and fostering social connections, particularly for health and social care workers (HSCWs) who frequently operate in high-pressure environments. These workers are prone to traumatic stress, which can elevate their sense of threat and undermine their psychological safety. This study aimed to validate the Neuroception of Psychological Safety Scale (NPSS) among HSCWs in the UK (n = 443). The NPSS is based on polyvagal theory and assesses the dimensions of compassion, social engagement and bodily sensations. Internal consistency, test-retest reliability, convergent, discriminant, and concurrent validity were examined, along with the scale's dimensionality. A three-factor structure was confirmed, with internal consistencies ranging from acceptable to excellent across subscales. Validity was supported by significant associations with measures of team psychological safety, well-being, post-traumatic stress, burnout, body perception, and personality. The NPSS also demonstrated strong test-retest reliability. These results validate the NPSS as a reliable and multidimensional tool for assessing psychological safety in health and social care settings. The study highlights the importance of psychological safety for HSCWs and provides a valuable measure to support interventions aimed at fostering safer and more supportive work environments.

Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study

BACKGROUND

In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce.

OBJECTIVE

This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning.

METHODS

A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined.

RESULTS

In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6%), of which 63 (36.4%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned.

CONCLUSIONS

This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context.

Evaluation of the Handover Training Program Given to Nursing Students Using the Kirkpatrick Model: A Quasi-Experimental Observational Study

BACKGROUND

Patient handover training given to nursing students is important to ensure patient safety. There are a variety of evaluation models that can be used to evaluate the impact of education in nursing, one of which is the Kirkpatrick model.

OBJECTIVE

This study aims to evaluate the patient handover training given to nursing students according to the Kirkpatrick model.

METHODS

A pretest and posttest design was used with a convenience sample of 33 nursing students. The training provided was evaluated according to the reaction, learning, behavior, and result levels of the Kirkpatrick model. In the study, data were collected by researchers observing students through face-to-face interactions and bedside observations using Handoff Evaluation Scale (Handoff CEX).

RESULTS

It was found that 42.1% of the nursing students practiced verbal, 19.7% taped, and 36.8% bedside handovers before the training, while all the students practiced taped, verbal, and bedside handovers after the training. While the mean (SD) scores of patient handover (2.87 [0.95]) were at an insufficient level before the training, the scores after the training (7.12 [1.06]) increased to a high level. The difference between the mean patient handover scores before and after the training was statistically significant (P < .001).

CONCLUSIONS

After the training provided in the study, it was observed that nursing students improved their patient handover levels and styles, handover participation, and information transfer. Patient handover training given to undergraduate student nurses can be evaluated using the Kirkpatrick model.

Establishing a Just Culture: Implications for the Veterans Health Administration Journey to High Reliability

Background

To establish a culture of safety and improve patient care, the Veterans Health Administration (VHA) is identifying and implementing necessary parameters and objectives across the health care landscape to enhance services on its journey to becoming a high reliability organization (HRO).

Methods

This quality improvement initiative sought to increase the understanding of factors that influence the establishment and sustainment of a just culture and identify specific methods for improving their implementation. Focus groups of HRO leads at 16 VHA hospital facilities identified emergent themes, facilitators, and barriers to maintaining a just culture and developed recommendations for enhancing both psychological safety and accountabilitity.

Results

The study identified the 5 key facilitators, barriers, and recommendations most frequently mentioned by HRO leads during focus group sessions. Implementing these strategies can potentially improve care standards and patient outcomes. Successfully integrating these recommendations demands consistent dedication, cooperation, and effort from stakeholders across all system levels, accompanied by regular evaluations to fortify the just culture principles.

Conclusions

This study offers an enriched perspective on initiating and sustaining a just culture and the broader application of HRO principles in health care. The methodology can act as a blueprint for broader HRO integration in the VHA and other institutions, particularly when paired with continuous quantitative evaluation of safety culture, just culture practices, and patient outcomes.

Implementing Lifestyle Medicine Competencies in Didactic and Clinical Settings for Allied Health Professionals: A Call to Action

In this article, we discuss and reflect on the essential components of our concurrent session presentation at the American College of Lifestyle Medicine (ACLM) annual conference LM2023, "Implementing Lifestyle Medicine Competencies in Didactic and Clinical Settings for Allied Health Professionals." We illustrate the necessity of interdisciplinary lifestyle medicine approaches through a conscious fusion of analysis and storytelling. This review concludes with a call to action empowering the medical community to embrace interdisciplinary lifestyle medicine approaches in effort to increase access to equitable healthcare.

Work-related smartphone use during off-job hours and work-life conflict: A scoping review

Over recent decades the use of smartphones for work purposes has burgeoned both within and beyond working hours. The aim of the study was to conduct a scoping review to explore the association between the use of smartphone technology for work purposes in off-job hours with employees' self-reported work-life conflict. Arksey and O'Malley's methodological framework was adopted. Searches were conducted in PsycINFO, International Bibliography of the Social Sciences (IBSS), Academic Search Complete, ProQuest Central, Web of Science, ProQuest Theses, Emerald, Business Source Complete, ScienceDirect, Scopus, Google Scholar. Articles were eligible that reported on a sample of workers, were published in English between 1st January 2012 and 29th November 2023. The review was conducted and reported using a quality assessment checklist and PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Data charting and synthesis was undertaken narratively, using the framework approach and thematic analysis. Twenty-three studies were identified, conducted in nine countries. Nineteen studies (83%) showed a significant association between increased use of smartphone for work purposes in off job-hours and increased work-life conflict, with small-to-moderate effect sizes. This relationship was mediated by psychological detachment from work, and communication about family demands with one's supervisor. Moderators either strengthened or attenuated the relationship between use of smartphone for work purposes in off job-hours and increased work-life conflict. Findings suggest that smartphone use during off-job hours is likely to impact negatively on work-life conflict, which has implications for employee wellbeing. Managers could play a key role in clarifying expectations about after-hours availability, reducing job pressure, advocating psychological detachment from work in off-job hours where it is appropriate, and creating a workplace culture where communication about the interplay between work and home life is encouraged. The protocol is registered on the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/WFZU6).

Enhancing communication within nursing and multiprofessional healthcare teams

Effective communication within nursing and multiprofessional healthcare teams is essential to promote patient safety. However, communication is a complex concept comprising various elements and variables that affect how messages are delivered, received and interpreted. In this article, the author explores communication within healthcare teams and provides some insight into the factors that affect team communication, such as interpersonal relationships. The author also explores organisational culture and cultural sensitivity, and discusses some evidence-based approaches to enhancing communication within healthcare teams.

Exploring Experiences of Conflict within Medical Teams in an Emergency Department: A Focus Group Approach during the COVID-19 Pandemic

The factors related to conflicts in emergency departments (EDs) have been studied for decades. The post-pandemic digital era may transform the medical landscape in EDs, potentially changing the patterns of conflict between healthcare professionals. This study used focus group interviews to explore conflicts in EDs. Four groups, each with 4-6 participants, took part in this study. Semi-structured interviews were conducted using six research questions. Summative content analysis was used to analyze the data. The participant's average age was 37.82 years, and the average number of working years was 12.12. The following five themes emerged: multiple patterns of internal conflict; external conflicts arising from cross-departmental coordination; conflicts due to unclear job boundaries; adapting to conflicts in diverse ways; and seeking hospital arbitration. The results of this study suggest extending interdisciplinary collaborative practice from emergency departments to all coordinating departments. An inclusive environment for equality between professions and open communication should be promoted by hospitals.

Interdisciplinary simulation-based teaching and learning for healthcare professionals: A systematic review and meta-analysis of randomized controlled trials

AIM

This study aimed to investigate the effects of interdisciplinary simulation-based teaching and learning on the interprofessional knowledge of healthcare professionals.

BACKGROUND

Interdisciplinary simulation-based teaching and learning have been employed to prepare learners to collaborate in clinical settings. This strategy could help healthcare professionals to better understand each other, develop interdisciplinary shared values and promote mutual respect between professions, while reducing errors and adverse events in hospital. A meta-analysis was performed to investigate the effects of interdisciplinary simulation-based teaching and learning on healthcare professionals.

DESIGN

A systematic review and meta-analysis.

METHODS

A systematic search was conducted of databases including Academic Search Complete, CINAHL Plus with full text, Cochrane Library, Embase, Medline Complete, PubMed and Web of Science from their inception to September 5, 2023. The study included randomized controlled trials that provided interdisciplinary simulation-based education to healthcare professionals. Protocol trials or studies that did not include median or mean and standard deviation were excluded. The pooled standardized mean differences of outcomes were analyzed using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using I2. Egger's regression test was used to examine publication bias indicated in forest plots.

RESULTS

Ten randomized control trials with a total of 766 participants were included in the pooled analyses. Interdisciplinary simulation-based teaching and learning positively enhanced the interprofessional knowledge of healthcare professionals (pooled SMD = 0.30; 95% CI = 0.10-0.50; p < 0.001). Egger's regression test results were non-significant, indicating that publication bias had little impact on the pooled SMDs.

CONCLUSION

Interdisciplinary simulation-based teaching and learning for health professionals appear to be significantly beneficial for increasing their interprofessional knowledge. This strategy highlights the importance of providing a well-developed scenario with relevant properties, which applies valid and rigorous instruments, to measure behavioral changes induced by interdisciplinary simulation-based teaching and learning.

Describing the impact of psychological safety on risk prevention: A threshold model construction

BACKGROUND

Like other things, psychological safety has a too-much-of-a-good-thing effect on the risk prevention process. There are warranted systematic and theoretical discussions on both positive and negative influences of psychological safety, which provide useful guides to handling potential risks for workers.

OBJECTIVE

This study focuses on the psychological safety analysis of work safety for workers in high-risk industries through the construction of a theoretical model, illustrating that a higher level of psychological safety is not better.

METHOD

This study explores the impact of workers' psychological safety on the potential risk of work safety by conducting a comprehensive analysis of relevant literature and employing inductive reasoning and analogy methodology.

RESULTS

We systematically reviewed the research background and several hypotheses of psychological safety, described the relationship between psychological safety and risk prevention from three levels, and constructed the threshold initial, special, and extended model of psychological safety to reveal the importance of workers' psychological safety when handling potential risks.

CONCLUSION

This research effectively describes the influence of high, moderate, and low levels of psychological safety on the risk prevention of work safety, which provides a psychological model guide to developing measures for the improvement of work safety management.

Telestration with augmented reality improves the performance of the first ten ex vivo porcine laparoscopic cholecystectomies: a randomized controlled study

INTRODUCTION

The learning curve in minimally invasive surgery (MIS) is steep compared to open surgery. One of the reasons is that training in the operating room in MIS is mainly limited to verbal instructions. The iSurgeon telestration device with augmented reality (AR) enables visual instructions, guidance, and feedback during MIS. This study aims to compare the effects of the iSurgeon on the training of novices performing repeated laparoscopic cholecystectomy (LC) on a porcine liver compared to traditional verbal instruction methods.

METHODS

Forty medical students were randomized into the iSurgeon and the control group. The iSurgeon group performed 10 LCs receiving interactive visual guidance. The control group performed 10 LCs receiving conventional verbal guidance. The performance assessment using Objective Structured Assessments of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) scores, the total operating time, and complications were compared between the two groups.

RESULTS

The iSurgeon group performed LCs significantly better (global GOALS 17.3 ± 2.6 vs. 16 ± 2.6, p ≤ 0.001, LC specific GOALS 7 ± 2 vs. 5.9 ± 2.1, p ≤ 0.001, global OSATS 25.3 ± 4.3 vs. 23.5 ± 3.9, p ≤ 0.001, LC specific OSATS scores 50.8 ± 11.1 vs. 41.2 ± 9.4, p ≤ 0.001) compared to the control group. The iSurgeon group had significantly fewer intraoperative complications in total (2.7 ± 2.0 vs. 3.6 ± 2.0, p ≤ 0.001) than the control group. There was no difference in operating time (79.6 ± 25.7 vs. 84.5 ± 33.2 min, p = 0.087).

CONCLUSION

Visual guidance using the telestration device with AR, iSurgeon, improves performance and lowers the complication rates in LCs in novices compared to conventional verbal expert guidance.