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Koller D, Espin S, Indar A, Oulton A, LeGrow K. Children's participation rights and the role of pediatric healthcare teams: A critical review. J Pediatr Nurs 2024; 77:1-12. [PMID: 38461775 DOI: 10.1016/j.pedn.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
AIM A critical review examined how childrens participation rights as represented in the United Nations Convention on the Rights of the Child inform the work of pediatric teams in healthcare settings. METHODS We systematically searched peer-reviewed literature on the enactment of child participation rights, within the context of pediatric teams. Articles were evaluated using the LEGEND (Let Evidence Guide Every New Decision) tool. Data extraction and analysis highlighted themes and disparities between articles, as well as gaps. A total of 25 studies were selected. RESULTS We reviewed studies from around the globe, with the majority of papers from the UK. Qualitative and mixed methods approaches were administered. The following observations were made: (1) limited language of children's rights exists in the literature, (2) lack of information regarding the composition of pediatric healthcare teams and how they work with children, (3) children's perspectives on what constitutes good interactions with healthcare providers are replicated, (4) minimal references to theory or philosophical underpinnings that can guide practice. CONCLUSION Explicit references to children's participation rights are lacking in the literature which may reflect the absence of rights language that could inform pediatric practice. Descriptive understandings of the tenets of pediatric interprofessional team composition and collaboration are necessary if we are to imagine the child as part of the team along with their family. Despite these shortcomings, the literature alludes to children's ability to discern desirable interactions with healthcare providers.
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Affiliation(s)
- Donna Koller
- School of Early Childhood Studies, Toronto Metropolitan University, Toronto, Canada.
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Alyssa Indar
- Nova Scotia Health/Dalhousie University, Halifax, Canada
| | - Angie Oulton
- School of Early Childhood Studies, Toronto Metropolitan University, Toronto, Canada
| | - Karen LeGrow
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
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LeGrow K, Espin S, Chui L, Rose D, Meldrum R, Sharpe M, Gucciardi E. Home Away from Home: How Undergraduate and Graduate Students Experience Space and Place in a new Health Sciences Building. Can J Nurs Res 2023; 55:447-456. [PMID: 37528568 PMCID: PMC10619180 DOI: 10.1177/08445621231190581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Buildings contribute in crucial ways to how students experience learning spaces. Four schools within a faculty (nursing, nutrition, occupational and public health, and midwifery) moved into a new Health Sciences building Fall of 2019. This new building created a unique opportunity to explore the intersection between higher education and learning space design, informed by concepts of space and place, and students' profession specific and interprofessional learning experiences in a new Health Sciences building. A qualitative descriptive design was used. All undergraduate and graduate students within the four schools were invited to participate. Focus groups were undertaken to gain a rich understanding of students' experiences and views of their space and place of learning. Data collection involved focus group data from profession specific participant users and interprofessional participant users. Inductive thematic analysis of focus group transcripts generated an initial coding scheme, key themes, and data patterns. Codes were sorted into categories and then organized into meaningful clusters. A building planning development project document relating to the vision, intentions, design, and planning for the new building provided content from which to view the study findings. The study data contributed to the conversation about space and place and its influence on higher learning within specific intraprofessional and interprofessional student groups and provided insight into the process of actualizing a vision for a new learning space and the resultant experiences and perceptions of students within that space/place.
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Affiliation(s)
- Karen LeGrow
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | - Lois Chui
- McMaster Children’s Hospital, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | - Don Rose
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | - Richard Meldrum
- School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | - Mary Sharpe
- School of Midwifery, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | - Enza Gucciardi
- School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
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LeGrow K, Cohen E, Espin S. Mother-nurse decision making practices for children with complex health care needs receiving homecare services: A qualitative descriptive study. Child Care Health Dev 2022; 48:605-612. [PMID: 35043429 DOI: 10.1111/cch.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 11/08/2021] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many children with complex health care needs face chronic health and developmental issues that may include functional impairments, neurodevelopmental disabilities, and lifelong dependence on medical technology. Providing the necessary care and services for this unique group of children and youth places substantial demands on the health care system. Much of the focus on improvements has been in acute care settings even though homecare accounts for the largest proportion of health care utilization among children with complex health care needs. While parents assume great responsibility for their child's care at home, they indicate that the balance of power between themselves and their health care providers does not change when care shifts from the hospital to home. Given the expanding role of paediatric homecare and parents' concerns of their role in decisions related to their child's care, it is imperative to explore these practices in this unique setting. PURPOSE The purpose of this work is to explore mother-nurse decision making practices for children with complex health care needs receiving health care services in their home. METHODS A qualitative descriptive study design was used. Five mothers and five nurses participated. Twenty-six home observations with accompanying analytical memos and 10 semistructured interviews were conducted with five mothers and five homecare nurses. Thematic analysis of study data, using an iterative process, identified major themes. FINDINGS Data revealed the complex and relational nature of mother-nurse decision making practices within the home setting. Three major themes were identified: (1) core areas of decision making, (2) a dynamic and collaborative process, and (3) centrality of relationships. CONCLUSIONS Study findings enhanced our understanding of how decision making and relational care practices take place in the home for children with complex health care needs receiving homecare services, which has implications for child and family health.
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Affiliation(s)
- Karen LeGrow
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - Eyal Cohen
- Complex Care Program, Hospital for Sick Children, Professor, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Edward S. H. Leong Centre for Health Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
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Paddley B, Espin S, Indar A, Rose D, Bookey-Bassett S. Communication of Code Status Escalation for Nurses and Physicians in the Intensive Care Unit: A Case Study. Can J Nurs Res 2022; 55:176-184. [PMID: 35538849 DOI: 10.1177/08445621221099117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Interprofessional teams working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient's code status can help clinicians to understand the appropriate life support measures to deliver to patients in this setting. Members of the interprofessional team, such as physicians and nurses, can experience challenges related to communication when the code status is unclear. PURPOSE The purpose of this study was to explore how nurses and physicians in the ICU experience communication of code status escalations. METHODS A qualitative case study approach was used. Participants were physicians and nurses, working in the medical-surgical ICU of a large, urban academic hospital. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. Data were analyzed using qualitative content analysis. RESULTS Thematic findings include: (1) engaging in an interprofessional discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the patient story. The study findings also provide contextual information about participants' experiences of code status communication during the first wave (February 2020 to May 2020) of the COVID-19 pandemic. CONCLUSIONS The results of this study could inform standard communication frameworks or practices related to dissemination of code status decisions among members of the ICU team.
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Affiliation(s)
- Brianna Paddley
- Medical Surgical Intensive Care Unit, 10071St. Michael's Hospital, Toronto, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Canada
| | - Alyssa Indar
- Faculty of Health Sciences and Wellness, 10025Humber College, Toronto, Canada
| | - Don Rose
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Canada
| | - Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Canada
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Serre N, Espin S, Indar A, Bookey-Bassett S, LeGrow K. Long-Term Care Nurses' Experiences With Patient Safety Incident Management: A Qualitative Study. J Nurs Care Qual 2022; 37:188-194. [PMID: 34261090 DOI: 10.1097/ncq.0000000000000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Global trends in the aging population will increase the demands for long-term care (LTC) resources. Due to recent pressures to deliver more complex care, there is further risk to resident safety in LTC. Emphasis on the management and the delivery in safe and quality resident care in LTC is required. PURPOSE The purpose of this study was to describe nurses' experiences with patient safety incident (PSI) management involving residents living in LTC. METHODS Using a qualitative descriptive approach, 9 nurses were recruited in 3 LTC homes. Semistructured interviews were conducted, and data were analyzed using inductive content analysis. RESULTS Three main categories emerged: commitment to resident safety, workplace culture, and emotional reaction. CONCLUSIONS Providing nurses with an opportunity to share their PSI management experiences highlights the current factors influencing frontline resident safety in LTC. Study results can inform nursing practice and policy development to support PSI identification and management.
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Affiliation(s)
- Nicole Serre
- Medicine Department, Royal Victoria Regional Health Centre, Barrie, Canada (Ms Serre); Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada (Drs Espin, Bookey-Bassett, and LeGrow); and School of Health Sciences, Humber College, Toronto, Canada (Ms Indar)
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LeGrow K, Cohen E, Espin S. Relational Aspects of Parent and Home Health Care Provider Care Practices for Children With Complex Care Needs Receiving Health Care Services in the Home: A Narrative Review. Acad Pediatr 2022; 22:196-202. [PMID: 34403801 DOI: 10.1016/j.acap.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 11/01/2022]
Abstract
Children with medical complexity have ongoing health needs that may require dependence on medical technologies. While hospital admissions are an important focus of care delivery for these children, a majority of the time they are cared for in their own homes. Parents' report feeling overwhelmed and stressed by the scope of their responsibilities, but they become sophisticated care providers and assume greater authority when providing their children's care at home. Communication, decision-making, and dealing with conflict with members of health care teams have been central concerns in parents' reports of their home health care experiences. The objective is to review literature on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. A narrative review was conducted. A search of MEDLINE, EMBASE, EBM Reviews, PsychINFO, ERIC, and CINAHL databases for English language studies published since database inception was carried out. Eligible studies focused on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. Nine empirical studies were selected for this review. Literature describes parents' and providers' experiences managing a child with medical complexity in the home and the effects for the family and the parent-health care provider relationship. Parents want to be actively involved in all aspects of care that affects their child and ultimately their family. Further investigation is needed to better understand relational aspects of parent-home health care provider care practices to support child/family health and well-being in the home setting.
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Affiliation(s)
- Karen LeGrow
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University (K LeGrow and S Espin), Toronto, Ontario, Canada.
| | - Eyal Cohen
- Complex Care Program, Child Health Evaluative Sciences, Hospital for Sick Children, Edwin S.H. Leong Centre for Healthy Children, Department of Pediatrics, University of Toronto (E Cohen), Toronto, Ontario, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University (K LeGrow and S Espin), Toronto, Ontario, Canada
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Espin S, D'Arpino M, Indar A, Gross M. Incident Management in Health Care: A Pan-Canadian Perspective. J Nurs Care Qual 2022; 37:E15-E21. [PMID: 34101696 DOI: 10.1097/ncq.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nearly 10% of patients experience a harmful patient safety incident in the hospital setting. Current evidence focuses on incident reporting, whereas little is known about how incidents are managed within organizations. PURPOSE The aim of this study was to explore processes, tools, and resources for incident management in Canadian health care organizations. METHODS Qualitative focus groups were conducted with key stakeholders, representing clinicians, managers, executives, governors, patients, and families (n = 45). RESULTS Qualitative data were thematically analyzed and presented as 3 themes: (1) variations in incident reporting and management; (2) simplification of the incident management process; and (3) need for leadership to support just culture and redefine harm. CONCLUSION The study findings support and inform efforts to create a patient safety culture in Canadian and international health care organizations. There is a need to develop a standardized, accessible incident reporting and management system for use across health care sectors to promote continuous learning and improvement about patient safety.
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Affiliation(s)
- Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada (Dr Espin); Canadian Patient Safety Institute, Ottawa, Ontario, Canada (Ms D'Arpino); UNB/Humber Collaborative Bachelor of Nursing Program, Faculty of Health Sciences & Wellness, Humber Institute of Technology & Advanced Learning, Toronto, Ontario, Canada (Ms Indar); and Sinai Health System, Toronto, Ontario, Canada (Ms Gross)
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Espin S, LeGrow K, Bookey-Bassett S, Rose D, Santa Mina E, Indar A. Exploring the Intersection Between Academic and Professional Practice During the COVID-19 Pandemic: Undergraduate and Graduate Nursing Students' Experiences. Can J Nurs Res 2021; 54:283-291. [PMID: 34706572 PMCID: PMC9378827 DOI: 10.1177/08445621211037147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The coronavirus disease-2019 (COVID-19) pandemic has implications for students who are
also nurses. Purpose and Methods This qualitative descriptive study used a practice development approach to explore the
intersection between academic and professional work experiences for undergraduate
Post-Diploma Registered Practical Nurses bridging to Registered Nurse Bachelor of
Science in Nursing students and Master of Nursing graduate nursing students during the
first wave of the COVID-19 pandemic. The study incorporated critical aesthetic
reflections that focused on the personal and aesthetic ways of knowing, as a data
collection approach and knowledge dissemination strategy. Results Analysis of the narrative component of participants’ reflections revealed the following
themes: sensing a “call to duty,” experiencing a myriad of emotions, shifting societal
and individual perceptions of nursing, and learning in an uncertain environment. Conclusions The results of the study can inform educational strategies and academic policies to
support this unique nursing population, who are frontline practitioners as well as
student learners.
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Affiliation(s)
- Sherry Espin
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, ON, Canada
| | - Karen LeGrow
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, ON, Canada
| | - Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, ON, Canada
| | - Donald Rose
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, ON, Canada
| | - Elaine Santa Mina
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, ON, Canada
| | - Alyssa Indar
- 70373Faculty of Health Sciences and Wellness, 10025Humber College, Toronto, ON, Canada
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Abstract
OBJECTIVE We explored the underlying mechanisms by which storytelling can promote disease self-management among people with type 2 diabetes. METHODS Two, eight-session storytelling interventions were delivered to a total of eight adults with type 2 diabetes at a community health center in Toronto, Ontario. Each week, participants shared stories about diabetes self-management topics of their choice. Using a qualitative descriptive approach, transcripts from each session and focus groups conducted during and following the intervention were coded and analyzed using NVivo software. Through content analysis, we identified categories that describe processes and benefits of the intervention that may contribute to and support diabetes self-management. RESULTS Our analysis suggests that storytelling facilitates knowledge exchange, collaborative learning, reflection, and making meaning of one's disease. These processes, in turn, could potentially build a sense of community that facilitates peer support, empowerment, and active engagement in disease self-management. CONCLUSION Venues that offer patients opportunities to speak of their illness management experiences are currently limited in our healthcare systems. In conjunction with traditional diabetes self-management education, storytelling can support several core aspects of diabetes self-management. Our findings could guide the design and/or evaluation of future story-based interventions.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Erica Reynolds
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Grace Karam
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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Zanchetta MS, Fredericks S, Mina ES, Schwind J, Sidani S, Miranda J, Santos WS, Bookey-Bassett S, Ehtesham N, Ziegler E, Fernandes JP, Lee K, Bailey A, Espin S, Rose D, Lee C. Apoiando a educação em pesquisa dos graduandos de enfermagem. Esc Anna Nery 2021. [DOI: 10.1590/2177-9465-ean-2020-0293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivos Descrever a experiência da implementação de um programa de treinamento de assistente de pesquisa voluntário para graduandos canadenses de Enfermagem, objetivando o desenvolvimento de habilidades de comunicação verbal e escrita, métodos de pesquisa e análise de dados, pensamento crítico e resolução de problemas, assim como o planejamento de suas carreiras e o avanço de seus papéis relacionados à pesquisa e às oportunidades administrativas e de liderança. Método Estudo descritivo com relato de experiência sobre o processo de treinamento para um novo papel profissional relativo ao engajamento dos graduandos em 11 oficinas, cada uma com duração de uma hora e o processo de apoiá-los para assumir papéis profissionais e de liderança. Resultados Os graduandos demonstraram comprometimento em todas as fases do treinamento. Destaca-se, ainda, o interesse por assumirem a liderança em atividades práticas que redefinem seu perfil profissional. Essa experiência contribuiu para construir e nutrir relações intelectuais docentes-graduandos. Os graduandos expandiram suas redes profissionais e a relação com o mentor de carreira, estão desenvolvendo suas habilidades práticas e relataram confiança em se candidatar para cargos de assistentes de pesquisa. Conclusão e implicações para a prática O treinamento pode instrumentalizá-los para escolhas de planos de carreira, ingresso no mercado de trabalho e a construção de plano para desenvolvimento profissional. O desejo genuíno dos docentes de Enfermagem, apoiando uma nova geração de enfermeiros, culminou nessa experiência de empoderamento mútuo.
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Espin S, Indar A, Gross M, Labricciosa A, D'Arpino M. Processes and tools to improve teamwork and communication in surgical settings: a narrative review. BMJ Open Qual 2020; 9:bmjoq-2020-000937. [PMID: 32554445 PMCID: PMC7304801 DOI: 10.1136/bmjoq-2020-000937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Alyssa Indar
- Faculty of Health Sciences and Wellness, Humber College Institute of Technology and Advanced Learning, Toronto, Ontario, Canada
| | | | | | - Maryanne D'Arpino
- Safety Improvement and Capability Building, Canadian Patient Safety Institute, Ottawa, Ontario, Canada
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Espin S, Sears N, Indar A, Duhn L, LeGrow K, Thapa B. Nursing students’ experiences of patient safety incidents and reporting: A scoping review. ACTA ACUST UNITED AC 2019. [DOI: 10.5430/jnep.v10n4p26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Nursing students gain exposure to the realities of patient safety incidents (PSIs) during clinical placements. How students learn about PSIs and reporting within clinical placements remains to be explored.Methods: This scoping review addressed: What is known about nursing students’ understanding and experiences of PSIs and incident reporting while practising in a clinical setting? CINAHL, MEDLINE, Scholars Portal, and ProQuest Nursing and Allied Health databases were searched. Study selection and data extraction were conducted by two independent reviewers. Data were collated, summarized and reported narratively.Results: Fifty-one articles were selected. Themes include: (1) types of PSIs reported; (2) how students engage in PSI reporting; (3) student factors related to PSIs; and (4) environmental factors relevant to student experiences of PSIs.Conclusions: This scoping review provides a necessary foundation from which to build future studies, to best support students and educators in addressing safety incidents within a just culture paradigm.
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Wang AH, Lee CT, Espin S. Undergraduate nursing students' experiences of anxiety-producing situations in clinical practicums: A descriptive survey study. Nurse Educ Today 2019; 76:103-108. [PMID: 30776531 DOI: 10.1016/j.nedt.2019.01.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/14/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Clinical practicums are regarded as one of the most anxiety-producing aspects of the curriculum by nursing students. Practicum-associated anxiety has negative impacts on learning, performance, and well-being. Little is known about what makes final year nursing students anxious during their practicum experience and the impact of clinical and student characteristics on their level of anxiety. OBJECTIVES The objectives of the study were (1) to explore which clinical situations final year nursing students perceive as anxiety-producing; (2) to identify if perceived level of anxiety associated with clinical tasks differ by clinical and student characteristics; and (3) to determine the relationship between clinical and student characteristics and perceived level of anxiety among nursing students. DESIGN Descriptive, cross-sectional survey. SETTING One university in Ontario, Canada. PARTICIPANTS A convenience sample of 93 final year undergraduate nursing students. METHODS The Clinical Experience Anxiety Form (CEAF) was administered to assess perceived level of anxiety associated with common practicum tasks. Descriptive statistics, one-way analysis of variance, and Pearson's correlation tests were used to address the research questions. Content analysis was conducted for open-ended questions. RESULTS Participants reported the following three situations as most anxiety-producing: fear of making mistakes, being observed by instructors, and initial clinical experience on a unit. Differences were noted between younger (18 to 24 years-old) and older (25 to 34 years-old) students, with the older student group reporting lower levels of anxiety associated with the following clinical situations: being observed by instructors and asking questions of faculty. Age was also found to be negatively correlated with CEAF scores wherein younger students reported higher CEAF scores. Content analysis indicated common areas that worried participants most about their practicum and their academic year. CONCLUSIONS Findings emphasize the importance of nursing educators to recognize anxiety-producing practicum situations and develop anxiety management interventions to ensure optimal learning.
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Affiliation(s)
- Angel H Wang
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
| | - Charlotte T Lee
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
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Abstract
Despite the prevalence of medical errors in pediatrics, little research examines stakeholder perspectives on the disclosure of adverse events, particularly in the case of children's own perspectives. Stakeholder perspectives, however, are integral to informing processes for pediatric disclosure. Building on a systematic review of the literature, this article presents findings from a series of focus groups with key pediatric stakeholders where perspectives were sought on the disclosure of medical errors. Focus groups were conducted with three stakeholder groups. Participants included child members of the Children's Council from a large pediatric hospital (n = 14), parents of children with chronic medical conditions (n = 5), and health-care providers including physicians, nurses, and patient safety professionals (n = 27). Children acknowledged various disclosure approaches while citing the importance of children's right to know about errors. Parents generally identified the need for full disclosure and the uncovering of hidden errors. Health-care providers were concerned about the process of disclosure and whether it always served the best interest of the child or family. While some health-care providers addressed the need for more clarity in pediatric policies, most stakeholders agreed that a case-by-case approach was necessary for supporting variations in how medical errors are disclosed.
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Affiliation(s)
- Donna Koller
- The Hospital for Sick Children, Ryerson University, Toronto, Ontario, Canada
| | - Sherry Espin
- The Hospital for Sick Children, Ryerson University, Toronto, Ontario, Canada
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Indar A, Espin S, LeGrow K, Janes N. Using Critical Creativity to Reveal Nursing Student Learning in Long-Term Care. J Nurs Educ 2018; 57:150-153. [PMID: 29505072 DOI: 10.3928/01484834-20180221-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/02/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of teaching-learning strategies that emphasize critical reflection aids students in making sense of complex clinical placement settings, such as those in long-term care (LTC) settings. METHOD A qualitative descriptive research design was used to explore the assumptions, anticipations, and realizations of six undergraduate nursing students regarding aging, gerontological nursing, and LTC as they engaged in facilitated critical reflection activities during a 12-week LTC placement. RESULTS The content analysis process revealed four main categories describing the student learning experience: Exploring the Therapeutic Nurse-Resident Relationship, Navigating Preceptor Relationships, Expanding Awareness of Context, and Embracing Many Feelings. CONCLUSION Students placed in LTC were challenged by the realization of LTC as a complex setting, especially with minimal support from preceptors. Educators should present LTC as a challenging environment, rich with complex issues. There is potential in easing the strain on preceptors by leveraging the faculty educator role in facilitating student learning through critically creative approaches. [J Nurs Educ. 2018;57(3):150-153.].
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Abstract
The Surgical Safety Checklist (SSC) has been adopted in operating rooms (OR) worldwide to reduce medical errors, increase patient safety and improve interprofessional communication. Despite often high compliance rates, recent studies suggested the SSC has not been associated with significant reductions in operative mortality or complications. This ethnographic study sought to understand this disconnection through approximately 50 hours of observation in the OR and 10 in-depth semi-structured interviews with surgeons, nurses, and anaesthesiologists in orthopaedic surgery. Inductive thematic analysis was used to analyse the data. By spending time in the OR and listening to the staff, this study was able to look beyond what "ought" to be happening in the OR and garner a deep understanding of the realities of OR work that acknowledges the complexities of surgical culture in which the SSC is being implemented. This study found SSC compliance was influenced by the perceived (un)importance of individual checklist items within the orthopaedic setting. Additionally, there remains a need to further explore patients' involvement in their operative experience.
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Affiliation(s)
- Roxanne Ziman
- a Daphne Cockwell School of Nursing, Faculty of Community Services , Ryerson University , Toronto , Ontario , Canada
| | - Sherry Espin
- a Daphne Cockwell School of Nursing, Faculty of Community Services , Ryerson University , Toronto , Ontario , Canada
| | - Rachel E Grant
- b Faculty of Education , University of Ottawa , Ottawa , Ontario , Canada
| | - Simon Kitto
- c Department of Innovation in Medical Education , University of Ottawa , Ottawa , Ontario , Canada.,d Office of Continuing Professional Development, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada
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Abstract
OBJECTIVE To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care. Participating sites included orthopaedic inpatient units from two acute care teaching hospitals and one orthopaedic unit at a rehabilitation hospital in an urban setting. FINDINGS Three distinct themes emerged from participants' narrative of their transitional care experience: (1) having no clue what the care plan is, (2) being told and notified about the plan and (3) experiencing challenges absorbing information. Participating patients and their caregivers reported not being engaged in an active discussion with healthcare professionals about their care transition plan. Several healthcare professionals described withholding information within the plan until they themselves were clear about the transition outcomes. CONCLUSION This study highlights the need to increase efforts to ensure that effective information exchanges occur during transition from acute care hospital to rehabilitation settings.
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Affiliation(s)
- Lianne Jeffs
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Marianne Saragosa
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Madelyn Law
- Department of Health Science, Brock University, St Michael's, Toronto, Canada
| | - Kerry Kuluski
- Community Health Sciences, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Canada
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Coffey M, Espin S, Hahmann T, Clairman H, Lo L, Friedman JN, Matlow A. Parent Preferences for Medical Error Disclosure: A Qualitative Study. Hosp Pediatr 2017; 7:24-30. [PMID: 28007750 DOI: 10.1542/hpeds.2016-0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE According to disclosure guidelines, patients experiencing adverse events due to medical errors should be offered full disclosure, whereas disclosure of near misses is not traditionally expected. This may conflict with parental expectations; surveys reveal most parents expect full disclosure whether errors resulted in harm or not. Protocols regarding whether to include children in these discussions have not been established. This study explores parent preferences around disclosure and views on including children. METHODS Fifteen parents of hospitalized children participated in semistructured interviews. Three hypothetical scenarios of different severity were used to initiate discussion. Interviews were audiotaped, transcribed, and coded for emergent themes. RESULTS Parents uniformly wanted disclosure if harm occurred, although fewer wanted their child informed. For nonharmful errors, most parents wanted disclosure for themselves but few for their children.With respect to including children in disclosure, parents preferred to assess their children's cognitive and emotional readiness to cope with disclosure, wishing to act as a "buffer" between the health care team and their children. Generally, as event severity decreased, they felt that risks of informing children outweighed benefits. Parents strongly emphasized needing reassurance of a good final outcome and anticipated difficulty managing their emotions. CONCLUSIONS Parents have mixed expectations regarding disclosure. Although survey studies indicate a stronger desire for disclosure of nonharmful events than for adult patients, this qualitative study revealed a greater degree of hesitation and complexity. Parents have a great need for reassurance and consistently wish to act as a buffer between the health care team and their children.
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Affiliation(s)
- Maitreya Coffey
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada; .,Departments of Paediatrics.,Centre for Quality Improvement and Patient Safety, and
| | - Sherry Espin
- Centre for Quality Improvement and Patient Safety, and.,Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | | | - Hayyah Clairman
- Faculty of Sciences, University of Toronto, Toronto, Ontario, Canada; and
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, and
| | - Jeremy N Friedman
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada.,Departments of Paediatrics
| | - Anne Matlow
- Departments of Paediatrics.,Centre for Quality Improvement and Patient Safety, and
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Grohmann B, Espin S, Gucciardi E. Patients' experiences of diabetes education teams integrated into primary care. Can Fam Physician 2017; 63:e128-e136. [PMID: 28209705 PMCID: PMC5395411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore patients' perspectives on care received from diabetes education teams (a registered nurse and a registered dietitian) integrated into primary care. DESIGN Qualitative study using semistructured, one-on-one interviews. SETTING Three diabetes education programs operating in 11 primary care sites in one region of Ontario. PARTICIPANTS Twenty-three patients with diabetes. METHODS Purposeful sampling was used to recruit participants from each site for interviews. Educator teams invited patients with whom they had met at least once to participate in semistructured interviews. Data were analyzed using thematic analysis with NVivo 11 software. MAIN FINDINGS The diabetes education teams integrated into primary care exhibited many of the principles of person-centred care, as evidenced by the 2 overarching themes. The first is personalized care, with the subthemes care environment, shared decision making, and patient preference for one-on-one care. Participants described feeling included in partnerships with their health care providers, as they collaborated with physicians and diabetes educators to develop knowledge and set goals in the convenience and comfort of their usual primary care settings. Many participants also expressed a preference for one-on-one sessions. The second theme is patient-provider relationship, with the subthemes respect, supportive interaction, and facilitating patient engagement. Supportive environments created by the educators built trusting relationships, where patients expressed enhanced motivation to improve their self-care. CONCLUSION Diabetes educators integrated into primary care can serve to enrich the experience of patients, provide key education to improve patient understanding, and support primary care physicians in providing timely and comprehensive clinical care. Diabetes patients appear to benefit from convenient access to interprofessional teams of educators in primary care to support diabetes self-management.
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Affiliation(s)
| | - Sherry Espin
- Associate Professor in the Daphne Cockwell School of Nursing at Ryerson University in Toronto, Ont
| | - Enza Gucciardi
- Associate Professor in the School of Nutrition at Ryerson University.
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20
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Jeffs L, Kuluski K, Law M, Saragosa M, Espin S, Ferris E, Merkley J, Dusek B, Kastner M, Bell CM. Identifying Effective Nurse-Led Care Transition Interventions for Older Adults With Complex Needs Using a Structured Expert Panel. Worldviews Evid Based Nurs 2017; 14:136-144. [DOI: 10.1111/wvn.12196] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lianne Jeffs
- St. Michael's Hospital Volunteer Association Chair in Nursing Research Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael's Hospital, Associate Professor, Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation; University of Toronto; Toronto ON Canada
| | - Kerry Kuluski
- Research Scientist, Sinai Health System; Lunenfeld-Tanenbaum Research Institute; Toronto ON Canada
| | - Madelyn Law
- Associate Professor; Brock University; St. Catherines ON Canada
| | | | - Sherry Espin
- Associate Professor; Ryerson University; Toronto ON Canada
| | - Ella Ferris
- Former Executive Vice-President-Programs; Chief Nursing Executive, and Chief Health Disciplines Executive; St. Michael's Hospital Toronto ON Canada
| | - Jane Merkley
- Executive Vice President Patient Care; Quality and Chief Nurse Executive Sinai Health System; Toronto ON Canada
| | - Brenda Dusek
- Former Program Manager; Registered Nurses’ Association of Ontario; Toronto ON Canada
| | - Monika Kastner
- Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
| | - Chaim M. Bell
- Clinician Scientist; Sinai Health System; Toronto ON Canada
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Abstract
A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
- Correspondence: Lianne Jeffs, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Room 720, 209 Victoria Street, Toronto, ON M5B 1T8, Canada, Tel +1 416 864 6060 ext 77644, Email
| | - Marianne Saragosa
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
| | - Madelyn P Law
- Department of Health Science, Brock University, St Catharines
| | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, ON, Canada
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Jayasuriya-Illesinghe V, Guruge S, Gamage B, Espin S. Interprofessional work in operating rooms: a qualitative study from Sri Lanka. BMC Surg 2016; 16:61. [PMID: 27596281 PMCID: PMC5011874 DOI: 10.1186/s12893-016-0177-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons’ perception of teamwork, team members’ roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. Results Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. Conclusions A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.
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Affiliation(s)
| | - Sepali Guruge
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Bawantha Gamage
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
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Koller D, Rummens A, Le Pouesard M, Espin S, Friedman J, Coffey M, Kenneally N. Patient disclosure of medical errors in paediatrics: A systematic literature review. Paediatr Child Health 2016; 21:e32-8. [PMID: 27429578 DOI: 10.1093/pch/21.4.e32] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified.
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Guay J, Bishop SE, Espin S. New Graduate RNs' Perceptions of Transitioning to Professional Practice After Completing Ontario's New Graduate Guarantee Orientation Program. J Contin Educ Nurs 2016; 47:37-44. [DOI: 10.3928/00220124-20151230-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/29/2015] [Indexed: 11/20/2022]
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Gucciardi E, Espin S, Morganti A, Dorado L. Implementing Specialized Diabetes Teams in Primary Care in Southern Ontario. Can J Diabetes 2015; 39:467-77. [PMID: 26482885 DOI: 10.1016/j.jcjd.2015.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study explores the implementation processes of integrating specialized diabetes teams into primary care in southern Ontario, Canada. METHODS In-depth qualitative interviews were conducted with 23 patients, 20 diabetes educators and 16 primary care physicians. In addition, group debriefing sessions were conducted and field notes were collected from diabetes educators and diabetes education program managers to further explore the day-to-day issues of implementation. Data were analyzed using an inductive content analysis approach. RESULTS Analysis revealed 3 main themes: Right Place, Right Time, Right Service: the convenience and comfort of local care, timely, preventive management and delivering person-centred care; Creating Partnerships: generating intervention buy-in, formal discussion, service agreements, site orientation and team development; Operational Complexities and Strategies: access to electronic medical records and documentation, referral and scheduling procedures, and costs and resources. CONCLUSIONS Because situating diabetes teams in primary care currently involves using existing healthcare structures and human resources, pragmatic methods of fostering successful implementation of this model of practice are required. The utility of this model was perceived as being viable, and benefits were visible to all study participants. Strategies to facilitate implementation include outlining roles and expectations by educators and the primary care providers' team in the beginning, investment in the intervention by all stakeholders, and clear channels of communication that allow educators to perform their roles and leverage opportunities for team collaboration in patient care. Further evaluation of implementation processes can serve to expand this model of practice, which has proven so far to be favourable to the players involved.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada.
| | - Sherry Espin
- Ryerson University, Daphne Cockwell School of Nursing, Toronto, Ontario, Canada
| | - Antonia Morganti
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Linda Dorado
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
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26
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Espin S, Meikle D. Fourth-Year Nursing Student Perceptions of Incidents and Incident Reporting. J Nurs Educ 2014; 53:238-43. [DOI: 10.3928/01484834-20140217-04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/22/2013] [Indexed: 11/20/2022]
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Aksenchuk K, Schwind JK, Espin S, McCay B, Gingras J. Patients’ Stories of Interprofessional Whole-Person Care. IJWPC 2014. [DOI: 10.26443/ijwpc.v1i1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: Interprofessional whole-person care has been depicted as being able to enhance patient health outcomes, increase health care provider satisfaction with care delivery, lower health care spending and decrease wait times for receiving care. Limited research has been conducted into exploring patients’ experiences of being recipients of this type of care. The objective of this oral presentation is to disseminate findings of a Master of Nursing study through patients’ stories of experience receiving care on aunit where inter professional care is practiced.Methods: Three participants underwent a two step data collection process: a one hour semi-structured interview and a 30 minute symbolic image artistic exercise, as adapted from Schwind’s Narrative Reflective Process. Participants were invited to describe how they experienced receivingcare from an interprofessional team and whether or not they believed whole-person care was delivered to them. Collected data are being analyzed using Clandinin and Connelly’s Narrative Inquiry approach of three dimensionalspace, temporality, sociality and place.Results: The emerging results suggest that participants express satisfaction with the care they received from the interprofessional team on their unit. Their stories indicate that strong interprofessional team-work can contribute to patient satisfaction in care received. For these teams to be successful, from the patients’ point of view, there needs to be: better communication between care providers, greater involvement of the patient in decision making, proper identification of who comprises the teams, andconsistency in team composition.Conclusion: By acknowledging experiences and feelings ofpatients who have received care from an interprofessional team, there is potential to increase sustainability of these teams. The data generated through this study can potentially help health care providers, who are members of interprofessional teams, to deliver more effective, comprehensive whole-personcare within health care institutions.
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Jeffs L, Sidani S, Rose D, Espin S, Smith O, Martin K, Byer C, Fu K, Ferris E. Using theory and evidence to drive measurement of patient, nurse and organizational outcomes of professional nursing practice. Int J Nurs Pract 2013; 19:141-8. [PMID: 23577971 DOI: 10.1111/ijn.12048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
An evolving body of literature suggests that the implementation of evidence based clinical and professional guidelines and strategies can improve patient care. However, gaps exist in our understanding of the effect of implementation of guidelines on outcomes, particularly patient outcomes. To address this gap, a measurement framework was developed to assess the impact of an organization-wide implementation of two nursing-centric best-practice guidelines on patient, nurse and organizational level outcomes. From an implementation standpoint, we anticipate that our data will show improvements in the following: (i) patient satisfaction scores and safety outcomes; (ii) nurses ability to value and engage in evidence based practice; and (iii) organizational support for evidence-informed nursing care that results in quality patient outcomes. Our measurement framework and multifaceted methodological approach outlined in this paper might serve as a blueprint for other organizations in their efforts to evaluate the impacts associated with implementation of clinical and professional guidelines and best practices.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's, Canada.
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29
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Rogers DA, Lingard L, Boehler ML, Espin S, Mellinger JD, Schindler N, Klingensmith M. Surgeons managing conflict in the operating room: defining the educational need and identifying effective behaviors. Am J Surg 2013; 205:125-30. [DOI: 10.1016/j.amjsurg.2012.05.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/25/2012] [Accepted: 05/25/2012] [Indexed: 12/21/2022]
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Fortugno M, Chandra S, Espin S, Gucciardi E. Fostering successful interprofessional teamwork through an undergraduate student placement in a secondary school. J Interprof Care 2013; 27:326-32. [DOI: 10.3109/13561820.2012.759912] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gucciardi E, Fortugno M, Horodezny S, Lou W, Sidani S, Espin S, Webster F, Shah BR. Will Mobile Diabetes Education Teams (MDETs) in primary care improve patient care processes and health outcomes? Study protocol for a randomized controlled trial. Trials 2012; 13:165. [PMID: 22974080 PMCID: PMC3519552 DOI: 10.1186/1745-6215-13-165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/07/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence to suggest that delivery of diabetes self-management support by diabetes educators in primary care may improve patient care processes and patient clinical outcomes; however, the evaluation of such a model in primary care is nonexistent in Canada. This article describes the design for the evaluation of the implementation of Mobile Diabetes Education Teams (MDETs) in primary care settings in Canada. METHODS/DESIGN This study will use a non-blinded, cluster-randomized controlled trial stepped wedge design to evaluate the Mobile Diabetes Education Teams' intervention in improving patient clinical and care process outcomes. A total of 1,200 patient charts at participating primary care sites will be reviewed for data extraction. Eligible patients will be those aged ≥18, who have type 2 diabetes and a hemoglobin A1c (HbA1c) of ≥8%. Clusters (that is, primary care sites) will be randomized to the intervention and control group using a block randomization procedure within practice size as the blocking factor. A stepped wedge design will be used to sequentially roll out the intervention so that all clusters eventually receive the intervention. The time at which each cluster begins the intervention is randomized to one of the four roll out periods (0, 6, 12, and 18 months). Clusters that are randomized into the intervention later will act as the control for those receiving the intervention earlier. The primary outcome measure will be the difference in the proportion of patients who achieve the recommended HbA1c target of ≤7% between intervention and control groups. Qualitative work (in-depth interviews with primary care physicians, MDET educators and patients; and MDET educators' field notes and debriefing sessions) will be undertaken to assess the implementation process and effectiveness of the MDET intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT01553266.
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Affiliation(s)
- Enza Gucciardi
- Ryerson University, School of Nutrition, 350 Victoria Street, Toronto, ON M5B 2 K3, Canada
| | - Mariella Fortugno
- Ryerson University, School of Nutrition, 350 Victoria Street, Toronto, ON M5B 2 K3, Canada
| | - Stacey Horodezny
- Trillium Health Centre, 5770 Hurontario Street, Mississauga, ON, L5R 3 G5, Canada
| | - Wendy Lou
- University of Toronto, Dalla Lana School of Public Health, 155 College Street, Health Science Building, 6th floor, Toronto, ON, M5T 3 M7, Canada
| | - Souraya Sidani
- Ryerson University, School of Nursing, 350 Victoria Street, Toronto, ON, M5B 2 K3, Canada
| | - Sherry Espin
- Ryerson University, School of Nursing, 350 Victoria Street, Toronto, ON, M5B 2 K3, Canada
| | - Fiona Webster
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada
| | - Baiju R Shah
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada
- Department of Medicine, Suite RFE 3-805, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
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Meffe F, Claire Moravac C, Espin S. An interprofessional education pilot program in maternity care: findings from an exploratory case study of undergraduate students. J Interprof Care 2012; 26:183-8. [PMID: 22251306 DOI: 10.3109/13561820.2011.645089] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An interprofessional team of maternity care providers and academics developed a pilot interprofessional education (IPE) program in maternity care for undergraduate students in nursing, midwifery and medicine. There are few published studies examining IPE programs in maternity care, particularly at the undergraduate level, that examine long-term outcomes. This paper outlines findings from a case study that explored how participation in an IPE program in maternity care may enhance student knowledge, skills/attitudes, and may promote their collaborative behavior in the practice setting. The program was launched at a Canadian urban teaching hospital and consisted of six workshops and two clinical shadowing experiences. Twenty-five semi-structured, in-depth interviews were completed with nine participants at various time points up to 20 months post-program. Qualitative analysis of transcripts revealed the emergence of four themes: relationship-building, confident communication, willingness to collaborate and woman/family-centered care. Participant statements about their intentions to continue practicing interprofessional collaboration more than a year post-program lend support to its sustained effectiveness. The provision of a safe learning environment, the use of small group learning techniques with mixed teaching strategies, augmented by exposure to an interprofessional faculty, contributed to the program's perceived success.
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Affiliation(s)
- Filomena Meffe
- St. Michael's Hospital, Department of Obstetrics and Gynecology, Toronto, Ontario, Canada.
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Rogers D, Lingard L, Boehler ML, Espin S, Klingensmith M, Mellinger JD, Schindler N. Teaching operating room conflict management to surgeons: clarifying the optimal approach. Med Educ 2011; 45:939-945. [PMID: 21848722 DOI: 10.1111/j.1365-2923.2011.04040.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Conflict management has been identified as an essential competence for surgeons as they work in operating room (OR) teams; however, the optimal approach is unclear. Social science research offers two alternatives, the first of which recommends that task-related conflict be managed using problem-solving techniques while avoiding relationship conflict. The other approach advocates for the active management of relationship conflict as it almost always accompanies task-related conflict. Clarity about the optimal management strategy can be gained through a better understanding of conflict transformation, or the inter-relationship between conflict types, in this specific setting. The purpose of this study was to evaluate conflict transformation in OR teams in order to clarify the approach most appropriate for an educational conflict management programme for surgeons. METHODS A constructivist grounded theory approach was adopted to explore the phenomenon of OR team conflict. Narratives were collected from focus groups of OR nurses and surgeons at five participating centres. A subset of these narratives involved transformation between and within conflict types. This dataset was analysed. RESULTS The results confirm that misattribution and the use of harsh language cause conflict transformation in OR teams just as they do in stable work teams. Negative emotionality was found to make a substantial contribution to responses to and consequences of conflict, notably in the swiftness with which individuals terminated their working relationships. These findings contribute to a theory of conflict transformation in the OR team. CONCLUSIONS There are a number of behaviours that activate conflict transformation in the OR team and a conflict management education programme should include a description of and alternatives to these behaviours. The types of conflict are tightly interwoven in this setting and thus the most appropriate management strategy is one that assumes that both types of conflict will exist and should be managed actively.
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Affiliation(s)
- David Rogers
- Department of Surgery, Faculty of School of Medicine, Southern Illinois University, Springfield, IL 67294, USA.
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Lingard L, Regehr G, Cartmill C, Orser B, Espin S, Bohnen J, Reznick R, Baker R, Rotstein L, Doran D. Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice. BMJ Qual Saf 2011; 20:475-82. [DOI: 10.1136/bmjqs.2009.032326] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abramovich IA, Espin S, Wickson-Griffiths A, Dematteo D, Baker L, Egan-Lee E, Reeves S. Translating collaborative knowledge into practice: findings from a 6-month follow-up study. J Interprof Care 2010; 25:226-7. [PMID: 21182440 DOI: 10.3109/13561820.2010.529961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ilona Alex Abramovich
- Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
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Jeffs L, Espin S, Shannon SE, Levinson W, Kohn MK, Lingard L. A new way of relating: perceptions associated with a team-based error disclosure simulation intervention. Qual Saf Health Care 2010; 19 Suppl 3:i57-60. [DOI: 10.1136/qshc.2009.036418] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gómez-Ramírez P, Martínez-López E, Maria-Mojica P, Espin S, Zweers H, García-Fernández A, Van Den Brink N. Organochlorine pesticides levels in eagle owl (Bubo bubo) eggs: Temporal trends and sublethal effects. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lingard L, Whyte S, Espin S, Baker GR, Orser B, Doran D. Towards safer interprofessional communication: Constructing a model of “utility” from preoperative team briefings. J Interprof Care 2009; 20:471-83. [PMID: 17000473 DOI: 10.1080/13561820600921865] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit confirmation, reminders, or education. "Functional utility" represented direct communication - work connections: many briefings identified problems, prompting decision-making and follow-up actions. The crux of the model is an elaboration of the causal pathway between a specific communication practice (the team briefing), intermediary processes such as enhanced knowledge and purposeful action, and the quality and safety of collaborative care processes. Modeling this pathway is a critical step in promoting change, as it renders visible both the latent dangers present in current team communication systems and the specific ways in which altered communication patterns can impact team awareness and behaviors.
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Affiliation(s)
- Lorelei Lingard
- Department of Paediatrics, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
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Cartmill C, Lingard L, Regehr G, Espin S, Bohnen J, Baker R, Rotstein L. Timing of surgical antibiotic prophylaxis administration: complexities of analysis. BMC Med Res Methodol 2009; 9:43. [PMID: 19549329 PMCID: PMC2711115 DOI: 10.1186/1471-2288-9-43] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 06/23/2009] [Indexed: 11/17/2022] Open
Abstract
Background The timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges. Challenges Two clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different timing classifications in a single case. A formalized protocol was developed for dealing with incomplete, ambiguous and unclear documentation. A hierarchical coding system was implemented for managing cases with multiple antibiotic regimens. Interpretation Researchers who are tracking prophylactic antibiotic timing as an outcome measure should be aware that documentation of antibiotic timing in the patient chart is frequently incomplete and unclear, and these inconsistencies should be accounted for in analyses. We have developed a systematic method for dealing with specific problematic patterns encountered in the data. We propose that the general adoption of a systematic approach to analysis of this type of data will allow for cross-study comparisons and ensure that interpretation of results is on the basis of timing practices rather than documentation practices.
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Jeffs L, Tregunno D, MacMillan K, Espin S. Building clinical and organizational resilience to reconcile safety threats, tensions and trade-offs: insights from theory and evidence. Healthc Q 2009; 12 Spec No Patient:75-80. [PMID: 19667780 DOI: 10.12927/hcq.2009.20971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Healthcare delivery settings are complex adaptive and tightly coupled, interrelated systems. Within the larger healthcare system, a key subsystem is the "clinical microsystem" level. It is at this level that clinicians are faced with high levels of uncertainty in their daily work - uncertainty that impacts the quality and safety of care that patients receive. The first aim of this paper is to enhance healthcare leaders' understanding of what is currently known about safety threats and strategies to manage the inherent tensions and trade-offs that occur in everyday practice. The second aim is to inform strategies that build clinical and organizational resilience through a multi-level framework derived from the collective theoretical and empirical work. Together, this information can strengthen safety practices throughout healthcare organizations.
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Affiliation(s)
- Lianne Jeffs
- The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Lingard L, Regehr G, Espin S, Whyte S. A theory-based instrument to evaluate team communication in the operating room: balancing measurement authenticity and reliability. Qual Saf Health Care 2007; 15:422-6. [PMID: 17142591 PMCID: PMC2464881 DOI: 10.1136/qshc.2005.015388] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Breakdown in communication among members of the healthcare team threatens the effective delivery of health services, and raises the risk of errors and adverse events. AIM To describe the process of developing an authentic, theory-based evaluation instrument that measures communication among members of the operating room team by documenting communication failures. METHODS 25 procedures were viewed by 3 observers observing in pairs, and records of events on each communication failure observed were independently completed by each observer. Each record included the type and outcome of the failure (both selected from a checklist of options), as well as the time of occurrence and a description of the event. For each observer, records of events were compiled to create a profile for the procedure. RESULTS At the level of identifying events in the procedure, mean inter-rater agreement was low (mean agreement across pairs 47.3%). However, inter-rater reliability regarding the total number of communication failures per procedure was reasonable (mean ICC across pairs 0.72). When observers recorded the same event, a strong concordance about the type of communication failure represented by the event was found. DISCUSSION Reasonable inter-rater reliability was shown by the instrument in assessing the relative rate of communication failures displayed per procedure. The difficulties in identifying and interpreting individual communication events reflect the delicate balance between increased subtlety and increased error. Complex team communication does not readily reduce to mere observation of events; some level of interpretation is required to meaningfully account for communicative exchanges. Although such observer interpretation improves the subtlety and validity of the instrument, it necessarily introduces error, reducing reliability. Although we continue to work towards increasing the instrument's sensitivity at the level of individual categories, this study suggests that the instrument could be used to measure the effect of team communication intervention on overall failure rates at the level of procedure.
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Affiliation(s)
- Lorelei Lingard
- Wilson Centre for Research in Education, University of Toronto, Eaton South, Toronto, Ontario, Canada.
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Abstract
To explore the influence of scope of practice and patient outcomes on error reporting, 13 nurses were interviewed after they reviewed four "error" scenarios ranging in both scope of practice and seriousness of outcome. Of 52 theoretical incidents, only 30 were identified as errors. The nurses indicated they would formally report errors for only eight of the incidents. For another 10 incidents, the nurses would have reported using an informal reporting system only. Qualitative analysis of the interviews revealed that perceived scope of practice influenced reporting preferences, and seriousness of outcome was only a secondary consideration. Selective error reporting and the reasons for selective reporting have negative implications for patient safety.
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Affiliation(s)
- Sherry Espin
- Ryerson University School of Nursing, Faculty of Community Services, Toronto, Ontario, Canada
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Espin S, Lingard L, Baker GR, Regehr G. Persistence of unsafe practice in everyday work: an exploration of organizational and psychological factors constraining safety in the operating room. Qual Saf Health Care 2006; 15:165-70. [PMID: 16751464 PMCID: PMC2464856 DOI: 10.1136/qshc.2005.017475] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper explores the factors that influence the persistence of unsafe practice in an interprofessional team setting in health care, towards the development of a descriptive theoretical model for analyzing problematic practice routines. Using data collected during a mixed method interview study of 28 members of an operating room team, participants' approaches to unsafe practice were analyzed using the following three theoretical models from organizational and cognitive psychology: Reason's theory of "vulnerable system syndrome", Tucker and Edmondson's concept of first and second order problem solving, and Amalberti's model of practice migration. These three theoretical approaches provide a critical insight into key trends in the interview data, including team members' definition of error as the breaching of standards of practice, nurses' sense of scope of practice as a constraint on their reporting behaviours, and participants' reports of the forces influencing tacit agreements to work around safety regulations. However, the relational factors underlying unsafe practice routines are poorly accounted for in these theoretical approaches. Incorporating an additional theoretical construct such as "relational coordination" to account for the emotional human features of team practice would provide a more comprehensive theoretical approach for use in exploring unsafe practice routines and the forces that sustain them in healthcare team settings.
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Affiliation(s)
- S Espin
- Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, Canada.
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Lingard L, Espin S, Rubin B, Whyte S, Colmenares M, Baker GR, Doran D, Grober E, Orser B, Bohnen J, Reznick R. Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR. Qual Saf Health Care 2006; 14:340-6. [PMID: 16195567 PMCID: PMC1744073 DOI: 10.1136/qshc.2004.012377] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pilot studies of complex interventions such as a team checklist are an essential precursor to evaluating how these interventions affect quality and safety of care. We conducted a pilot implementation of a preoperative team communication checklist. The objectives of the study were to assess the feasibility of the checklist (that is, team members' willingness and ability to incorporate it into their work processes); to describe how the checklist tool was used by operating room (OR) teams; and to describe perceived functions of the checklist discussions. METHODS A checklist prototype was developed and OR team members were asked to implement it before 18 surgical procedures. A research assistant was present to prompt the participants, if necessary, to initiate each checklist discussion. Trained observers recorded ethnographic field notes and 11 brief feedback interviews were conducted. Observation and interview data were analyzed for trends. RESULTS The checklist was implemented by the OR team in all 18 study cases. The rate of team participation was 100% (33 vascular surgery team members). The checklist discussions lasted 1-6 minutes (mean 3.5) and most commonly took place in the OR before the patient's arrival. Perceived functions of the checklist discussions included provision of detailed case related information, confirmation of details, articulation of concerns or ambiguities, team building, education, and decision making. Participants consistently valued the checklist discussions. The most significant barrier to undertaking the team checklist was variability in team members' preoperative workflow patterns, which sometimes presented a challenge to bringing the entire team together. CONCLUSIONS The preoperative team checklist shows promise as a feasible and efficient tool that promotes information exchange and team cohesion. Further research is needed to determine the sustainability and generalizability of the checklist intervention, to fully integrate the checklist routine into workflow patterns, and to measure its impact on patient safety.
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Affiliation(s)
- L Lingard
- University of Toronto, Wilson Centre for Research in Education, Toronto, Ontario, Canada M5G 2C4.
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Espin S, Levinson W, Regehr G, Baker GR, Lingard L. Error or “act of God”? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure. Surgery 2006; 139:6-14. [PMID: 16364712 DOI: 10.1016/j.surg.2005.07.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 07/14/2005] [Accepted: 07/15/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Calls abound for a culture change in health care to improve patient safety. However, effective change cannot proceed without a clear understanding of perceptions and beliefs about error. In this study, we describe and compare operative team members' and patients' perceptions of error, reporting of error, and disclosure of error. METHODS Thirty-nine interviews of team members (9 surgeons, 9 nurses, 10 anesthesiologists) and patients (11) were conducted at 2 teaching hospitals using 4 scenarios as prompts. Transcribed responses to open questions were analyzed by 2 researchers for recurrent themes using the grounded-theory method. Yes/no answers were compared across groups using chi-square analyses. RESULTS Team members and patients agreed on what constitutes an error. Deviation from standards and negative outcome were emphasized as definitive features. Patients and nurse professionals differed significantly in their perception of whether errors should be reported. Nurses were willing to report only events within their disciplinary scope of practice. Although most patients strongly advocated full disclosure of errors (what happened and how), team members preferred to disclose only what happened. When patients did support partial disclosure, their rationales varied from that of team members. CONCLUSIONS Both operative teams and patients define error in terms of breaking the rules and the concept of "no harm no foul." These concepts pose challenges for treating errors as system failures. A strong culture of individualism pervades nurses' perception of error reporting, suggesting that interventions are needed to foster collective responsibility and a constructive approach to error identification.
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Affiliation(s)
- Sherry Espin
- Donald R. Wilson Centre for Research in Education, University Health Network, Toronto, Ontario, Canada.
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Lingard L, Regehr G, Espin S, Devito I, Whyte S, Buller D, Sadovy B, Rogers D, Reznick R. Perceptions of operating room tension across professions: building generalizable evidence and educational resources. Acad Med 2005; 80:S75-9. [PMID: 16199464 DOI: 10.1097/00001888-200510001-00021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication. Replication of these naturalistic findings in a controlled, video-based format could provide a basis for formal curricula. METHOD Seventy-two surgeons, nurses, and anesthesiologists independently rated three video-based scenarios for the three professions' level of tension, responsibility for creating tension and responsibility for resolution. Data were analyzed using three-way, mixed-design analyses of variance. RESULTS The three professions rated tension levels of the various scenarios similarly (F=1.19, ns), but rated each profession's responsibility for creating (F=2.86, p<.05) and resolving (F=1.91, p<.01) tension differently, often rating their profession as having relatively less responsibility than the others. CONCLUSIONS These results provide an evidence base for team communications training about tension patterns, disparity of professional perspectives, and implications for team function.
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Affiliation(s)
- Lorelei Lingard
- Wilson Centre for Research in Education, 200 Elizabeth Street, Eaton South 1-605, Toronto, Ontario, Canada.
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Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, Grober E. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 2004. [PMID: 15465935 DOI: 10.1136/qshc.2003.008425] [Citation(s) in RCA: 710] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ineffective team communication is frequently at the root of medical error. The objective of this study was to describe the characteristics of communication failures in the operating room (OR) and to classify their effects. This study was part of a larger project to develop a team checklist to improve communication in the OR. METHODS Trained observers recorded 90 hours of observation during 48 surgical procedures. Ninety four team members participated from anesthesia (16 staff, 6 fellows, 3 residents), surgery (14 staff, 8 fellows, 13 residents, 3 clerks), and nursing (31 staff). Field notes recording procedurally relevant communication events were analysed using a framework which considered the content, audience, purpose, and occasion of a communication exchange. A communication failure was defined as an event that was flawed in one or more of these dimensions. RESULTS 421 communication events were noted, of which 129 were categorized as communication failures. Failure types included "occasion" (45.7% of instances) where timing was poor; "content" (35.7%) where information was missing or inaccurate, "purpose" (24.0%) where issues were not resolved, and "audience" (20.9%) where key individuals were excluded. 36.4% of failures resulted in visible effects on system processes including inefficiency, team tension, resource waste, workaround, delay, patient inconvenience and procedural error. CONCLUSION Communication failures in the OR exhibited a common set of problems. They occurred in approximately 30% of team exchanges and a third of these resulted in effects which jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tension in the OR.
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Affiliation(s)
- L Lingard
- University of Toronto, Toronto, Ontario, Canada.
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Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, Grober E. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 2004; 13:330-4. [PMID: 15465935 PMCID: PMC1743897 DOI: 10.1136/qhc.13.5.330] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022]
Abstract
BACKGROUND Ineffective team communication is frequently at the root of medical error. The objective of this study was to describe the characteristics of communication failures in the operating room (OR) and to classify their effects. This study was part of a larger project to develop a team checklist to improve communication in the OR. METHODS Trained observers recorded 90 hours of observation during 48 surgical procedures. Ninety four team members participated from anesthesia (16 staff, 6 fellows, 3 residents), surgery (14 staff, 8 fellows, 13 residents, 3 clerks), and nursing (31 staff). Field notes recording procedurally relevant communication events were analysed using a framework which considered the content, audience, purpose, and occasion of a communication exchange. A communication failure was defined as an event that was flawed in one or more of these dimensions. RESULTS 421 communication events were noted, of which 129 were categorized as communication failures. Failure types included "occasion" (45.7% of instances) where timing was poor; "content" (35.7%) where information was missing or inaccurate, "purpose" (24.0%) where issues were not resolved, and "audience" (20.9%) where key individuals were excluded. 36.4% of failures resulted in visible effects on system processes including inefficiency, team tension, resource waste, workaround, delay, patient inconvenience and procedural error. CONCLUSION Communication failures in the OR exhibited a common set of problems. They occurred in approximately 30% of team exchanges and a third of these resulted in effects which jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tension in the OR.
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Affiliation(s)
- L Lingard
- University of Toronto, Toronto, Ontario, Canada.
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Lingard L, Espin S, Evans C, Hawryluck L. The rules of the game: interprofessional collaboration on the intensive care unit team. Crit Care 2004; 8:R403-8. [PMID: 15566584 PMCID: PMC1065058 DOI: 10.1186/cc2958] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 08/12/2004] [Accepted: 08/24/2004] [Indexed: 11/24/2022]
Abstract
Background The intensive care unit (ICU) is a nexus for interspecialty and interdisciplinary tensions because of its pivotal role in the care of the hospital's most critically ill patients and in the management of critical care resources. In an environment charged with temporal, financial and professional tensions, learning how to get results collaboratively is a critical aspect of professional competence. This study explored how team members in the ICU interact to achieve daily clinical goals, delineate professional boundaries and negotiate complex systems issues. Methods Seven 1-hour focus groups were conducted with ICU team members in two hospitals. Participants consisted of four nursing groups (n = 27), two resident groups (n = 6) and one intensivist group (n = 4). Interviews were audio-recorded, anonymized and transcribed. With the use of a standard qualitative approach, transcripts were analyzed iteratively for recurrent themes by four researchers. Results Team members articulated their perceptions of the mechanisms by which team collaboration was achieved or undermined in a complex and high-pressure context. Two mechanisms were recurrently described: the perception of 'ownership' and the process of 'trade'. Analysis of these mechanisms reveals how power is commodified, possessed and exchanged as team members negotiate their daily needs and goals with one another. Conclusion Our data provide a non-idealized depiction of how health care professionals function on a team so as to meet both individual and collective goals. We contend that the concept of 'team' must move beyond the rhetoric of 'cooperation' and towards a more authentic depiction of the skills and strategies required to function in the competitive setting of the interprofessional health care team.
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Affiliation(s)
- Lorelei Lingard
- Department of Pediatrics and The Wilson Centre for Research in Education, University of Toronto, Ontario, Canada.
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Abstract
Freshly harvested soybean, rice and corn from farms and corn-based pelleted feeds were collected from ranches from the coastal and mountain regions in Ecuador during 1998, and assessed for fungal contamination. The most prevalent fungi on pelleted feed were Aspergillus flavus and Fusarium graminearum. The prevalent fungi recovered from soybean were F. verticillioides, F. semitectum, Aspergillus flavus and A. ochraceus. In rice, F. oxysporum was the most prevalent toxigenic fungal species recorded, followed by F. verticillioides and A. flavus. In corn, F. verticillioides was the most prevalent fungus isolated in both the coastal and mountain regions, with high isolation frequencies of A. flavus and A. parasiticus at the coast. Based on the toxigenic species recovered, ochratoxin A may pose a contamination risk for soybean. A higher probability of aflatoxin contamination of corn was found in the coastal samples compared to those of the mountain region, while a risk of fumonisin contamination of corn exists in both regions.
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Affiliation(s)
- A M Pacin
- Centro de Investigaciones en Micotoxinas Universidad Nacional de Luján, Argentina
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