Nursing perception of risk in common nursing practice situations

Nasogastric tube care and flushing in a Portuguese general medicine ward: a best practice implementation project

OBJECTIVES

To implement evidence-based practice related to care and flushing of nasogastric tubes inserted for feeding, in a general medicine ward.

INTRODUCTION

Nasogastric tube feeding is a widely used nutritional support form. Although performed by qualified professionals, it is not a harm-free intervention. Progression to the trachea during initial insertion, aspiration of gastric contents, improper position for patient feeding, and/or a blocked tube are examples of problems that can occur.

METHODS

The project used JBI's methodological approach of the Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit focused on nursing procedures related to the maintenance of nasogastric tube feeding, based on 14 criteria informed by the JBI evidence summaries, was performed for a month. Education sessions and other engagement strategies and resources were used to increase nasogastric tube maintenance. This best-practice implementation was conducted in Portugal, between January 2020 and April 2021, in a 33-bed general medicine ward with a staff of 30 registered nurses.

RESULTS

Different samples, for each audited procedure, were obtained from a universe of 25 nurses and 14 episodes of patients with nasogastric tube in baseline and 10 in follow-up audit. At baseline, compliance with the criteria ranged from 0 to 88%. Ten of the 14 criteria were below 50%. The follow-up audit showed significant improvement in all compliance criteria (ranging from 44.4 to 100%). Criteria 1 and 2, which were aimed at preventing adverse consequences related to wrong placement or displacement of the nasogastric tube, showed a high postimplementation compliance level (89.3 and 90%).

CONCLUSION

With an integrated plan incorporating interventions, strategies, and resources, tailored for this context, we improved nurses' knowledge of nasogastric tube maintenance and achieved significantly increased compliance with nasogastric tube care best-practice. We suggest maintaining current strategies, and reinforcing clinical supervision and regular assessment.

Nursing Students' Knowledge, Personality Traits, and Self-Efficacy Related to Medication Administration Error

BACKGROUND

Nursing education influences medication administration practices, which involve clinical decision making and risk perceptions.

METHOD

This mixed-methods concurrent nested study explored the relationship among knowledge, personality traits, and self-efficacy related to medication administration error in fourth-year, prelicen-sure nursing students (n = 60) who were recruited from three campuses of a large university.

RESULTS

Results indicated low mean knowledge (70.75) and neuroticism (2.44) scores, and high mean self-efficacy and confidence (5.78) and conscientiousness (4.51) scores. Conscientiousness was correlated with both knowledge (r = .271, p = .036) and neuroticism (r = -.313, p = .015). Thematic analysis yielded four themes: nature of risk perceptions, more opportunities to learn, experiences with medication administration error, and intrinsic characteristics influence errors. Convergence was evident in both knowledge and personality data; self-efficacy/confidence and risk perceptions data diverged.

CONCLUSION

Knowledge, personality traits, and self-efficacy appear to influence nursing students' risk perceptions of medication administration error, indicating an area for future research. [J Nurs Educ. 2022;61(7):367-374.].

Prevention and Control of COVID-19 Risks for Long-Term Care Facilities Based on the Prospect Theory

Given the complexity and uncertainty of the current COVID-19 risks, the elderly people in long-term care facilities are at the highest risk for infection. In order to study the prevention and control strategies of COVID-19 risks in long-term care facilities, this paper uses the prospect theory to construct the decision-making model of COVID-19 risk behavior of long-term care facilities, analyses the risk behavior strategies of the caregivers and managers, and reveals the impact of risk management cost, risk loss and external supervision on the risk behavior decision-making of the caregivers and managers. Furthermore, from the perspective of long-term care facilities, this paper analyzes the constraints that enable it to achieve optimal risk management strategy. Combined with the simulation analysis, it is found that the decision of risk behavior of the caregivers and managers is positively related to the risk behavior choice, risk loss, and supervision. Then, only when the incentives set by the supervision are within a reasonable range can the caregivers and managers be motivated to take proactive risk management strategies. The study has important theoretical and practical significance for the management of COVID-19 risks in long-term care facilities.

Nursing students' risk perceptions related to medication administration error: A qualitative study

AIM

The purpose of this study was to explore and describe pre-licensure nursing students' perceptions of risk for medication administration errors in fourth-year baccalaureate student nurses from three campuses at a large central Pennsylvania university.

BACKGROUND

Medication administration errors continue to be a significant safety concern in healthcare settings. Pre-licensure nursing education is a critical time period during which to have an impact on future medication administration practices. Perception of risk influences decision making and behavior, including nursing clinical decision making.

DESIGN

This descriptive, exploratory study involved a qualitative design.

METHODS

A thematic analysis of the qualitative data resulting from 60 individual, in-depth semi-structured interviews was conducted.

RESULTS

The participants offered rich, detailed narratives which revealed the following themes: (1) the nature of risk perceptions, (2) more opportunities to learn, (3) experiences with medication administration error, and (4) intrinsic characteristics influence errors.

CONCLUSIONS

The findings provide a broad description of the nature of student nurse risk perceptions for future medication administration errors. Recommendations for nursing education practice and pedagogy include additional clinical experiences, modified pharmacology curricula and instruction, and expanded simulations involving medication administration error.

Development and psychometric testing of a questionnaire to assess Nurse's perception of risks during enteral nutrition

Background

Enteral nutrition (EN) therapy is widely used in clinical practice to provide artificial nutrition to patients, while the incidence of adverse events are relatively highly. In the clinical setting, the occurrence of adverse events is associated with the nurse’s risk perception. Thus, using tool to evaluate nurse’s risk perception of enteral nutrition is necessary.

Methods

The draft questionnaire with 37-items was formed by comprehensive literature reviews and semi-structured in-depth interviews with 11 nurses. Two iterations of expert consultations were used to evaluate the content validity, and 4 items were deleted in this phrase. A 33-items questionnaire was used to survey 352 nurses from five tertiary hospitals in China from May to July 2019 with convenience sampling. Content validity, construct validity and known-groups validity were evaluated by content validity index (CVI), exploratory factor analysis, and the comparisons of the different EN risk perception levels of nurses at different working departments and different educational backgrounds, respectively. Reliability was tested by internal consistency, test-retest reliability, and split-half reliability.

Results

After the exploratory factor analysis, four items were excluded. Finally, the newly developed questionnaire included 29 items explaining 71.356% of the total variance. It consisted of three factors: Risks of operation (15 items); Risks of EN-related adverse events (11 items), and Risks of EN solution selection (3 items). The CVI of the questionnaire was 0.95 and the CVI of items ranged from 0.875–1.0. The results of known-groups validity showed that the nurses with different educational backgrounds had a statistically significant difference of EN risk perception (z = − 3.024, p = 0.002), whereas there was not significantly different between EN risk perception of nurses working in different departments (z = − 1.644, p = 0.100). The Cronbach’s α, test-retest reliability, and split-half reliability of the questionnaire were 0.967, 0.818, and 0.815, respectively.

Conclusions

The newly developed questionnaire for assessing nurse’s EN risk perception showed good reliability and validity. It can be used as a tool for nursing managers to assess Chinese nurses’ EN risk perception ability, so as to help to reduce the occurrence of adverse events during EN implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00520-z.

Influence of Risk Perception on Task and Contextual Performance: A Case of Work-Related Musculoskeletal Disorders in Nurses

Assessing the risk perception of workers can be very informative in predicting their behavioral outcomes, including task and contextual performance. Yet, research to assess the effect of risk perception on task performance and contextual performance remains scarce. Thus, this study explored the effect of risk perception of work-related musculoskeletal disorders on task and contextual performance in nurses. This study further examined safety behavior as a mediator of these relationships. Using structural equation modeling, the researchers examined these relationships by employing a cross-sectional survey with a quantitative approach. The data was collected via questionnaires from 382 nurses who work in three major hospitals in Accra Metropolis, Ghana. The results showed that nurses' risk perception positively influenced their task and contextual performance, and that safety behavior partially mediated the effects of risk perception on task and contextual performance. This study offers a theoretical framework and empirical evidence for the concept of risk perception and its association with safety behavior, task, and contextual performance. To the best of our knowledge, this is the first study to assess the relationships that exist among these variables. Thus, future studies are needed to verify the causality of the relationships.