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Isaac D, Li Y, Wang Y, Jiang D, Liu C, Fan C, Boah M, Xie Y, Ma M, Shan L, Gao L, Jiao M. Healthcare workers perceptions of patient safety culture in selected Ghanaian regional hospitals: a qualitative study. BMC Psychol 2024; 12:272. [PMID: 38750584 PMCID: PMC11094925 DOI: 10.1186/s40359-024-01628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/27/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Patient safety culture is an integral part of healthcare delivery both in Ghana and globally. Therefore, understanding how frontline health workers perceive patient safety culture and the factors that influence it is very important. This qualitative study examined the health workers' perceptions of patient safety culture in selected regional hospitals in Ghana. OBJECTIVE This study aimed to provide a voice concerning how frontline health workers perceive patient safety culture and explain the major barriers in ensuring it. METHOD In-depth semi-structured interviews were conducted with 42 health professionals in two regional government hospitals in Ghana from March to June 2022. Participants were purposively selected and included medical doctors, nurses, pharmacists, administrators, and clinical service staff members. The inclusion criteria were one or more years of clinical experience. Interviews were recorded and transcribed. Thematic analysis was used to identify themes. RESULT The health professionals interviewed were 38% male and 62% female, of whom 54% were nurses, 4% were midwives, 28% were medical doctors; lab technicians, pharmacists, and human resources workers represented 2% each; and 4% were critical health nurses. Among them, 64% held a diploma and 36% held a degree or above. This study identified four main areas: general knowledge of patient safety culture, guidelines and procedures, attitudes of frontline health workers, and upgrading patient safety culture. CONCLUSIONS This qualitative study presents a few areas for improvement in patient safety culture. Despite their positive attitudes and knowledge of patient safety, healthcare workers expressed concerns about the implementation of patient safety policies outlined by hospitals. Healthcare professionals perceived that curriculum training on patient safety during school education and the availability of dedicated officers for patient safety at their facilities may help improve patient safety.
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Affiliation(s)
| | - Yuanheng Li
- Harbin Medical University, Harbin, Heilongjiang, China
| | - Yushu Wang
- Northeastern University, Shenyang, Liaoning, China
| | - Deyou Jiang
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Chenggang Liu
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Chao Fan
- Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Michael Boah
- School of Public health University for Development studies, Tamale, Ghana
| | - Yuzhuo Xie
- Harbin Medical University, Harbin, Heilongjiang, China
| | - Mingxue Ma
- Harbin Medical University, Harbin, Heilongjiang, China
| | - Linghan Shan
- Harbin Medical University, Harbin, Heilongjiang, China.
| | - Lei Gao
- Harbin Medical University, Harbin, Heilongjiang, China.
| | - Mingli Jiao
- Harbin Medical University, Harbin, Heilongjiang, China.
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Venesoja A, Lindström V, Castrén M, Tella S. Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study. J Clin Nurs 2023; 32:847-858. [PMID: 35672936 PMCID: PMC10083998 DOI: 10.1111/jocn.16396] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship. BACKGROUND Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills. DESIGN The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions. METHODS Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study. RESULTS Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork. CONCLUSIONS This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services. RELEVANCE TO CLINICAL PRACTICE Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.
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Affiliation(s)
- Anu Venesoja
- South Carelia Social and Healthcare District, Lappeenranta, Finland.,Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Veronica Lindström
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.,Samariten Ambulance, Stockholm, Sweden.,Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Maaret Castrén
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Tella
- LAB University of Applied Sciences, Lappeenranta, Finland.,University of Eastern Finland, Kuopio, Finland
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Walker D, Moloney C, SueSee B, Sharples R, Blackman R, Long D, Hou XY. Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review. PREHOSP EMERG CARE 2022:1-18. [PMID: 35579544 DOI: 10.1080/10903127.2022.2068089] [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: 10/18/2022]
Abstract
INTRODUCTION There is limited research available on safe medication management practices in EMS practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. Prevention of errors requires recognition of contributing factors across the spectrum from the organizational level to procedural elements and patient characteristics. Evidence is inconsistent regarding the incidence of medication errors and multiple sources also state that errors are under-reported, making the true magnitude of the problem difficult to quantify. Definitions of error also vary, with the specific context of medication errors in prehospital practice yet to be established. The objective of this review is to identify the factors influencing the occurrence of medication errors by EMS personnel in the prehospital environment. METHODS AND ANALYSIS The review included both qualitative and quantitative research involving interventions or phenomena related to medication safety or medication error by EMS personnel in the prehospital environment. A search of multiple databases was conducted to identify studies meeting these inclusion criteria. All studies selected were assessed for methodological quality, however this was not used as a basis for exclusion. Each stage of study selection, appraisal and data extraction was conducted by two independent reviewers, with a third reviewer deciding any unresolved conflicts. The review follows a convergent integrated approach, conducting a single qualitative synthesis of qualitative and "qualitized" quantitative data. RESULTS 56 articles were included in the review, with case reports and qualitative studies being the most frequent study types. Qualitative analysis revealed seven major themes: organizational factors (with reporting as a sub-theme), equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors (with pediatrics as a sub-theme) and cognitive factors. Both contributing factors and protective factors were identified. DISCUSSION The body of evidence regarding medication errors is heterogenous and limited in both quantity and quality. Multiple factors influence medication errors occurrence; knowledge of these is necessary to mitigate the risk of errors. Medication error incidence is difficult to quantify due to inconsistent measure, definitions and contexts of research conducted to date. Further research is required to quantify the prevalence of identified factors in specific practice settings.
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Affiliation(s)
- Dennis Walker
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Clint Moloney
- Program of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Brendan SueSee
- School of Linguistics, Adult and Special Education, University of Southern Queensland, Springfield, Australia
| | - Renee Sharples
- College of Science, Health, and Engineering, LaTrobe University, Bendigo, Australia
| | - Rosanna Blackman
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - David Long
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Australia
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Shepard K, Spencer S, Kelly C, Wankhade P. Staff perceptions of patient safety in the NHS ambulance services: an exploratory qualitative study. Br Paramed J 2022; 6:18-25. [PMID: 35340577 PMCID: PMC8892446 DOI: 10.29045/14784726.2022.03.6.4.18] [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: 11/11/2022] Open
Abstract
Objectives Most research investigating staff perceptions of patient safety has been based in primary care or hospitals, with little research on emergency services. Therefore, this study aimed to explore staff perceptions of patient safety in the NHS ambulance services. Design A stratified qualitative study using semi-structured interviews. Setting Three urban or rural ambulance service NHS trusts in England. Participants A total of 44 participants from three organisational levels, including executives, managers and operational staff. Methods The semi-structured interviews explored the interpretation and definition of patient safety, perceived risks, incident reporting, communication and organisational culture. The framework method of qualitative data analysis was used to analyse the interviews and NVivo software was used to manage and organise the data. Results We identified five dominant themes: varied interpretation of patient safety; significant patient safety risks; reporting culture shift; communication; and organisational culture. The findings demonstrated that staff perceptions of patient safety ranged widely across the three organisational levels, while they remained consistent within those levels across the participating ambulance service NHS trusts in England. Conclusions The findings suggest that participants from all organisational levels perceive that the NHS ambulance services have become much safer for patients over recent years, which signifies an awareness of the historical issues and how they have been addressed. The inclusion of three distinct ambulance service NHS trusts and organisational levels provides deepened insight into the perceptions of patient safety by staff. As the responses of participants were consistent across the three NHS trusts, the identified issues may be generic and have application in other ambulance and emergency service settings, with implications for health policy on a national basis.
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Affiliation(s)
- Keegan Shepard
- University of Oxford ORCID iD: https://orcid.org/0000-0003-3867-9752
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Estrada-Orozco K, Cantor Cruz F, Benavides Cruz J, Ruiz-Cardozo MA, Suárez-Chacón AM, Cortés Tribaldos JA, Chaparro Rojas MA, Rojas Contreras RA, González-Camargo JE, González Berdugo JC, Villate-Soto SL, Moreno-Chaparro J, García López A, Aristizábal Robayo MF, Bonilla Regalado IA, Castro Barreto NL, Ceballos-Inga L, Gaitán-Duarte H. Hospital Adverse Event Reporting Systems: A Systematic Scoping Review of Qualitative and Quantitative Evidence. J Patient Saf 2021; 17:e1866-e1872. [PMID: 32209952 DOI: 10.1097/pts.0000000000000690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Reducing the incidence of reportable events with undesirable effects (REUE) is a priority in the hospital environment, which is why reporting systems have been implemented to identify and manage them. Information is required regarding the performance of reporting systems, barriers, or facilitators for reporting and strategies that improve passive reporting. METHODOLOGY Systematic scoping review of the literature that included studies performed in the population exposed to the occurrence of REUE in the health system (teams, patients, and family). A search was performed in Cochrane Database of Systematic Reviews, Epistemonikos, MEDLINE (PubMed), MEDLINE In-Process and MEDLINE Daily Update, EMBASE, LILACS, and databases of the World Health Organization and Pan-American Health Organization. RESULTS Fifteen studies were found, 1 systematic review, 2 clinical trials, 8 observational studies, 3 qualitative studies, and 1 mixed study. In 4 of them, the effectiveness of active versus passive reporting systems was compared. The measures to improve the passive systems were education about REUE, simplification of the reporting format, activities focused on increasing the motivation for self-report, adoption of self-report as an obligatory institutional policy, and using specific report formats for each service. CONCLUSIONS There is information that allows to find differences between the performance of the active and passive reporting systems. The reviewed research articles found that passive techniques significantly underreported adverse events. It is recommended that institutions adopt both active and passive techniques in adverse event surveillance. New studies should be directed to answer the comparative efficiency of the reporting systems.
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Chegini Z, Kakemam E, Asghari Jafarabadi M, Janati A. The impact of patient safety culture and the leader coaching behaviour of nurses on the intention to report errors: a cross-sectional survey. BMC Nurs 2020; 19:89. [PMID: 32973398 PMCID: PMC7504664 DOI: 10.1186/s12912-020-00472-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background There is growing interest in examining the factors affecting the reporting of errors by nurses. However, little research has been conducted into the effects of perceived patient safety culture and leader coaching of nurses on the intention to report errors. Methods This cross-sectional study was conducted amongst 256 nurses in the emergency departments of 18 public and private hospitals in Tabriz, northwest Iran. Participants completed the Hospital Survey on Patient Safety Culture (HSOPSC), Coaching Behavior Scale and Intention to Report Errors’ questionnaires and the data was analyzed using multiple linear regression analysis. Results Overall, 43% of nurses had an intention to report errors; 50% of respondents reported that their nursing managers demonstrated high levels of coaching. With regard to patient safety culture, areas of strength and weakness were “teamwork within units” (PRR = 66.8%) and “non-punitive response errors” (PRR = 19.7%). Regression analysis findings highlighted a significant association between an intention to report errors and patient safety culture (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.05), leader coaching behavior (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.01) and nurses’ educational status (B = 0.8, 95% CI: − 0.1 to 1.6, P < 0.05). Conclusions Further research is needed to assess how interventions addressing patient safety culture and leader coaching behaviours might increase the intention to report errors.
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Zip code, Qazvin, 1531534199 Iran.,National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Edris Kakemam
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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