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AlZahrani R, Al Thobaity A, Saleh MSM. Identifying the obstacles facing emergency nurses regarding treating CTAS1 and CTAS2 in Saudi Arabia. BMC Emerg Med 2024; 24:123. [PMID: 39020274 PMCID: PMC11256410 DOI: 10.1186/s12873-024-01044-4] [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: 02/17/2023] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Emergency nurses play a pivotal role in delivering efficient emergency healthcare, yet they often encounter numerous challenges, especially while managing life-threatening cases, impacting both their well-being and patient satisfaction. This study seeks to identify the prevalent challenges faced by these nurses in Saudi hospitals when handling Canadian Triage and Acuity Scale (CTAS1 and CTAS2) cases, with the aim of mitigating or managing these issues in the future. METHODS This study incorporated a mixed-method approach to identify obstacles in Emergency Department (ED) nursing treatment of CTAS1 and CTAS2 cases in two major Saudi Arabian hospitals. The research began with qualitative focus group interviews with expert ED nurses, followed by a quantitative survey to measure and explore relationships among the qualitative findings. Data analysis leveraged qualitative thematic analysis and principal component analysis, ensuring rigorous examination and validation of data to drive meaningful conclusions. FINDINGS From expert interviews, key challenges for emergency nurses were identified, including resource management, communication, training compliance, and psychological factors. A survey of 172 nurses further distilled these into five major issues: patient care management, handling critical cases, administration support, patient care delay, and stress from patients' families. CONCLUSION Through a mixed-method approach, this study pinpoints five pivotal challenges confronting emergency nurses in Saudi hospitals. These encompass difficulties in patient care management, the psychological toll of handling critical cases, inadequate administrative support, delays due to extended patient stays, and the stress induced by the presence of patients' families, all of which significantly impede emergency department efficiency and compromise nurse well-being.
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Affiliation(s)
- Rawan AlZahrani
- King Faisal Medical Complex, Ministry of Health, Taif, Saudi Arabia
| | - Abdulellah Al Thobaity
- Department of Medical Surgical Nursing, College of Nursing at Taif University, Taif, Saudi Arabia.
| | - Manal Saleh Moustafa Saleh
- Nursing Department, College of Applied Medical Science, Shaqra University, Shaqra, Saudi Arabia.
- Nursing Administration, Faculty of Nursing, Zagazig University, Zagazig, Alsharqia, Egypt.
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Batalha EMSDS, Borges EMDN, Melleiro MM. Association between patient safety culture and professional quality of life among nursing professionals. Rev Esc Enferm USP 2024; 58:e20230359. [PMID: 38985821 PMCID: PMC11268136 DOI: 10.1590/1980-220x-reeusp-2023-0359en] [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: 12/04/2023] [Accepted: 04/29/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVE To analyze the association between patient safety culture and professional quality of life in nursing professionals. METHOD Correlational study carried out in a hospital in Salvador, Bahia, Brazil, with 180 participants. The data were collected through the Hospital Survey on Patient Safety Culture and Professional Quality of Life Scale and analyzed with correlation tests. RESULTS The use of the Quality of Professional Life model, which encompasses Compassion Satisfaction, Burnout and Traumatic Stress, showed that a better assessment of the safety culture was negatively associated with Burnout. Regarding the dimensions of culture, better evaluations of the general perception of safety, teamwork and staffing were negatively associated with Burnout and Traumatic Stress. Higher Burnout was negatively associated with better handoffs and greater Traumatic Stress was positively associated with error communication. CONCLUSION Higher levels of Burnout were associated with worse perception of safety culture and worse teamwork evaluations; staffing and general perception of safety were associated to a higher level of Burnout and Traumatic Stress, which emphasizes the importance of investment in these areas.
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Lassoued L, Gharssallah I, Tlili MA, Sahli J, Kouira M, Abid S, Chaieb A, Khairi H. Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals. BMC Health Serv Res 2024; 24:704. [PMID: 38840130 PMCID: PMC11151572 DOI: 10.1186/s12913-024-11152-3] [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: 08/11/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.
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Affiliation(s)
- Latifa Lassoued
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Ines Gharssallah
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Mohamed Ayoub Tlili
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie.
- Department of Nursing Administration, College of Nursing, University of Hail, Hail, Saudi Arabia.
| | - Jihene Sahli
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
| | - Mouna Kouira
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Skender Abid
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Anouar Chaieb
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Hedi Khairi
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
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Naya K, Aikawa G, Ouchi A, Ikeda M, Fukushima A, Yamada S, Kamogawa M, Yoshihara S, Sakuramoto H. Second victim syndrome in intensive care unit healthcare workers: A systematic review and meta-analysis on types, prevalence, risk factors, and recovery time. PLoS One 2023; 18:e0292108. [PMID: 37788270 PMCID: PMC10547210 DOI: 10.1371/journal.pone.0292108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Patient safety incidents, including medical errors and adverse events, frequently occur in intensive care units, leading to a significant psychological burden on healthcare workers. This burden results in second victim syndrome, which impacts the psychological and psychosomatic well-being of these workers. However, a systematic review focusing specifically on this condition among intensive care unit healthcare workers is lacking. Therefore, we aimed to conduct a systematic review and meta-analysis to examine the occurrence of second victim syndrome among intensive care unit healthcare workers, including the types, prevalence, risk factors, and recovery time associated with this condition. METHODS We conducted a comprehensive search of the MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi databases. The eligibility criteria encompassed retrospective, prospective, and cross-sectional studies and controlled trials, with no language restrictions. Data on the type, prevalence, risk factors, and recovery time of second victim syndrome were extracted and pooled. Prevalence estimates from the included studies were combined using a random-effects meta-analytic model. RESULTS Of the 2,245 records retrieved, 16 potentially relevant studies were identified. Following full-text evaluation, five studies met the inclusion criteria and were included in the review. The findings revealed that 58% of intensive care unit healthcare workers experienced second victim syndrome. Frequent symptoms included guilt (12-68%), anxiety (38-63%), anger at self (25-58%), and lower self-confidence (7-58%). However, specific risk factors exclusive to intensive care unit healthcare workers were not identified in the review. Furthermore, approximately 20% of individuals took more than a year to recover or did not recover at all from the second victim syndrome. CONCLUSIONS Thus, this condition is prevalent among intensive care unit healthcare workers and may persist for extended periods, potentially exceeding a year. The risk factors for second victim syndrome in the intensive care unit setting are unclear and require further investigation.
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Affiliation(s)
- Kazuaki Naya
- Department of Adult Health Nursing, Tokyo Healthcare University Wakayama Faculty of Nursing, Wakayama City, Wakayama, Japan
| | - Gen Aikawa
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Ibaraki, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Ibaraki, Japan
| | - Mitsuki Ikeda
- Department of Emergency and Critical Care Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, Japan
| | - Ayako Fukushima
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Shuhei Yamada
- Department of Adult Health Nursing, Tokyo Healthcare University Wakayama Faculty of Nursing, Wakayama City, Wakayama, Japan
| | - Megumi Kamogawa
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Shun Yoshihara
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
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Liu A, Ben-Zion S, Schwartz A, Mahan JD, Reed S. Well-being factors associated with confidence in providing calm, compassionate care in pediatric residents. PATIENT EDUCATION AND COUNSELING 2023; 115:107906. [PMID: 37478547 DOI: 10.1016/j.pec.2023.107906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Engagement in calm, compassionate care (CCC) is important in fostering patient-centered care. We aimed to study factors which predict confidence in providing CCC in pediatric residents. METHODS We performed a retrospective, multi-center, cohort study utilizing data from the Pediatric Resident Burnout and Resilience Study (PRB-RSC) from 2016 to 2018. The Calm Compassionate Care Scale (CCCS) was used to assess confidence in delivering CCC. We examined cross-sectional associations between CCC, demographic measures, programmatic features, and psychological scales. RESULTS The following showed significant positive associations with confidence in providing CCC: Cognitive and Affective Mindfulness Scale, Neff's Self Compassion, Patient Reported Outcomes Measures-mental health, and Interpersonal Reactivity Index-empathetic concern. For the Maslach Burnout Index subscales, decreased personal accomplishment, increased emotional exhaustion, and increased depersonalization showed significant negative associations. CONCLUSIONS We found that several well-being measures and an increased sense of personal accomplishment are associated with increased confidence in providing CCC. These findings underscore the interrelatedness of these measures and highlight the importance of personal accomplishment as a positive factor in trainee development. PRACTICE IMPLICATIONS Program level interventions that decrease trainee burnout and enhance resiliency as well as support trainees' development of empathy and compassion may help trainees develop skills that promote patient-centered, compassionate care.
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Affiliation(s)
- Alex Liu
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sabrina Ben-Zion
- Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
| | - Alan Schwartz
- Department of Pediatrics, University of Illinois College of Medicine - Chicago, Chicago, IL, USA
| | - John D Mahan
- Department of Pediatrics Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, OH, USA
| | - Suzanne Reed
- Department of Pediatrics Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, OH, USA.
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Lin JS, Olutoye OO, Samora JB. To Err is human, but what happens when surgeons Err? J Pediatr Surg 2023; 58:496-502. [PMID: 35914964 DOI: 10.1016/j.jpedsurg.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physicians involved in adverse events may suffer from second victim syndrome and can experience emotional and physical distress long after the complication occurred. We sought determine the prevalence of second victim syndrome among surgeons at our children's hospital and evaluate any differences in how surgeons respond to adverse events based on their age, position, and gender. METHODS An anonymous 19-question questionnaire distributed via institutional emails linking to an anonymous Research Electronic Data Capture (REDCap) survey. Eligible participants included all surgeons and rotating surgical trainees at our hospital. RESULTS Of 64 faculty surgeons eligible to participate, 63 surveys were returned for a 98% completion rate. Ten additional surveys from surgical trainees were completed for a total of 73 participants. Eighty-four percent reported having had difficulty dealing with a poor outcome or unhappy patient/family. Speaking with a colleague was the most common coping strategy, reported by 82%. Fifty-six percent indicated they believed reporting a poor outcome would have negative ramifications for them. Younger surgeons were more likely to suppress their feelings following an adverse event, and trainees were less likely to advise their peers to speak to a superior about the event (p < 0.05). CONCLUSION There is a high prevalence of second victim syndrome among surgeons at our children's hospital. There exist differences in ways that surgeons respond to adverse events based on age and position. Healthcare institutions should establish formal mechanisms of support to shift the culture towards one where help is actively sought and offered. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- James S Lin
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Oluyinka O Olutoye
- The Ohio State University College of Medicine, Columbus, OH, United States of America; Nationwide Children's Hospital, Columbus, OH, United States of America
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A Scoping Review on the Concept of Physician Caring. J Gen Intern Med 2022; 37:3134-3146. [PMID: 35391622 PMCID: PMC8989128 DOI: 10.1007/s11606-021-07382-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/22/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Physicians' interest in the health and well-being of their patients is a tenet of medical practice. Physicians' ability to act upon this interest by caring for and about their patients is central to high-quality clinical medicine and may affect burnout. To date, a strong theoretical and empirical understanding of physician caring does not exist. To establish a practical, evidence-based approach to improve health care delivery and potentially address physician burnout, we sought to identify and synthesize existing conceptual models, frameworks, and definitions of physician caring. METHODS We performed a scoping review on physician caring. In November 2019 and September 2020, we searched PubMed MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL Register of Controlled Trials to identify conceptual models, frameworks, and definitions of physician caring. Eligible articles involved discussion or study of care or caring among medical practitioners. We created a content summary and performed thematic analysis of extracted data. RESULTS Of 11,776 articles, we reviewed the full text of 297 articles; 61 articles met inclusion criteria. Commonly identified concepts referenced Peabody's "secret of care" and the ethics of care. In bioethics, caring is described as a virtue. Contradictions exist among concepts of caring, such as whether caring is an attitude, emotion, or behavior, and the role of relationship development. Thematic analysis of all concepts and definitions identified six aspects of physician caring: (1) relational aspects, (2) technical aspects, (3) physician attitudes and characteristics, (4) agency, (5) reciprocity, and (6) physician self-care. DISCUSSION Caring is instrumental to clinical medicine. However, scientific understanding of what constitutes caring from physicians is limited by contradictions across concepts. A unifying concept of physician caring does not yet exist. This review proposes six aspects of physician caring which can be used to develop evidence-based approaches to improve health care delivery and potentially mitigate physician burnout.
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Tlili MA, Aouicha W, Sahli J, Mtiraoui A, Ajmi T, Laatiri H, Chelbi S, Ben Rejeb M, Mallouli M. An Intervention to Optimize Attitudes Toward Adverse Events Reporting Among Tunisian Critical Care Nurses. J Patient Saf 2022; 18:e872-e876. [PMID: 35044996 DOI: 10.1097/pts.0000000000000961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed at evaluating the impact of a combined-strategies intervention on ICUs nurses' attitudes toward AE reporting. METHODS We conducted a quasi-experimental study from January to October 2020 which consisted of an intervention to improve attitudes toward incident reporting among nurses working in 10 intensive care units at a university hospital using the Reporting of Clinical Adverse Events Scale. The intervention consisted of a 2-hour educational presentation for nurse unit managers and a 30-minute in-units educational training for intensive care unit nurses, which encompassed technical aspects of reporting, the reporting process, a nonpunitive environment, and the importance of submitting reports. The educational presentation was reinforced with distributing posters and brochures and biweekly patient safety rounds that inquired about events, reinforced education, and provided follow-up to incident reports. RESULTS All dimensions were significantly improved. Score increased from 27.4% to 42.1% ( P < 0.01) for perceived blame, from 35.2% to 52.5% for perceived criteria for identifying events that should be reported ( P < 0.01), from 34.3% to 46% for perceptions of colleagues' expectations ( P = 0.04), from 37.1% to 51.4% for perceived benefits of reporting ( P = 0.01), and from 29.2% to 51.4% for perceived clarity of reporting procedures ( P < 0.01). CONCLUSIONS Interventions using a combination of several strategies such as training, safety round, and messaging can be effective and should be considered by hospitals attempting to increase adverse events reporting. Results reinforce the assumption that a nonpunitive environment and the resulting feeling of safety and reassurance are crucial to foster the submission of reports.
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Affiliation(s)
- Mohamed Ayoub Tlili
- From the Department of Family and Community Health, Laboratory of Research LR12ES03 "Quality of Care and Management of Healthcare Services," Faculty of Medicine of Sousse, University of Sousse
| | - Wiem Aouicha
- From the Department of Family and Community Health, Laboratory of Research LR12ES03 "Quality of Care and Management of Healthcare Services," Faculty of Medicine of Sousse, University of Sousse
| | - Jihene Sahli
- From the Department of Family and Community Health, Laboratory of Research LR12ES03 "Quality of Care and Management of Healthcare Services," Faculty of Medicine of Sousse, University of Sousse
| | - Ali Mtiraoui
- From the Department of Family and Community Health, Laboratory of Research LR12ES03 "Quality of Care and Management of Healthcare Services," Faculty of Medicine of Sousse, University of Sousse
| | - Thouraya Ajmi
- From the Department of Family and Community Health, Laboratory of Research LR12ES03 "Quality of Care and Management of Healthcare Services," Faculty of Medicine of Sousse, University of Sousse
| | - Houyem Laatiri
- Department of Prevention and Care Safety, Sahloul University Hospital
| | - Souad Chelbi
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, Sahloul University Hospital
| | - Manel Mallouli
- From the Department of Family and Community Health, Laboratory of Research LR12ES03 "Quality of Care and Management of Healthcare Services," Faculty of Medicine of Sousse, University of Sousse
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Beirouti M, Kamalinia M, Daneshmandi H, Soltani A, Dehghani P, Fararooei M, Zakerian SA, Zamanian Z. Application of the HEART method to enhance patient safety in the intensive care unit. Work 2022; 72:1087-1097. [DOI: 10.3233/wor-205338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The intensive care unit (ICU) is a complex, dynamic, high stress and time-sensitive place. While a variety of rules and regulations provided to reduce medication errors in recent years, many studies have emphasized that medication errors still happen. OBJECTIVE: The purpose of this investigation is to predict, reveal and assess medication errors among surgical intensive care unit (SICU) nurses. METHODS: This study was performed in one of the public hospitals in Shiraz, namely Shahid Faghihi hospital. The human error assessment and reduction technique (HEART) method was adopted to measure and assess medication errors in the ICU. RESULTS: Findings indicate that ICU nurses perform 27 main tasks and 125 sub-tasks. The results also showed that setting and using DC shock task has the highest human error probability value, and assessment of patients by a nutritionist has the lowest human error probability value. CONCLUSION: Medical errors are key challenges in the ICU. Therefore, alternative solutions to mitigate medication errors and enhance patient safety in the ICU are necessary. Although the technique can be used in healthcare; there is a need to localize the coefficients and definitions to achieve more accurate results and take appropriate controls. Employing experienced people and providing conditions that reduce the possibility of errors in nurses, increasing the number of staff, and developing specialized and simulated training were identified as the most important control strategies to reduce errors in nurses.
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Affiliation(s)
- Mohammad Beirouti
- Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Science, Shiraz, Iran
| | - Mojtaba Kamalinia
- Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Science, Shiraz, Iran
| | - Hadi Daneshmandi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Soltani
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooyan Dehghani
- Cardiovascular Research Center, Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararooei
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Syed Abolfazl Zakerian
- Department of Occupational Health Engineering, School of Public Health and Institute of Health Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Zahra Zamanian
- Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Science, Shiraz, Iran
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Cifra CL, Custer JW, Fackler JC. A Research Agenda for Diagnostic Excellence in Critical Care Medicine. Crit Care Clin 2022; 38:141-157. [PMID: 34794628 PMCID: PMC8963385 DOI: 10.1016/j.ccc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diagnosing critically ill patients in the intensive care unit is difficult. As a result, diagnostic errors in the intensive care unit are common and have been shown to cause harm. Research to improve diagnosis in critical care medicine has accelerated in past years. However, much work remains to fully elucidate the diagnostic process in critical care. To achieve diagnostic excellence, interdisciplinary research is needed, adopting a balanced strategy of continued biomedical discovery while addressing the complex care delivery systems underpinning the diagnosis of critical illness.
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11
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Shafer G, Gautham KS. Diagnostic Error: Why Now? Crit Care Clin 2021; 38:1-10. [PMID: 34794623 DOI: 10.1016/j.ccc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diagnostic errors remain relatively understudied and underappreciated. They are particularly concerning in the intensive care unit, where they are more likely to result in harm to patients. There is a lack of consensus on the definition of diagnostic error, and current methods to quantify diagnostic error have numerous limitations as noted in the sentinel report by the National Academy of Medicine. Although definitive definition and measurement remain elusive goals, increasing our understanding of diagnostic error is crucial if we are to make progress in reducing the incidence and harm caused by errors in diagnosis.
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Affiliation(s)
- Grant Shafer
- Division of Neonatology, Children's Hospital of Orange County, 1201 West La Veta Avenue, Orange, CA 92868, USA.
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12
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Tian M, Yang H, Yin X, Wu Y, Zhang G, Lv C, Mu K, Gong Y. Evaluating effort-reward imbalance among nurses in emergency departments: a cross-sectional study in China. BMC Psychiatry 2021; 21:353. [PMID: 34261458 PMCID: PMC8278678 DOI: 10.1186/s12888-021-03344-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Effort-reward imbalance is an adverse psychological response to working conditions that has several negative effects on nurses. However, there is little research on effort-reward imbalance and its influencing factors among nurses in emergency departments. This study aimed to understand the current situation of effort-reward imbalance and explore its influencing factors among emergency department nurses in China. METHODS From July to August 2018, a structured online questionnaire survey was conducted among emergency department nurses in China. Data were collected from emergency department nurses employed in hospitals providing pre-hospital care in China. The questionnaire consisted of sociodemographic characteristics, work-related factors and effort-reward imbalance. A descriptive analysis and a binary logistic regression were conducted to explore the effort-reward imbalance and its influencing factors among emergency department nurses. RESULTS The study involved 17,582 emergency department nurses; notably, the prevalence of effort-reward imbalance was 59.66%. The participating nurses who were males, aged 25 to 34 years, whose educational level was a bachelor degree or above, who had a junior or above title, who had longer years of service, and who had suffered verbal or physical violence in the past year had a higher risk of effort-reward imbalance. Furthermore, the nurses with a high monthly income, who believed that the number of nurses met the department's demand had a lower risk of effort-reward imbalance. CONCLUSIONS Effort-reward imbalance was prevalent among emergency department nurses in China. Measures such as adjusting the night shift frequency, increasing the number of nurses, raising salaries and reducing workplace violence should be considered to reduce the level of effort-reward imbalance.
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Affiliation(s)
- Mengge Tian
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Heping Yang
- grid.507061.50000 0004 1791 5792Wuchang University of Technology, Wuhan, P. R. China
| | - Xiaoxv Yin
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yafei Wu
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Guopeng Zhang
- grid.33199.310000 0004 0368 7223Department of Nuclear medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Chuanzhu Lv
- grid.443397.e0000 0004 0368 7493Department of Emergency, The Frist Affiliated Hospital of Hainan Medical University, Haikou, China ,grid.443397.e0000 0004 0368 7493Emergency and Trauma College, Hainan Medical University, Haikou, Hainan China ,grid.443397.e0000 0004 0368 7493Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan China
| | - Ketao Mu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China.
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China.
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13
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Hancock J, Witter T, Comber S, Daley P, Thompson K, Candow S, Follett G, Somers W, Collins C, White J, Kits O. Understanding burnout and moral distress to build resilience: a qualitative study of an interprofessional intensive care unit team. Can J Anaesth 2020; 67:1541-1548. [PMID: 32844247 DOI: 10.1007/s12630-020-01789-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore personal and organizational factors that contribute to burnout and moral distress in a Canadian academic intensive care unit (ICU) healthcare team. Both of these issues have a significant impact on healthcare providers, their families, and the quality of patient care. These themes will be used to design interventions to build team resilience. METHODS This is a qualitative study using focus groups to elicit a better understanding of stakeholder perspectives on burnout and moral distress in the ICU team environment. Thematic analysis of transcripts from focus groups with registered intensive care nurses (RNs), respiratory therapists (RTs), and physicians (MDs) considered causes of burnout and moral distress, its impact, coping strategies, as well as suggestions to build resilience. RESULTS Six focus groups, each with four to eight participants, were conducted. A total of 35 participants (six MDs, 21 RNs, and eight RTs) represented 43% of the MDs, 18.8% of the RNs, and 20.0% of the RTs. Themes were concordant between the professions and included: 1) organizational issues, 2) exposure to high-intensity situations, and 3) poor team experiences. Participants reported negative impacts on emotional and physical well-being, family dynamics, and patient care. Suggestions to build resilience were categorized into the three main themes: organizational issues, exposure to high intensity situations, and poor team experiences. CONCLUSIONS Intensive care unit team members described their experiences with moral distress and burnout, and suggested ways to build resilience in the workplace. Experiences and suggestions were similar between the interdisciplinary teams.
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Affiliation(s)
- Jennifer Hancock
- Department of Critical Care Medicine, Dalhousie University, Queen Elizabeth II Hospital, 1276 South Park St., Halifax, NS, B3H 2Y9, Canada.
| | - Tobias Witter
- Department of Critical Care, Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Scott Comber
- Rowe School of Business, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Patricia Daley
- MSNICU, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Kim Thompson
- Respiratory Therapy Department, Central Zone, Nova Scotia Health Authority, Health Sciences Centre, Halifax, NS, Canada
| | - Stewart Candow
- Intensive Care Unit, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Gisele Follett
- Respiratory Therapy DGH, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Walter Somers
- Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Corry Collins
- CLU, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Janet White
- Respiratory Therapy DGH, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Olga Kits
- Research Methods Unit, Research, Innovation & Discovery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
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14
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Goldsmith AJ, Shokoohi H, Loesche M, Patel RC, Kimberly H, Liteplo A. Point-of-care Ultrasound in Morbidity and Mortality Cases in Emergency Medicine: Who Benefits the Most? West J Emerg Med 2020; 21:172-178. [PMID: 33207163 PMCID: PMC7673874 DOI: 10.5811/westjem.2020.7.47486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/13/2020] [Accepted: 07/09/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is an essential tool in the timely evaluation of an undifferentiated patient in the emergency department (ED). Our primary objective in this study was to determine the perceived impact of POCUS in high-risk cases presented at emergency medicine (EM) morbidity and mortality (M&M) conferences. Additionally, we sought to identify in which types of patients POCUS might be most useful, and which POCUS applications were considered to be highest yield. METHODS This was a retrospective survey of cases submitted to M&M at an EM residency program that spans two academic EDs, over one academic year. Postgraduate year 4 (PGY) residents who presented M&M cases at departmental sessions were surveyed on perceived impacts of POCUS on individual patient outcomes. We evaluated POCUS use and indications while the POCUS was used. RESULTS Over the 12-month period, we reviewed 667 cases from 18 M&M sessions by 15 PGY-4 residents and a supervising EM attending physician who chairs the M&M committee. Of these cases, 75 were selected by the M&M committee for review and presentation. POCUS was used in 27% (20/75) of the cases and not used in 73% (55/75). In cases where POCUS was not used, retrospective review determined that if POCUS had been used it would have "likely prevented the M&M" in 45% (25/55). Of these 25 cases, the majority of POCUS applications that could have helped were cardiac (32%, 8/25) and lung (32%, 8/25) ultrasound. POCUS was felt to have greatest potential in identifying missed diagnoses (92%, 23/25), and decreasing the time to diagnosis (92%, 23/25). Patients with cardiopulmonary chief complaints and abnormal vital signs were most likely to benefit. There were seven cases (35%, 7/20, 95% CI 15-59%) in which POCUS was performed and thought to have possibly adversely affected the outcome of the M&M. CONCLUSION POCUS was felt to have the potential to reduce or prevent M&M in 45% of cases in which it was not used. Cardiac and lung POCUS were among the most useful applications, especially in patients with cardiopulmonary complaints and in those with abnormal vital signs.
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Affiliation(s)
- Andrew J. Goldsmith
- Harvard Medical School, Department, Boston, Massachusetts
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Hamid Shokoohi
- Harvard Medical School, Department, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Michael Loesche
- Harvard Medical School, Department, Boston, Massachusetts
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Ravish C. Patel
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Medical College of Georgia School of Medicine, Department, Augusta, Georgia
| | - Heidi Kimberly
- Harvard Medical School, Department, Boston, Massachusetts
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Andrew Liteplo
- Harvard Medical School, Department, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
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15
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Santos TAD, Santos HS, Sampaio EES, Melo CMMD, Souza EA, Pires CGDS. Intensity of nursing work in public hospitals. Rev Lat Am Enfermagem 2020; 28:e3267. [PMID: 32401902 PMCID: PMC7217623 DOI: 10.1590/1518-8345.3221.3267] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/07/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: to analyze the intensity of nursing work in public hospitals. Method: cross-sectional, quantitative study, carried out in 22 public hospitals. The
sample was composed of 265 nurses and 810 nursing technicians and
assistants. Data were collected through a questionnaire and analyzed with
Exploratory Factor Analysis. The calculation of the distribution of the work
intensity by category was done using a score ranging from -1 to +1 standard
deviation of the data. Fisher’s exact test (0.05 <p≤0.10) was used to
observe the significance between groups according to the employment
bond. Results: work intensity contributed to the explanation of precarization of work, with
a value of 13% for nurses and 51.2% for technicians and assistants. For the
technicians and assistants, the variables with the highest factor loadings
were ‘work requires more than she can do’ (0.6696) and
‘takes on multiple tasks due to staff shortages’
(0.6156). Among nurses, the highest factor loadings were observed in the
variables ‘time pressure at work (0.6779) and ‘Work
pace’ (0.6651). Conclusion: the variables analyzed indicate that work intensity occurs differently among
nursing workers, and is revealed by the versatility, understaffing and
flexibility of work.
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Affiliation(s)
| | | | | | | | - Ednir Assis Souza
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador, BA, Brazil
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