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Fekonja Z, Kmetec S, Fekonja U, Reljić NM, Pajnkihar M, Strnad M. Emergency triage nurses' perceptions of caring behaviors and the safety of the patient during triage encounters: a grounded theory study. BMC Nurs 2024; 23:453. [PMID: 38961433 PMCID: PMC11221186 DOI: 10.1186/s12912-024-02122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Triage is a dynamic process prioritising the patient coming to the emergency department. Caring behaviour and patient safety during the triage process are essential for ensuring a good care experience and treatment outcome. OBJECTIVE To describe triage nurses' perceptions on caring behaviors and patient safety in the triage area. DESIGN Strauss and Corbin's Grounded theory method was used to develop the model. METHODS The study was conducted in the emergency department in northeastern Slovenia. Semi-structured interviews were used for data collection, and 19 triage nurses were selected by theoretical sampling, guided by emerging categories between November 2021 and July 2022. The data analysis was conducted according to Strauss and Corbin's coding framework. RESULTS The analysis of the interviews generated one category: The process of creating a caring and safe triage encounter for the patient, together with two categories that explain the key phenomenon: (1) Triage caring and (2) Safety in the triage process. Within the category "Triage caring", four subcategories were developed: (1) Assurance of triage nurses' presence, (2) Connectedness, (3) Respectful attitude, and (4) Knowledge and skills. The category Safety in the triage process consists of three identified subcategories: (1) Conception and perception of safety, (2) Factors influencing patient safety, and (3) Improving the triage safety. CONCLUSIONS The triage nurses' perceptions about caring for the patient and his safety in the triage area show that caring and safety are inseparably linked and coincide when triaging a patient. Namely, caring for the patient means ensuring the patient's safety at the same time. IMPLICATIONS FOR THE NURSING FIELD A better understanding of the importance of triage nurses' caring behavior and patient safety emerges from the findings, highlighting the challenges faced in a busy emergency department where nurses must balance providing care and responding to patients' needs while ensuring safety. Findings in the study show that patient care and safety are inseparably linked and coincide when triaging a patient. Moreover, applying caring behaviour during triage encounter results in greater patient safety. NO PATIENT OR PUBLIC CONTRIBUTION The study's design, evaluation of the findings, and execution did not need the involvement of patients or the general public. Participants were triage nurses working in the emergency department. Triage nurses were interviewed about their perceptions of triage nurses on caring behaviors and patient safety during triage encounter.
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Affiliation(s)
- Zvonka Fekonja
- Faculty of Health Science, University of Maribor, Žitna ulica 15, Maribor, 2000, Slovenia.
| | - Sergej Kmetec
- Faculty of Health Science, University of Maribor, Žitna ulica 15, Maribor, 2000, Slovenia
| | - Urška Fekonja
- Emergency Department, University Medical Centre Maribor, Maribor, Slovenia
| | - Nataša Mlinar Reljić
- Faculty of Health Science, University of Maribor, Žitna ulica 15, Maribor, 2000, Slovenia
| | - Majda Pajnkihar
- Faculty of Health Science, University of Maribor, Žitna ulica 15, Maribor, 2000, Slovenia
| | - Matej Strnad
- Emergency Department, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Prehospital Unit, Department for Emergency Medicine, Community Healthcare Center Maribor, Maribor, Slovenia
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Amritzer MA, Göransson KE, Berg LM, Nymark C. A New Perspective on Missed Nursing Care in the Emergency Department: A Descriptive Cross-Sectional Study. J Emerg Nurs 2024; 50:392-402. [PMID: 38310494 DOI: 10.1016/j.jen.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting. METHODS Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE survey-Swedish version was used for data collection. RESULTS Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants. DISCUSSION The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in-hospital wards.
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Hrymak C, Lim R, Trivedi S, Alvarez A, Purdy E, Belisle S, Thull-Freedman J, Leeies M, Lang E, Chartier LB. An Exploration of the Interplay Between Well-being and Quality and Safety. CAN J EMERG MED 2024; 26:148-155. [PMID: 38421518 DOI: 10.1007/s43678-024-00653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Quality improvement and patient safety (QIPS) and clinician well-being work are interconnected and impact each other. Well-being is of increased importance in the current state of workforce shortages and high levels of burnout. The Canadian Association of Emergency Physicians (CAEP) Academic Symposium sought to understand the interplay between QIPS and clinician well-being and to provide practical recommendations to clinicians and institutions on ensuring that clinician well-being is integrated into QIPS efforts. METHODS A team of emergency physicians with expertise in well-being and QIPS performed a literature review, drafted goals and recommendations, and presented at the CAEP Academic Symposium in 2023 for feedback. Goals and recommendations were then further refined. RESULTS Three goals and recommendations were developed as follows: QIPS leaders and practitioners must (1) understand the potential intersection of well-being and QIPS, (2) consider a well-being lens for all QIPS work, and (3) incorporate QIPS methodology in efforts to improve clinician well-being. CONCLUSION QIPS and clinician well-being are often closely linked. By incorporating these recommendations, QIPS strategies can enhance clinician well-being.
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Affiliation(s)
- Carmen Hrymak
- Department of Emergency Medicine and Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.
| | - Rodrick Lim
- Departments of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Sachin Trivedi
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Eve Purdy
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Sheena Belisle
- Departments of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine and Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Lucas B Chartier
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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Chen L, Yang H, Cui S, Ye D. Impact of Target Management Card on Patient Safety in the Emergency Department: A Mixed Methods Study. Risk Manag Healthc Policy 2023; 16:1905-1914. [PMID: 37746044 PMCID: PMC10516123 DOI: 10.2147/rmhp.s427988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose This study aimed to investigate the potential impact of the Target Management Card on patient safety in the emergency department. Patients and Methods A mixed method design was developed, combining a one-group pretest-posttest design with a qualitative study. Target Management Cards were formulated for 32 emergency nurse practitioners and focus group interviews were conducted after the intervention. Wilcoxon's signed rank test was used to compare pre-test and post-test scores. The interview data were subject to content analysis. Results After developing the Target Management Card, there were significant improvements in safety behaviors (Z = 4.709, p < 0.01) and perception of patient safety (Z = 4.257, p < 0.01) among emergency nurse practitioners. The nurses in the focus group interviews agreed that the Target Management Card could improve patient safety by warning and supervising nursing work in the emergency department, promoting a positive change in nurses' attitudes and behaviors toward patient safety. Conclusion Our study found that nurses and nursing managers jointly formulating Target Management Cards in emergency departments significantly enhances patient safety.
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Affiliation(s)
- Lixia Chen
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Heng Yang
- Department of Emergency, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Shaomei Cui
- Department of Emergency, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Danjuan Ye
- Department of Emergency, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
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Fekonja Z, Kmetec S, Fekonja U, Mlinar Reljić N, Pajnkihar M, Strnad M. Factors contributing to patient safety during triage process in the emergency department: A systematic review. J Clin Nurs 2023; 32:5461-5477. [PMID: 36653922 DOI: 10.1111/jocn.16622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Triage is a dynamic environment in which large numbers of people can present. It presents a vulnerable assessment point, as a triage nurse must assess a patient's urgency level and analyse their health status and expected resource needs. Given the critical nature of triage, it is necessary to understand the factors contributing to patient safety. OBJECTIVES To identify and examine the factors contributing to patient safety during the triage process. METHODS A systematic review of the literature was undertaken, and a thematic analysis of the factors contributing to patient safety during the triage process. PubMed, CINAHL, Web of Sciences, Science Direct, SAGE, EMBASE and reference lists of relevant studies published in English until March 2022 were searched for relevant studies. The search protocol has been registered at the PROSPERO (CRD42019146616), and the review was conducted using the PRISMA criteria. RESULTS Out of 5366 records, we included 11 papers for thematic synthesis. Identified factors contributing to patient safety in triage are related to the emergency's work environment, such as patient assessment, high workload, frequent interruptions and staffing, and personal factors such as nurse traits, experience, knowledge, triage fatigue and work schedule. CONCLUSIONS This review shows that patient safety is influenced by the attitude, capabilities and experiences of triage nurses, the time when nurses can dedicate themselves to the patient and triage the patient without disruption. It is necessary to raise awareness among nursing administrators and healthcare professionals to provide a safe triage environment for patients. RELEVANCE TO CLINICAL PRACTICE This review highlights the evidence on the factors contributing to patient safety in the triage process. Further research is needed for this cohort of triage nurses in the emergency department concerning ensuring patient safety. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required to design or undertake this review.
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Affiliation(s)
- Zvonka Fekonja
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Urška Fekonja
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
| | | | - Majda Pajnkihar
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Matej Strnad
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Prehospital Unit, Department for Emergency Medicine, Community Healthcare Center Maribor, Maribor, Slovenia
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Johnson EA, Rainbow JG, Carrington JM. Clinical Nurses' Identification of a Wearable Universal Serial Bus Used for Pediatric Oncology Clinical Trial Participant Safety Management. Comput Inform Nurs 2023; 41:687-697. [PMID: 36716099 DOI: 10.1097/cin.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The expanded access to clinical trials has provided more patients the opportunity to participate in novel therapeutics research. There is an increased likelihood of a patient, as a pediatric oncology clinical trial participant, to present for clinical care outside the research site, such as at an emergency room or urgent care center. A novel wearable universal serial bus device is a proposed technology to bridge potential communication gaps, pertaining to critical information such as side effects and permitted therapies, between research teams and clinical teams where investigational agents may be contraindicated to standard treatments. Fifty-five emergency and urgent care nurses across the United States were presented, via online survey without priming to the context of clinical trials or the device, a picture of a pediatric patient wearing the novel wearable device prompted to identify significant, environmental cues important for patient care. Of the 40 nurses observing the patient photo, three identified the wearable device within Situational Awareness Global Assessment Tool formatted narrative response fields. Analysis of the narrative nurse-participant responses of significant clinical findings upon initial assessment of the pediatric patient photo is described, as well as the implications for subsequent prototyping of the novel universal serial bus prototype.
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Affiliation(s)
- Elizabeth A Johnson
- Author Affiliations: Montana State University College of Nursing (Dr Johnson), Bozeman; The University of Arizona College of Nursing (Dr Rainbow), Tucson; and University of Florida (Dr Carrington), Gainesville
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An Empirical Study on Physical Subhealth Risk Perception: A Physical Examination Data of Tertiary Grade-A Hospitals in Anhui Province, China. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2023; 2023:3959571. [PMID: 36755784 PMCID: PMC9902138 DOI: 10.1155/2023/3959571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/01/2022] [Accepted: 12/28/2022] [Indexed: 01/31/2023]
Abstract
Background Physical subhealth directly correlates to people's work effectiveness and quality of life, so subhealth prevention has become an urgent medical problem. Methods A random sampling method was used to conduct a questionnaire survey of physical examinees from June to September, 2019. In total, 770 people participated in our study. The Pearson correlation and multiple stepwise regression analysis were used to explore the relationship among demographic variables, physical subhealth, and risk perception. Also, this study used a two-way interaction moderated multiple regression approach to examine the moderating effects of demographic variables on physical subhealth and risk perception. Results The risk perception level was negatively associated with physical health. Age, education level, and subhealth proportion in the work unit all significantly and positively influence physical health, whereas living place, subhealth duration, and marital status negatively influence physical health. Living place, average annual household income, number of employees in the work unit, and subhealth proportion in the work unit significantly and positively influence the risk perception, and only age negatively influences the risk perception. The number of children had a moderating effect on physical subhealth and risk perception (Interaction coefficient α = -0.3, P < 0.05). Conclusions To achieve the overall improvement of public health, relevant management departments can provide targeted interventions for the public with different levels of risk perception. Also, the physical subhealth of the public can be addressed by encouraging the public to attach importance to education, improving the public living environment to build a livable city, strengthening psychological guidance and intervention for couples heading toward divorce to reduce the divorce rate, focusing on the health of work unit employees and regularly organizing employees to attend medical checkups, and actively responding to the national policy of family planning.
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Muthelo L, Seimela HM, Mbombi MO, Malema R, Phukubye A, Tladi L. Challenges for Optimum Cardiopulmonary Resuscitation in the Emergency Departments of Limpopo Province: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11020158. [PMID: 36673526 PMCID: PMC9859251 DOI: 10.3390/healthcare11020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
AIM To describe the challenges for optimum resuscitation processes in Emergency Departments in Limpopo Province, South Africa. DESIGN A qualitative explorative research approach was adopted to explore the resuscitation team's experiences in Emergency Departments. METHOD Five medical doctors and twelve professional nurses were purposively sampled to participate in the study. The depth of the information obtained from the participants determined the sample size. Data collected from semi-structured individual interviews were analyzed using thematic analysis. Data quality was ensured by applying four elements: credibility, transferability, dependability, and confirmability. RESULTS The study findings indicated diverse challenges for optimum resuscitation processes that include: A general shortage of emergency personnel, the lack of material resources and the unavailability of funds for payment of national and international trauma symposiums, the poor maintenance of emergency equipment, the lack of a continuous training program and the resuscitation team receiving different instructions from various team leaders about the standardized procedures and policies of the resuscitation process. The team leaders and managers often blamed, depreciated and disregarded the resuscitation team for failed resuscitation efforts. Public contribution: The study findings are a point of reference for the emergency resuscitation team and the department of health policymakers. Trained and well-equipped emergency resuscitation teams can improve the quality of life for patients with cardiac arrest.
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Affiliation(s)
- Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
- Correspondence:
| | - Hendrica Mosima Seimela
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Masenyani Oupa Mbombi
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Rambelani Malema
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Arthur Phukubye
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Lerato Tladi
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
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Alquwez N. Association between nurses' experiences of workplace incivility and the culture of safety of hospitals: A cross-sectional Study. J Clin Nurs 2023; 32:320-331. [PMID: 35098598 DOI: 10.1111/jocn.16230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
AIM AND OBJECTIVES This article examined the association between workplace incivility experiences of nurses and patient safety (PS) culture in hospitals. BACKGROUND Workplace incivility, which is characterised by low-intensity behaviours with unclear intention to harm and disruption of workplace ambiance of mutual respect, may threaten the work environment, resulting in an unhealthy and unsafe workplace. DESIGN Cross-sectional study. METHOD This study surveyed 261 nurses in Saudi Arabia from June 2019 to August 2019 using the 'Hospital Survey of Patients' Safety Culture' and the 'Nurse Incivility Scale'. A multiple linear regression was performed with unit- and hospital-level PS culture as the dependent variables. RESULTS 'Organizational learning-continuous improvement' and 'Teamwork within units' were recognised as PS culture strengths. The nurses reported workplace incivility from patient/visitor as the most frequently experienced (mean = 2.27, standard deviation = 0.88). Working in Hospital B (ß = 0.24, p < .001, 95%CI = 0.15, 0.33) and having a baccalaureate degree in nursing (ß = 0.13, p = .014, 95%CI = 0.03, 0.23) were associated with better perceptions of unit-level PS, whereas working in medical-surgical wards (ß = -0.16, p = .002, 95%CI = -0.26, -0.06) and in intensive care units (ß = -0.19, p = .002, 95%CI = -0.32, -0.07) and experiencing patient/visitor incivility (ß = -0.09, p = .004, 95%CI = -0.15, -0.03) were associated with poor unit-level PS culture perceptions. Experiences of general incivility (ß = -0.24, p < .001, 95%CI = -0.35, -0.13) and supervisor incivility (ß = -0.26, p = .011, 95%CI = -0.46, -0.06) were associated with poor hospital-level PS culture perceptions. CONCLUSIONS Workplace incivility from patients/visitors had a negative association with unit-level PS culture perceptions, whereas experiences on general and supervisor incivilities had an adverse relationship with hospital-level PS culture perceptions. RELEVANCE TO CLINICAL PRACTICE The study emphasises the call to eradicate any form of incivility in healthcare settings to guarantee a PS culture. Hospital and nursing managers should prioritise the creation and implementation of policies aimed at eliminating uncivil behaviours in clinical settings to ensure that unit- and hospital-level PS culture are above standards.
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Affiliation(s)
- Nahed Alquwez
- Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia
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Fekonja U, Strnad M, Fekonja Z. Association between triage nurses' job satisfaction and professional capability: Results of a mixed-method study. J Nurs Manag 2022; 30:4364-4377. [PMID: 36206481 PMCID: PMC10091795 DOI: 10.1111/jonm.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/18/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIM This study aims to examine factors related to the job satisfaction of triaging nurses and their professional capability in the clinical setting. BACKGROUND Triage is a complex process that relies on making decisions in favour of the patient and his treatment. The professional capability of a triaging nurse is an important psychological construct of job satisfaction. METHODS The study used a mixed-method methodology, with data collection based on an explanatory research design. The research instrument in the quantitative part was a survey questionnaire, and in the qualitative part, a semi-structured interview. The results were integrated using the 'Pillar Integration Process'. RESULTS There are significant relationships between professional capability and job satisfaction. Six main topics were exposed: characteristics and traits, work organization, safety is the key, burdening circumstances, capability and self-evaluation. CONCLUSION Professional capability is associated with job satisfaction. The necessary managerial changes should be made to achieve job satisfaction and develop professional competence while focusing on already trained and competent triage nurses, as satisfied triage nurses will stay longer in the institution. IMPLICATIONS FOR NURSING MANAGEMENT The manager's job is to be aware of the level of job satisfaction, take care to develop their employee's professional capability and take action in case of disrupted balance.
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Affiliation(s)
- Urška Fekonja
- Emergency Department, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Matej Strnad
- Emergency Department, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Prehospital Unit, Department for Emergency Medicine, Community Healthcare Center Maribor, Maribor, Slovenia
| | - Zvonka Fekonja
- Emergency Department, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Kosydar-Bochenek J, Krupa S, Religa D, Friganović A, Oomen B, Brioni E, Iordanou S, Suchoparski M, Knap M, Mędrzycka-Dąbrowska W. The Perception of the Patient Safety Climate by Health Professionals during the COVID-19 Pandemic-International Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159712. [PMID: 35955067 PMCID: PMC9368342 DOI: 10.3390/ijerph19159712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 05/28/2023]
Abstract
The patient safety climate is a key element of quality in healthcare. It should be a priority in the healthcare systems of all countries in the world. The goal of patient safety programs is to prevent errors and reduce the potential harm to patients when using healthcare services. A safety climate is also necessary to ensure a safe working environment for healthcare professionals. The attitudes of healthcare workers toward patient safety in various aspects of work, organization and functioning of the ward are important elements of the organization’s safety culture. The aim of this study was to determine the perception of the patient safety climate by healthcare workers during the COVID-19 pandemic. Methods: The study was conducted in five European countries. The Safety Attitude Questionnaire (SAQ) short version was used for the study. A total of 1061 healthcare workers: physicians, nurses and paramedics, participated in this study. Results: All groups received the highest mean results on the stress recognition subscale (SR): nurses 98.77, paramedics 96.39 and physician 98.28. Nurses and physicians evaluated work conditions (WC) to be the lowest (47.19 and 44.99), while paramedics evaluated perceptions of management (PM) as the worst (46.44). Paramedics achieved statistically significantly lower scores compared to nurses and physicians in job satisfaction (JS), stress recognition (SR) and perception of management (PM) (p < 0.0001). Paramedics compared to nurses and physicians rank better in working conditions (WC) in relation to patient safety (16.21%). Most often, persons of lower seniority scored higher in all subscales (p = 0.001). In Poland, Spain, France, Turkey, and Greece, healthcare workers scored highest in stress recognition (SR). In Poland, Spain, France, and Turkey, they assessed working conditions (WC) as the worst, while in Greece, the perception of management (PM) had the lowest result. Conclusion: Participant perceptions about the patient safety climate were not at a particularly satisfactory level, and there is still a need for the development of patient safety culture in healthcare in Europe. Overall, positive working conditions, good management and effective teamwork can contribute to improving employees’ attitudes toward patient safety. This study was carried out during the COVID-19 pandemic and should be repeated after its completion, and comparative studies will allow for a more precise determination of the safety climate in the assessment of employees.
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Affiliation(s)
- Justyna Kosydar-Bochenek
- Institute of Health Sciences, Medical College, Rzeszow University, Warzywna St. 1, 35-310 Rzeszow, Poland
| | - Sabina Krupa
- Institute of Health Sciences, Medical College, Rzeszow University, Warzywna St. 1, 35-310 Rzeszow, Poland
| | - Dorota Religa
- Division for Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, 14152 Huddinge, Sweden
| | - Adriano Friganović
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Department of Nursing, University of Applied Health Sciences, Mlinarska Cesta 38, 10000 Zagreb, Croatia
| | - Ber Oomen
- The European Specialist Nurses Organisation (ESNO), 6821HR Arnhem, The Netherlands
| | - Elena Brioni
- Nephrology and Dialysis Unit, San Raffaele Hospital, 20132 Milan, Italy
| | - Stelios Iordanou
- Intensive Care Unit, Limassol General Hospital, Kato Polemidia 3085, Cyprus
| | - Marcin Suchoparski
- Admission Room District Hospital in Golub Dobrzyń, 87-400 Golub Dobrzyń, Poland
| | - Małgorzata Knap
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, 25-369 Kielce, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland
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12
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Asmoro CP, Hariyati RTS, Ayuningtyas D, Umar J, Tartila DYR. Researching nurses' adherence to patient safety guidelines in emergency departments. Emerg Nurse 2022; 30:e2129. [PMID: 35762099 DOI: 10.7748/en.2022.e2129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND One of the reasons why patient safety may be put at risk during healthcare interventions is a lack of staff adherence to patient safety guidelines. There could be a relationship between staff's adherence to patient safety guidelines and their perceived level of reward for their work and/or motivation. AIM To examine the relationship between reward and adherence to patient safety guidelines, and between motivation and adherence to patient safety guidelines, among nurses working in emergency departments (EDs) in Indonesia. METHOD This was a cross-sectional study of 101 nurses working in the EDs of four hospitals in Indonesia. Self-reported questionnaires were used to collect data on the level of reward participants felt they received for their work, the level of participants' motivation for their work, and participants' adherence to patient safety guidelines. Spearman's rank correlation testing was used to determine the relationships between variables. RESULTS There was a statistically significant negative relationship between reward and adherence (P=0.019, r=-0.233), which meant that those who perceived their reward as low were more likely to adhere to patient safety guidelines than those who felt they were highly rewarded. There was a statistically significant positive relationship between motivation and adherence to patient safety guidelines (P=0.017, r=0.236), which meant that the higher the motivation, the higher participants' level of adherence to patient safety guidelines. CONCLUSION Ensuring ED nurses are motivated for their work by offering rewards - such as a decent salary, a supportive workplace environment and career progression opportunities - is important to enhance their adherence to patient safety guidelines.
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Affiliation(s)
| | | | | | - Jahja Umar
- Universitas Islam Negeri Syarif Hidayatullah Jakarta, South Tangerang, Indonesia
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Diz ABM, Lucas PRMB. Hospital patient safety at the emergency department - a systematic review. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022275.22742021en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to analyze the scientific evidence on the nurses’ perception and opinion on patient safety in the emergency department. Systematic literature review with 3 steps. 1) Primary search at CINHAL and MEDLINE. 2) A broader search, using the same keywords and search terms in the remaining database of the EBSCOHost platform. 3) Search the bibliographic references of the selected articles. The selected studies were published between 2014 and 2019. Five articles were selected. The nurses’ perception reveal that the work environment, teamwork and matters related to the leadership of hierarchical superiors are fundamental factors to improve the quality of care provided and patient safety. Promoting teamwork improves patient care, reduces adverse events and improves quality. Recognizing the nurses’ perception on patient safety culture in emergency services, contributes to improving the quality of care provided.
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Identification and analysis of human errors in emergency department nurses using SHERPA method. Int Emerg Nurs 2022; 62:101159. [DOI: 10.1016/j.ienj.2022.101159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/05/2022] [Accepted: 02/28/2022] [Indexed: 12/15/2022]
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Diz ABM, Lucas PRMB. Hospital patient safety at the emergency department - a systematic review. CIENCIA & SAUDE COLETIVA 2022; 27:1803-1812. [PMID: 35544810 DOI: 10.1590/1413-81232022275.22742021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022] Open
Abstract
Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to analyze the scientific evidence on the nurses' perception and opinion on patient safety in the emergency department. Systematic literature review with 3 steps. 1) Primary search at CINHAL and MEDLINE. 2) A broader search, using the same keywords and search terms in the remaining database of the EBSCOHost platform. 3) Search the bibliographic references of the selected articles. The selected studies were published between 2014 and 2019. Five articles were selected. The nurses' perception reveal that the work environment, teamwork and matters related to the leadership of hierarchical superiors are fundamental factors to improve the quality of care provided and patient safety. Promoting teamwork improves patient care, reduces adverse events and improves quality. Recognizing the nurses' perception on patient safety culture in emergency services, contributes to improving the quality of care provided.
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Affiliation(s)
- Ana Beatriz Martins Diz
- Centro Hospitalar de Lisboa Ocidental. Estrada do Forte do Alto do Duque. 1449-005 Lisboa Portugal.
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Alshyyab MA, Albsoul RA, Kinnear FB, Saadeh RA, Alkhaldi SM, Borkoles E, Fitzgerald G. Assessment of patient safety culture in two emergency departments in Australia: a cross sectional study. TQM JOURNAL 2022. [DOI: 10.1108/tqm-01-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposePatient safety culture is a vital element to create patient safety in healthcare organisations. Emergency department (ED) professionals operate in unstable conditions that may pose risk to patient safety on day-to-day basis. The aim of this study was to assess the status of patient safety culture and to quantify the dimensions of safety culture in the ED setting.Design/methodology/approachThis was a descriptive cross sectional study that used a validated questionnaire distributed to the staff working in the nominated EDs . Perceptions on various dimensions of safety culture were reported and the frequency of positive responses for each dimension was calculated.Findings“Teamwork” is the only dimension that rated positive by over 70% of participants. Other dimensions rated below 50%, except for “Organisational learning–continuous improvement” which rated 51.2%. Areas that rated the lowest were “Handover and transitions”, “Staffing”, “Non-punitive response to error” and “Frequency of event reporting” with average positive response rate of 15.4%, 26%, 26.8% and 27.6%, respectively.Originality/valueThis study displayed a concerning perceptions held by participants about the deficiency of patient safety culture in their EDs. Moreover, it provided a baseline finding giving a clearer vision of the areas of patient safety culture that need improvement.
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Subhealth Risk Perception Scale: Development and Validation of a New Measure. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9950890. [PMID: 35058986 PMCID: PMC8764275 DOI: 10.1155/2022/9950890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Background To develop an individual's physical subhealth risk perception scale and evaluate its reliability and validity, so as to provide a measurement tool for individual physical health risk. Methods A questionnaire on the perception risk of physical subhealth was developed. Using a random sampling method, 785 people in the Anhui provincial physical examination centre were selected as the research participants. Of the questionnaires returned, 770 were valid, giving an effective rate of 98%. Firstly, the Pearson correlation coefficient method was used to study the correlation of 35 items in the initial scale, and then, polychoric factor structure analysis was carried out by using the Pratt D matrix to optimize the item structure. The Cronbach'α coefficient method was used to test the internal consistency reliability, and a structural equation model was used to explore the construct validity of the scale. The discriminant validity of the scale was obtained by factor analysis. A general linear model was used to analyse the relationship between the clinical manifestations of physical subhealth and the level of risk perception, and the convergent validity of the scale was evaluated. Results All the data of 35 items were significantly correlated at the 0.01 level. The correlation coefficients between a1 and a2, a3 and a4, b1 and b2, b2 and b3, c4 and c5, c5 and c6, c6 and c7, c8 and c9, d1 and d2, d2 and d3, e5 and e6, g1 and g2, g2 and g3, and g2 and g4 were greater than 0.6. The items with correlation coefficients greater than 0.6 were reduced by a Pratt D matrix. The resulting physical subhealth risk perception scale covers five factors with a total of 18 items. The Cronbach'α coefficient of the scale was 0.889, and the Cronbach'α coefficients of the five factors F1-F5 were 0.780, 0.825, 0.801, 0.736, and 0.704, respectively. Structural equation model analysis showed that χ2/df = 3.43, p < 0.001, RMSEA = 0.08, GFI = 0.88, NFI = 0.84, AGFI = 0.84, and CFI = 0.88. Factor analysis showed that factors F1–F5 had significant correlations (p < 0.01), and the correlation coefficients were less than the corresponding square root value of AVE. Based on the subhealth clinical manifestations of the participants, the general linear model was used to explore the convergent validity of the scale, and the results indicated that the scale passed the convergent validity test. Conclusions We propose a physical subhealth risk perception scale amounting to 18 items, which includes five dimensions: health knowledge (2 items), risk perception (5 items), trust selection (4 items), information channel (4 items), and social groups (3 items). The reliability and validity of the physical subhealth risk perception scale are acceptable. Applying the scale into practice has potential to improve the overall public health level.
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Zhu L, Reychav I, McHaney R, Broda A, Tal Y, Manor O. Extension to 'combined SNA and LDA methods to understand adverse medical events': Doctor and nurse perspectives. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 31:221-246. [PMID: 32538872 DOI: 10.3233/jrs-190031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients' daily lives and mental well-being. This results in reporting and describing medical adverse events differently. OBJECTIVE We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA). METHODS The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon. RESULTS A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage. CONCLUSIONS Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.
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Affiliation(s)
- Lin Zhu
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Iris Reychav
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Roger McHaney
- Daniel D. Burke Chair for Exceptional Faculty, Management Information Systems, Kansas State University, Manhattan, KS, USA
| | - Arik Broda
- Risk Management Department, Maccabi Healthcare Services, Israel
| | - Yossi Tal
- Risk Management Department, Maccabi Healthcare Services, Israel
| | - Orly Manor
- Risk Management Department, Maccabi Healthcare Services, Israel
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Kanstrup M, Rudman A, Göransson K, Andersson E, Lauri KO, Rapoport E, Sunnergård L, Bragesjö M, Andersson E, Iyadurai L, Holmes EA. Reaching people soon after a traumatic event: an exploratory observational feasibility study of recruitment in the emergency department to deliver a brief behavioral intervention via smartphone to prevent intrusive memories of trauma. Pilot Feasibility Stud 2021; 7:184. [PMID: 34620249 PMCID: PMC8499533 DOI: 10.1186/s40814-021-00916-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background The current study explored how to recruit patients soon after a traumatic event, to deliver a novel intervention in a new emergency department in Sweden. This brief behavioral intervention aims to prevent intrusive memories and is delivered soon after trauma in the emergency department. In the UK, it has shown promising results. Traumatic events resulting in admission to the emergency department (e.g., road traffic accidents) may result in subsequent mental health problems such as post-traumatic stress disorder, where intrusive memories of the trauma constitute a core clinical feature. Early interventions that prevent intrusive memories after psychological trauma are lacking. Specific aims were to explore identification of eligible patients (aim 1), fitting in with emergency department staff routines to deliver the study protocol (aim 2), and using the patients’ own smartphones to deliver intervention/control task (aim 3). Two changes to the previous study were (i) extending the trauma types included (ii) a new control condition, also by smartphone. Methods This is an explorative observational study. Data was both analyzed descriptively and using the Framework method. Results We identified several possible ways to recruit patients, and establish a sense of embeddedness in the Swedish emergency department context and a positive appreciation from staff. The study protocol was tested with 8 participants. Tasks both in the intervention and control condition were readily delivered via patients’ own smartphones. Conclusion Recruitment of patients and smartphone delivery of the intervention indicates initial feasibility. Researcher presence and administration of study procedures was successfully fitted to emergency department routines and well received by staff. Further pilot work is warranted, underscoring the importance of our collaboration between nursing and psychology. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00916-x.
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Affiliation(s)
- Marie Kanstrup
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Medical Unit for Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.
| | - Ann Rudman
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Katarina Göransson
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Emil Andersson
- Functional Area of Emergency Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Klara Olofsdotter Lauri
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Emma Rapoport
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Linda Sunnergård
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Maria Bragesjö
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | | | - Emily A Holmes
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
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Explaining the process of dealing with nursing errors in the emergency department: A grounded theory study. Int Emerg Nurs 2021; 59:101066. [PMID: 34563938 DOI: 10.1016/j.ienj.2021.101066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/14/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Errors are among the factors threatening patient safety. It is essential to understand how to deal with nursing errors in the emergency department. Thus, the present study aimed to explain the process of dealing with nursing errors in the emergency department. METHOD This qualitative study adopted Corbin and Strauss's (2008) grounded theory method. The data were collected by in-depth semi-structured interviews and field notes. Eighteen nurses, two doctors, and one patient companion participated in this study. The research setting was the emergency departments of five teaching hospitals in down tone of Tehran, Iran. The participants were selected by purposive sampling at first, and then by theoretical sampling. RESULTS Following the data analysis, four main categories of "reality shock", "formulating a situational response", "reactive measure", and "progress or regress" were extracted. The data analysis showed that "formulating a situational response" is the core category of the process of dealing with errors among nurses in the study emergency departments. The first step in the process of dealing with errors in ED was the reality shock, then nurses entered the stage of formulating a situational response, after that they entered the stage of "reactive measure" and finally they entered the stage of progress or regress. DISCUSSION AND CONCLUSION After an error occurs in the emergency department, nurses experience four stages during the process of dealing with nursing errors. When dealing with an error, nurses think about protecting the patients. However, some contextual factors direct the nurses towards protecting themselves rather than the patient. The decision-makers in the healthcare system can modify these contextual factors, provide in-service training, develop anonymous reporting systems, and establish a positive support environment, thus directing the nurses towards supporting the patients (in addition to trying to protect oneself).
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Alshyyab MA, FitzGerald G, Albsoul RA, Ting J, Kinnear FB, Borkoles E. Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study. Int J Health Plann Manage 2021; 36:2392-2410. [PMID: 34476834 DOI: 10.1002/hpm.3314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment. METHODS A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale. RESULTS Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility. CONCLUSIONS This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard FitzGerald
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joseph Ting
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Erika Borkoles
- Department of Public Health, School of Medicine, Public Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Enayati M, Sir M, Zhang X, Parker SJ, Duffy E, Singh H, Mahajan P, Pasupathy KS. Monitoring Diagnostic Safety Risks in Emergency Departments: Protocol for a Machine Learning Study. JMIR Res Protoc 2021; 10:e24642. [PMID: 34125077 PMCID: PMC8240801 DOI: 10.2196/24642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/15/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diagnostic decision making, especially in emergency departments, is a highly complex cognitive process that involves uncertainty and susceptibility to errors. A combination of factors, including patient factors (eg, history, behaviors, complexity, and comorbidity), provider-care team factors (eg, cognitive load and information gathering and synthesis), and system factors (eg, health information technology, crowding, shift-based work, and interruptions) may contribute to diagnostic errors. Using electronic triggers to identify records of patients with certain patterns of care, such as escalation of care, has been useful to screen for diagnostic errors. Once errors are identified, sophisticated data analytics and machine learning techniques can be applied to existing electronic health record (EHR) data sets to shed light on potential risk factors influencing diagnostic decision making. OBJECTIVE This study aims to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques. METHODS This study plans to use trigger algorithms within EHR data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on whether they meet certain criteria. Samples from both data sets will be validated using medical record reviews, upon which we expect to find a higher number of diagnostic safety events in the trigger-positive subset. Machine learning will be used to evaluate relationships between certain patient factors, provider-care team factors, and system-level risk factors and diagnostic safety signals in the statistically matched groups of trigger-positive and trigger-negative charts. RESULTS This federally funded study was approved by the institutional review board of 2 academic medical centers with affiliated community hospitals. Trigger queries are being developed at both organizations, and sample cohorts will be labeled using the triggers. Machine learning techniques such as association rule mining, chi-square automated interaction detection, and classification and regression trees will be used to discover important variables that could be incorporated within future clinical decision support systems to help identify and reduce risks that contribute to diagnostic errors. CONCLUSIONS The use of large EHR data sets and machine learning to investigate risk factors (related to the patient, provider-care team, and system-level) in the diagnostic process may help create future mechanisms for monitoring diagnostic safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/24642.
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Affiliation(s)
- Moein Enayati
- Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | | | - Xingyu Zhang
- Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sarah J Parker
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth Duffy
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, United States
| | - Prashant Mahajan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kalyan S Pasupathy
- Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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van den Oetelaar WFJM, Roelen CAM, Grolman W, Stellato RK, van Rhenen W. Exploring the relation between modelled and perceived workload of nurses and related job demands, job resources and personal resources; a longitudinal study. PLoS One 2021; 16:e0246658. [PMID: 33635900 PMCID: PMC7909623 DOI: 10.1371/journal.pone.0246658] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/24/2021] [Indexed: 12/21/2022] Open
Abstract
Aim Calculating a modelled workload based on objective measures. Exploring the relation between this modelled workload and workload as perceived by nurses, including the effects of specific job demands, job resources and personal resources on the relation. Design Academic hospital in the Netherlands. Six surgical wards, capacity 15–30 beds. Data collected over 15 consecutive day shifts. Methods Modelled workload is calculated as a ratio of required care time, based on patient characteristics, baseline care time and time for non-patient related activities, and allocated care time, based on the amount of available nurses. Both required and allocated care time are corrected for nurse proficiency. Five dimensions of perceived workload were determined by questionnaires. Both the modelled and the perceived workloads were measured on a daily basis. Linear mixed effects models study the longitudinal relation between this modelled and workload as perceived by nurses and the effects of personal resources, job resources and job demands. ANOVA and post-hoc tests were used to identify differences in modelled workload between wards. Results Modelled workload varies roughly between 70 and 170%. Significant differences in modelled workload between wards were found but confidence intervals were wide. Modelled workload is positively associated with all five perceived workload measures (work pace, amount of work, mental load, emotional load, physical load). In addition to modelled workload, the job resource support of colleagues and job demands time spent on direct patient care and time spent on registration had the biggest significant effects on perceived workload. Conclusions The modelled workload does not exactly predict perceived workload, however there is a correlation between the two. The modelled workload can be used to detect differences in workload between wards, which may be useful in distributing workload more evenly in order prevent issues of over- and understaffing and organizational justice. Extra effort to promote team work is likely to have a positive effect on perceived workload. Nurse management can stimulate team cohesion, especially when workload is high. Registered nurses perceive a higher workload than other nurses. When the proportion of direct patient care in a workday is higher, the perceived workload is also higher. Further research is recommended. The findings of this research can help nursing management in allocating resources and directing their attention to the most relevant factors for balancing workload.
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Affiliation(s)
| | | | - Wilko Grolman
- Division of Surgical Specialties, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Rebecca K. Stellato
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Willem van Rhenen
- ArboUnie Occupational Health Service, Utrecht, the Netherlands
- Center for Human Resource Organization and Management Effectiveness, Business University Nyenrode, Breukelen, the Netherlands
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Shan Y, Shang J, Yan Y, Lu G, Hu D, Ye X. Mental workload of frontline nurses aiding in the COVID-19 pandemic: A latent profile analysis. J Adv Nurs 2021; 77:2374-2385. [PMID: 33594687 PMCID: PMC8014576 DOI: 10.1111/jan.14769] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/06/2020] [Accepted: 01/10/2021] [Indexed: 01/23/2023]
Abstract
Aims To investigate the mental workload level of nurses aiding the most affected area during the Coronavirus disease 2019 (COVID‐19) pandemic and explore the subtypes of nurses regarding their mental workload. Design Cross‐sectional study. Methods A sample of 446 frontline nurses participated from March 8 to 19, 2020. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of the National Aeronautics and Space Administration Task Load Index. The differences among the classes and the variables including sociodemographic characteristics, psychological capital and coping style were explored. Results The level of mental workload indicates that the nurses had high self‐evaluations of their performance while under extremely intensive task loads. The following three latent subtypes were identified: ‘low workload & low self‐evaluation’ (8.6%); ‘medium workload & medium self‐evaluation’ (35.3%) and ‘high workload & high self‐evaluation’ (56.1%) (Classes 1, 2, and 3, respectively). Nurses with shared accommodations, fewer years of practice, junior professional titles, lower incomes, nonmanagement working positions, lower psychological capital levels and negative coping styles had a higher likelihood of belonging to Class 1. In contrast, senior nurses with higher psychological capital and positive coping styles were more likely to belong to Classes 2 and 3. Conclusion The characteristics of the ‘low workload & low self‐evaluation’ subtype suggest that attention should be paid to the work pressure and psychological well‐being of junior nurses. Further research on regular training program of public health emergency especially for novices is needed. Personnel management during public health events should be focused on the allocation between novice and senior frontline nurses. Impact This study addresses the level of mental workload of frontline nurses who aid in the most severe area of the COVID‐19 pandemic in China and delineates the characteristics of the subtypes of these nurses.
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Affiliation(s)
- Yawei Shan
- School of Nursing, Naval Medical University (Second Military Medical University), Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Shang
- School of Nursing, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Yan Yan
- School of Nursing, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Gendi Lu
- Department of Nursing, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Deying Hu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuchun Ye
- School of Nursing, Naval Medical University (Second Military Medical University), Shanghai, China
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Husna C, Yahya M, Kamil H, Tahlil T. Islamic-based Disaster Response Competencies: Perceptions, Roles and Barriers Perceived by Nurses in Aceh, Indonesia. Open Nurs J 2021. [DOI: 10.2174/1874434602115010018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Indonesia, being a part of the Pacific “ring of fire,” is prone to disasters. Several disasters occurred from 2004 to 2019, which resulted in the loss of many lives. These disasters impacted the physical, psychological, psychosocial, and spiritual conditions of survivors. Nurses are the frontline care providers who need adequate competencies to respond to disasters.
Objective:
This study aimed to explore the nurses’ perception of disaster, roles, barriers, and Islamic-based nurses’ competencies in managing psychological, psychosocial, and spiritual problems due to disasters in hospital settings.
Methods:
This is a qualitative study conducted in three large referral hospitals in Banda Aceh, Indonesia. Focus group discussion was conducted on 24 nurses from three hospitals using the discussion guide consisting of five open-ended questions. The data was analyzed through inductive content analysis.
Results:
The study found four themes of Islamic nurses’ competencies in disaster response: 1) perception about the disaster is influenced by religiosity, belief, and values, 2) communication skills, 3) nurses’ roles in disaster response consisted of disaster competencies (the use of Islamic values in managing patients’ conditions, and family engagement, 4) competency barriers consisted of inadequate training, insufficient Islamic-based services, and inadequate involvement of policymakers. This study explored Islamic nurses’ competencies in disaster response related perceptions about the disaster, nurses’ roles, and barriers. The limitation and future of the study were also discussed.
Conclusion:
Perceptions, roles, and barriers in disaster response might influence the development of the Islamic-based nurses’ competencies in care delivery.
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Delayed flow is a risk to patient safety: A mixed method analysis of emergency department patient flow. Int Emerg Nurs 2020; 54:100956. [PMID: 33360361 DOI: 10.1016/j.ienj.2020.100956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 10/10/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Increasing emergency department (ED) demand and crowding has heightened focus on the need for better understanding of patient flow. AIM This study aimed to identify input, throughput and output factors contributing to ED patient flow bottlenecks and extended ED length of stay (EDLOS). METHOD Concurrent nested mixed method study based on retrospective analysis of attendance data, patient flow observational data and a focus group in an Australian regional ED. RESULTS Analysis of 89 013 ED presentations identified increased EDLOS, particularly for patients requiring admission. Mapping of 382 patient journeys identified delays in time to triage assessment (0-39 mins) and extended waiting room stays (0-348 mins). High proportions of patients received care outside ED cubicles. Four qualitative themes emerged: coping under pressure, compromising care and safety, makeshift spaces, and makeshift roles. CONCLUSION Three key findings emerged: i) hidden waits such as extended triage-queuing occur during the input phase; ii) makeshift spaces are frequently used to assess and treat patients during times of crowding; and iii) access block has an adverse effect on output flow. Data suggests arrival numbers may not be a key predictor of EDLOS. This research contributes to our understanding of ED crowding and patient flow, informing service delivery and planning.
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Han JH, Roh YS. Teamwork, psychological safety, and patient safety competency among emergency nurses. Int Emerg Nurs 2020; 51:100892. [PMID: 32659674 DOI: 10.1016/j.ienj.2020.100892] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/04/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The patient safety competency of emergency nurses is critical because the emergency department is a complex and dynamic setting in which patient safety incidents are likely to occur owing to difficulties in controlling and predicting situations. PURPOSE This study aimed to identify factors that predict the patient safety competency of emergency nurses. METHODS A descriptive correlational study using cross-sectional survey methodology was conducted with a convenience sample of 200 emergency nurses. Teamwork, psychological safety, and patient safety competency were measured using a self-administered questionnaire. Data were analyzed using descriptive statistics, Pearson's correlation, and stepwise multiple regression. RESULTS Multiple regression analysis revealed that situation monitoring, reporting of patient safety adverse events, number of night shifts per month, and psychological safety were significant factors affecting patient safety competency, accounting for 27.1% of the variance. CONCLUSIONS A training program targeting emergency nurses with vulnerable factors is needed to improve their patient safety competency. As situation monitoring and psychological safety were found to be influential factors for patient safety competency, multi-level intervention is needed to improve nurses' situation monitoring ability and psychological safety.
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Affiliation(s)
- Jee Hye Han
- Graduate School of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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Towiwat P, Phungoen P, Tantrawiwat K, Laohakul P, Aiewruengsurat D, Thanadetsuntorn C, Ruchakorn N, Sangsawangchot P, Buttham B. Quality of gout care in the emergency departments: a multicentre study. BMC Emerg Med 2020; 20:27. [PMID: 32312248 PMCID: PMC7171834 DOI: 10.1186/s12873-020-00319-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/19/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To report on prevalence of gout flare in emergency departments and to report the quality of gout care in emergency departments and causes of admission at emergency departments. METHODS A retrospective chart review of visits that had a primary diagnosis in gout by the International Classification of Diseases, the tenth revision, at emergency departments from 6 universities in Thailand over a 5 year period from 1 January 2012 to 31 December 2016. RESULTS Six hundred thirty-two visits were included to the study. Prevalence of gout flare in emergency departments was 0.04. Only 29.3% of the visits had arthrocentesis. 628/632 (99.4%) and 519/585 (88.7%) of the visits were prescribed medications in emergency departments and had home medications, respectively. Although all visits that were prescribed colchicine in emergency departments received adequate doses of colchicine, it was also found that more than 2.4 mg/day of colchicine was prescribed (3/394, 0.8%) for home medications. In addition, 183/343 (53.4%) of the visits with normal renal function were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). However, prescribed NSAIDs in abnormal renal function (42/343, 12.2%) was also found. The interruption of dosing, including increase, decrease, addition or discontinuance of urate lowing therapy in a gout flare period was 42/632 (6.6%). The most common cause of admission was acute gouty arthritis (31/47, 66.0%). CONCLUSIONS Quality of gout care in the emergency departments was not good. Inappropriate management of gout flare in emergency departments was demonstrated in our study, particularly with regard to investigations and pharmacological management. Gaps between clinicians and guidelines, the knowledge of clinicians, and overcrowding in emergency departments were hypothesized in the results.
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Affiliation(s)
- Patapong Towiwat
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, 65000 Thailand
| | - Pariwat Phungoen
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kitti Tantrawiwat
- Department of Surgery, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Pavita Laohakul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Duangkamol Aiewruengsurat
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Chokchai Thanadetsuntorn
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nopparat Ruchakorn
- Department of Internal Medicine, Faculty of Medicine, Srinakharinthawirot University, Bangkok, Thailand
| | - Passagorn Sangsawangchot
- Department of Internal Medicine, Faculty of Medicine, Srinakharinthawirot University, Bangkok, Thailand
| | - Bodin Buttham
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, 65000 Thailand
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Zhu L, Reychav I, McHaney R, Broda A, Tal Y, Manor O. Combined SNA and LDA methods to understand adverse medical events. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 30:129-153. [PMID: 31476171 DOI: 10.3233/jrs-180052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare primary medical adverse event keywords from reporters (e.g. physicians and nurses) and harm level perspectives to explore the underlying behaviors of medical adverse events using social network analysis (SNA) and latent Dirichlet allocation (LDA) leading to process improvements. DESIGN Used SNA methods to explore primary keywords used to describe the medical adverse events reported by physicians and nurses. Used LDA methods to investigate topics used for various harm levels. Combined the SNA and LDA methods to discover common shared topic keywords to better understand underlying behaviors of physicians and nurses in different harm level medical adverse events. SETTING Maccabi Healthcare Community is the second largest healthcare organization in Israel. DATA 17,868 medical adverse event data records collected between 2000 and 2017. METHODS Big data analysis techniques using social network analysis (SNA) and latent Dirichlet allocation (LDA). RESULTS Shared topic keywords used by both physicians and nurses were determined. The study revealed that communication, information transfer, and inattentiveness were the most common problems reported in the medical adverse events data. CONCLUSIONS Communication and inattentiveness were the most common problems reported in medical adverse events regardless of healthcare professional reporting or harm levels. Findings suggested that an information-sharing and feedback mechanism should be implemented to eliminate preventable medical adverse events. Healthcare institutions managers and government officials should take targeted actions to decrease these preventable medical adverse events through quality improvement efforts.
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Affiliation(s)
- Lin Zhu
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Iris Reychav
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Roger McHaney
- Daniel D. Burke Chair for Exceptional Faculty, Professor and University Distinguished Teaching Scholar, Management Information Systems, Kansas State University, Manhattan, KS, USA
| | - Aric Broda
- Head of Risk Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yossi Tal
- Risk Management and Patient Safety Advisor, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Orly Manor
- Deputy of Risk Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
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Stone T, Banks J, Brant H, Kesten J, Redfern E, Remmers A, Redwood S. The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use. J Clin Nurs 2020; 29:1267-1275. [PMID: 31944438 PMCID: PMC7161913 DOI: 10.1111/jocn.15184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/16/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
Aims and objectives To explore the extent to which a checklist designed to support patient safety in hospital Emergency Departments was recognised and used by staff. Background Patient crowding in UK Emergency Departments makes it difficult for staff to monitor all patients for signs of clinical deterioration. An Emergency Department Safety Checklist was developed at a UK hospital to ensure patients are regularly monitored. It was subsequently implemented in six hospitals and recommended for use across the National Health Service in England. Methods This was a qualitative study in two UK hospital Emergency Departments. Data collection consisted of sixty‐six hours of nonparticipant observation and interviews with twenty‐six staff. Observations were sampled across different days and times. Interviews sampled a range of staff. Data were analysed thematically. The study was undertaken in accordance with COREQ guidelines. Results Staff described the Emergency Department Safety Checklist as a useful prompt and reminder for monitoring patients' vital signs and other aspects of care. It was also reported as effective in communicating patient care status to other staff. However, completing the checklist was also described as a task which could be overlooked during busy periods. During implementation, the checklist was promoted to staff in ways that obscured its core function of maintaining patient safety. Conclusions The Emergency Department Safety Checklist can support staff in maintaining patient safety. However, it was not fully recognised by staff as a core component of everyday clinical practice. Relevance to clinical practice The Emergency Department Safety Checklist is a response to an overcrowded environment. To realise the potential of the checklist, emergency departments should take the following steps during implementation: (a) focus on the core function of clinical safety, (b) fully integrate the checklist into the existing workflow and (c) employ a departmental team‐based approach to implementation and training.
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Affiliation(s)
- Tracey Stone
- The National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Banks
- The National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Heather Brant
- The National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Kesten
- The National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Health Protection Research Unit in Evaluation of Interventions, The National Institute for Health Research, University of Bristol, Bristol, UK
| | - Emma Redfern
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,West of England Academic Health Science Network, Bristol, UK
| | - Ann Remmers
- West of England Academic Health Science Network, Bristol, UK
| | - Sabi Redwood
- The National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Martin A, Manley K. Developing an integrated career and competence framework for a whole systems approach to urgent and emergency care delivery. Int Emerg Nurs 2020; 48:100784. [DOI: 10.1016/j.ienj.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/21/2019] [Accepted: 06/16/2019] [Indexed: 10/26/2022]
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Frank C, Elmqvist C. Staff strategies for dealing with care situations at an emergency department. Scand J Caring Sci 2019; 34:1038-1044. [PMID: 31865626 DOI: 10.1111/scs.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/28/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Overcrowding is a common international problem at Emergency Departments often due to those patients get recommendations or referrals from other health professionals to seek care at the emergency department. Crowding brings with it an amount of adverse consequences for both patients and staff, and knowledge about staff's strategies of dealing with this caring situation is limited. AIM The aim of the present study was thus to describe staffs' strategies to deal with the caring situations at an emergency department. METHOD Secondary analysis has been made of 18 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis. FINDINGS The results showed that the staff at the ED worked in twofold directions using both proactive and reactive strategies in order to deal with the care situation when caring for patients at ED. The proactive strategy is optimising conditions, controlling patient flow and being boundary. The reactive strategy is about customising the conversation and holding an open approach. CONCLUSION In conclusion, the proactive strategy is to make what you decided for unseen circumstances. The reactive strategy is then about less anticipation of the encounter, waiting for the patient to act and react to it. IMPLICATION The result can have implications with respect to developing and improving care at crowded Emergency departments. Knowledge about strategies creates a fundament for developing visible sustainable structure for patient flow in making work patient safety for patients, staff and organisation.
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Affiliation(s)
- Catharina Frank
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
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Alqattan H, Morrison Z, Cleland JA. A Narrative Synthesis of Qualitative Studies Conducted to Assess Patient Safety Culture in Hospital Settings. Sultan Qaboos Univ Med J 2019; 19:e91-e98. [PMID: 31538005 PMCID: PMC6736257 DOI: 10.18295/squmj.2019.19.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/23/2018] [Accepted: 01/10/2019] [Indexed: 12/02/2022] Open
Abstract
This review aimed to identify methodological aspects of qualitative studies conducted to assess patient safety culture (PSC) in hospital settings. Searches of Google Scholar (Google LLC, Menlo Park, California, USA), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA), EMBASE (Elsevier, Amsterdam, Netherlands), PsycINFO (American Psychological Association, Washington, District of Columbia, USA) and Web of Science (Clarivate Analytics, Philadelphia, Pennsylvania, USA) databases were used to identify qualitative articles published between 2000 and 2017 that focused on PSC. A total of 22 studies were included in this review and analysis of methodological approaches showed that most researchers adopted purposive sampling, individual interviews, inductive content and thematic analysis. PSC was affected by factors related to staffing, communication, non-human resources, organisation and patient-related factors. Most studies lacked theoretical frameworks. However, many commonalities were found across studies. Therefore, it is recommended that future studies adopt a mixed methods approach to gain a better understanding of PSC.
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Affiliation(s)
- Hamad Alqattan
- Department of Medical Education, University of Aberdeen, Aberdeen, Scotland
| | - Zoe Morrison
- Department of Human Resources & Organisational Behaviour, University of Greenwich, London, UK
| | - Jennifer A Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
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Alzahrani N, Jones R, Rizwan A, Abdel-Latif ME. Safety attitudes in hospital emergency departments: a systematic review. Int J Health Care Qual Assur 2019; 32:1042-1054. [PMID: 31411093 PMCID: PMC7068731 DOI: 10.1108/ijhcqa-07-2018-0164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/10/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments (EDs). DESIGN/METHODOLOGY/APPROACH An electronic search was conducted of PsychINFO, ProQuest, MEDLINE, EMBASE, PubMed and CINAHL databases. The review included all studies that focussed on the safety attitudes of professional hospital staff employed in EDs. FINDINGS Overall, the review revealed that the safety attitudes of ED health staff are generally low, especially on teamwork and management support and among nurses when compared to doctors. Conversely, two intervention studies showed the effectiveness of team building interventions on improving the safety attitudes of health staff employed in EDs. RESEARCH LIMITATIONS/IMPLICATIONS Six studies met the inclusion criteria, however, most of the studies demonstrated low to moderate methodological quality. ORIGINALITY/VALUE Teamwork, communication and management support are central to positive safety attitudes. Teamwork training can improve safety attitudes. Given that EDs are the "front-line" of hospital care and patients within EDs are especially vulnerable to medical errors, future research should focus on the safety attitudes of medical staff employed in EDs and its relationship to medical errors.
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Affiliation(s)
- Naif Alzahrani
- Men, Women and Children's Health, The Medical School, College of Health and Medicine, Australian National University , Canberra, Australia
| | - Russell Jones
- Emergency Services Research Group and Health Simulation Centre, School of Medical and Health Sciences, Edith Cowan University , Joondalup, Australia
| | - Amir Rizwan
- Saudi German Hospitals Group, Riyadh, Saudi Arabia
| | - Mohamed E Abdel-Latif
- Men, Women and Children's Health, The Medical School, College of Health and Medicine, Australian National University , Canberra, Australia
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, Australia
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Innes K, Jackson D, Plummer V, Elliott D. A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions. Int Emerg Nurs 2018; 43:67-73. [PMID: 30381142 DOI: 10.1016/j.ienj.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/27/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. AIM To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. METHODS Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively. RESULTS Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. CONCLUSIONS The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.
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Affiliation(s)
- Kelli Innes
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia; Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia.
| | - Debra Jackson
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
| | - Virginia Plummer
- Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia; Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia.
| | - Doug Elliott
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
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Alshyyab MA, FitzGerald G, Dingle K, Ting J, Bowman P, Kinnear FB, Borkoles E. Developing a conceptual framework for patient safety culture in emergency department: A review of the literature. Int J Health Plann Manage 2018; 34:42-55. [PMID: 30187536 DOI: 10.1002/hpm.2640] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/08/2022] Open
Abstract
Patient safety culture is a critical component of modern health care. However, the high-paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department. Articles were analysed for consistent themes with the aim to construct a conceptual framework. Ten articles met the inclusion criteria that specifically examined safety culture in the ED. Synthesis of the literature resulted in the emergence of three overarching themes of ED practice found to impact on safety culture in the ED. These were the dimensions of patient safety culture, the factors influencing it, and the interventions for improving it. A conceptual framework was constructed that identifies elements that significantly impact the patient safety culture in the ED. This framework may assist managers and researchers to take a comprehensive approach to build an effective safety culture in ED setting.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kaeleen Dingle
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joseph Ting
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, QLD, Australia
| | - Paula Bowman
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Frances B Kinnear
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Erika Borkoles
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Bhat PN, Costello JM, Aiyagari R, Sharek PJ, Algaze CA, Mazwi ML, Roth SJ, Shin AY. Diagnostic errors in paediatric cardiac intensive care. Cardiol Young 2018; 28:675-682. [PMID: 29409553 PMCID: PMC7271069 DOI: 10.1017/s1047951117002906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IntroductionDiagnostic errors cause significant patient harm and increase costs. Data characterising such errors in the paediatric cardiac intensive care population are limited. We sought to understand the perceived frequency and types of diagnostic errors in the paediatric cardiac ICU. METHODS Paediatric cardiac ICU practitioners including attending and trainee physicians, nurse practitioners, physician assistants, and registered nurses at three North American tertiary cardiac centres were surveyed between October 2014 and January 2015. RESULTS The response rate was 46% (N=200). Most respondents (81%) perceived that diagnostic errors harm patients more than five times per year. More than half (65%) reported that errors permanently harm patients, and up to 18% perceived that diagnostic errors contributed to death or severe permanent harm more than five times per year. Medication side effects and psychiatric conditions were thought to be most commonly misdiagnosed. Physician groups also ranked pulmonary overcirculation and viral illness to be commonly misdiagnosed as bacterial illness. Inadequate care coordination, data assessment, and high clinician workload were cited as contributory factors. Delayed diagnostic studies and interventions related to the severity of the patient's condition were thought to be the most commonly reported process breakdowns. All surveyed groups ranked improving teamwork and feedback pathways as strategies to explore for preventing future diagnostic errors. CONCLUSIONS Paediatric cardiac intensive care practitioners perceive that diagnostic errors causing permanent harm are common and associated more with systematic and process breakdowns than with cognitive limitations.
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Affiliation(s)
- Priya N Bhat
- 1Department of Pediatrics,Divisions of Pediatric Cardiology and Critical Care Medicine,Washington University School of Medicine,St. Louis,Missouri,USA
| | - John M Costello
- 2Department of Pediatrics,Divisions of Pediatric Cardiology and Critical Care Medicine,Northwestern University Feinberg School of Medicine,Chicago,Illinois,USA
| | - Ranjit Aiyagari
- 3Department of Pediatrics,Division of Pediatric Cardiology,University of Michigan School of Medicine,Ann Arbor,Michigan,USA
| | - Paul J Sharek
- 4Department of Pediatrics,Division of Hospitalist Medicine,Stanford University School of Medicine,Palo Alto,California,USA
| | - Claudia A Algaze
- 5Department of Pediatrics,Division of Pediatric Cardiology,Stanford University School of Medicine,Palo Alto,California,USA
| | - Mjaye L Mazwi
- 2Department of Pediatrics,Divisions of Pediatric Cardiology and Critical Care Medicine,Northwestern University Feinberg School of Medicine,Chicago,Illinois,USA
| | - Stephen J Roth
- 5Department of Pediatrics,Division of Pediatric Cardiology,Stanford University School of Medicine,Palo Alto,California,USA
| | - Andrew Y Shin
- 4Department of Pediatrics,Division of Hospitalist Medicine,Stanford University School of Medicine,Palo Alto,California,USA
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Frazzetto A, Tibrewal P, Dhillon R, Bastiampillai T, Harris J. Conversion disorder or multiple sclerosis? Asian J Psychiatr 2017; 28:177-178. [PMID: 28784382 DOI: 10.1016/j.ajp.2017.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | - Prashant Tibrewal
- Cramond Clinic, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia.
| | - Rohan Dhillon
- Central Adelaide Local Health Network- Mental Health, Cramond Clinic, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia.
| | - Tarun Bastiampillai
- Mental Health Strategy, SA Health, Flinders University, Bedford Park, South Australia, 5042, Australia.
| | - Joseph Harris
- Department of Psychiatry, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.
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