A Practice Model for Patient Safety

The Definitions and Conceptualizations of the Practice Context in the Health Professions: A Scoping Review

INTRODUCTION

Health care professionals work in different contexts, which can influence professional competencies. Despite existing literature on the impact of context on practice, the nature and influence of contextual characteristics, and how context is defined and measured, remain poorly understood. The aim of this study was to map the breadth and depth of the literature on how context is defined and measured and the contextual characteristics that may influence professional competencies.

METHODS

A scoping review using Arksey and O'Malley's framework. We searched MEDLINE (Ovid) and CINAHL (EBSCO). Our inclusion criteria were studies that reported on context or relationships between contextual characteristics and professional competencies or that measured context. We extracted data on context definitions, context measures and their psychometric properties, and contextual characteristics influencing professional competencies. We performed numerical and qualitative analyses.

RESULTS

After duplicate removal, 9106 citations were screened and 283 were retained. We compiled a list of 67 context definitions and 112 available measures, with or without psychometric properties. We identified 60 contextual factors and organized them into five themes: Leadership and Agency, Values, Policies, Supports, and Demands.

DISCUSSION

Context is a complex construct that covers a wide array of dimensions. Measures are available, but none include the five dimensions in one single measure or focus on items targeting the likelihood of context influencing several competencies. Given that the practice context plays a critical role in health care professionals' competencies, stakeholders from all sectors (education, practice, and policy) should work together to address those contextual characteristics that can adversely influence practice.

Patient safety value, safety attitude and safety competency among emergency nurses in China: A structural equation model analysis

AIMS

We aim to determine the levels of patient safety value, safety attitude and safety competency and to explore the associations among these variables in emergency nurses in China.

BACKGROUND

Studies have focused on the individual characteristics of nurses as influencing factors of patient safety but not on the factors that may affect patient safety competency in the context of Chinese culture, such as safety value and safety attitude.

METHOD

A cross-sectional survey was conducted among emergency nurses in 22 hospitals.

RESULTS

The final model had acceptable fit indices (χ² /df = 3.512 < 5; CFI = 0.955 > 0.9; TLI = 0.942 > 0.9; IFI = 0.955 > 0.9; RMSEA = 0.068 < 0.08 [90% CI, 0.059 to 0.077]). A fully adjusted model was also tested, and the effects among variables were consistent with the hypothesized model. The SEM results showed that patient safety values had a significant direct effect on safety competency (b = .407, p < .001) and safety attitude (b = .656, p < .001). Patient safety attitude had a significant direct effect on safety competency (b = .493, p < .001). Patient safety values had an indirect effect on safety competency through safety attitude, and the total effect of safety values on safety competency was 0.730.

CONCLUSIONS

Chinese nurses are at a moderate level of patient safety attitude and competency. Emergency nurses' safety value and safety attitude can be direct predictors of patient safety competency, and safety value can indirectly predict their patient safety competency through safety attitude.

IMPLICATIONS FOR NURSING MANAGEMENT

Strengthening safety value is a critical step toward improving patient safety competency. Hospital administrators and educators should construct a patient safety culture that is guided and driven by appropriate values and ensure the development of necessary competencies in nurses.

What made Lebanese emigrant nurses leave and what would bring them back? A cross-sectional survey

BACKGROUND

The nursing workforce is critical for the provision of quality health-care and positive patient outcomes. There is a global trend of migration of nurses from under-developed to developed countries due to attractive job offers in the host countries. Lebanon presents such a case where nurses are migrating abroad, leading to shortages in the nursing workforce in their home country.

OBJECTIVES

The aim of this study was to investigate reasons for the migration of Lebanese nurses, and incentives that would attract them back to their home country in order to enhance the nursing workforce in Lebanon.

DESIGN

This study is a cross-sectional survey of emigrant Lebanese nurses.

SETTINGS

Recipient countries where Lebanese nurses emigrated.

PARTICIPANTS

440 Emigrant Lebanese nurses were identified through the registration database of the Order of Nurses in Lebanon. The survey was sent to all of them via email; 153 responses were received.

METHODS

Data were collected from November 2017 to March 2018. Analysis included univariate and bivariate tests to present descriptive statistics of the respondents, and to examine region of residence and gender in relation to their current job satisfaction, reasons for leaving Lebanon, intention to return to Lebanon, and aspects that would attract them back to their home country. Logistic regression analysis was used to determine the socio-demographic and work-related characteristics associated with the odds of returning to practice nursing in Lebanon.

RESULTS

A total 136 completed responses were considered. Emigrant Lebanese nurses were highly educated, with more years of work experience, and older than nurses remaining in their home country. Top reasons for nurses to leave Lebanon included unsatisfactory salary or benefits, better work opportunities in other countries, and lack of professional development or career advancement. The majority of surveyed nurses (59%) expressed willingness to return to practice nursing in Lebanon. Aspects that would attract emigrant Lebanese nurses back to their home country include attractive salary or better benefits and opportunities for professional development, career advancement, or continuing education. Emigrant Lebanese nurses residing in the Gulf, staff nurses, and nurses with more years of work experience were more likely to return to practice nursing in Lebanon.

CONCLUSION

Highly educated and experienced nurses are departing from Lebanon. This presents a challenge for the less experienced nurses remaining in the country, who could benefit from the mentorship and experience of their migrating peers. Creating an environment that could enhance the professional development of nurses in Lebanon, with financial incentives could retain the nursing workforce in the country.

Patient safety competency and the new nursing care delivery model

AIM

To identify the factors affecting nurses' patient safety competency under the new nursing care delivery model.

BACKGROUND

In Korea, a new model was introduced in 2013 to ensure that nursing personnel provided inpatients with care without relying on guardians. After the launch of this service, there continue to be nurse-related patient safety incidents.

METHODS

This is a descriptive study. Data from 132 general hospital nurses were collected during 15-24 February 2017 and analysed using hierarchical multiple regression.

RESULTS

Participants' mean patient safety competency score was 3.82 (range 1-5). Clinical career (Pratt index = 47.3%), critical thinking disposition (30.4%), teamwork (24.1%) and critical thinking training experience (7.3%) were found to affect nurses' patient safety competency.

CONCLUSION

Under the new model, new nurses showed a low level of patient safety competency. Clinical career most influenced patient safety competency. Enhanced critical thinking and teamwork training are needed to improve patient safety competency among nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing leaders must consider qualitative staffing mix involving appropriate placement of experienced nurses as well as quantitative staffing level to provide patients with high-quality, safe care and to implement the new model successfully. Regular training on critical thinking and teamwork should be carried out.

Bridging the gap between guidelines and practice in the management of emerging infectious diseases: a qualitative study of emergency nurses

AIMS AND OBJECTIVES

To explore the difficulties and strategies regarding guideline implementation among emergency nurses.

BACKGROUND

Emerging infectious diseases remain an underlying source of global health concern. Guidelines for accident and emergency departments would require adjustments for infectious disease management. However, disparities between guidelines and nurses' practice are frequently reported, which undermines the implementation of these guidelines into practice. This article explores the experience of frontline emergency nurses regarding guideline implementation and provides an in-depth account of their strategies in bridging guideline-practice gaps.

DESIGN

A qualitative descriptive design was used.

METHODS

Semi-structured, face-to-face, individual interviews were conducted between November 2013-May 2014. A purposive sample of 12 frontline emergency nurses from five accident and emergency departments in Hong Kong were recruited. The audio-recorded interviews were transcribed verbatim and analysed with a qualitative content analysis approach.

RESULTS

Four key categories associated with guideline-practice gaps emerged, including getting work done, adapting to accelerated infection control measures, compromising care standards and resolving competing clinical judgments across collaborating departments. The results illustrate that the guideline-practice gaps could be associated with inadequate provision of corresponding organisational supports after guidelines are established.

CONCLUSIONS

The nurses' experiences have uncovered the difficulties in the implementation of guidelines in emergency care settings and the corresponding strategies used to address these problems. The nurses' experiences reflect their endeavour in adjusting accordingly and adapting themselves to their circumstances in the face of unfeasible guidelines.

RELEVANCE TO CLINICAL PRACTICE

It is important to customise guidelines to the needs of frontline nurses. Maintaining cross-departmental consensus on guideline interpretation and operation is also indicated as an important component for effective guideline implementation.

Mentorship for newly appointed physicians: a strategy for enhancing patient safety?

OBJECTIVE

Mentorship is an increasingly popular innovation from business and industry that is being applied in health-care contexts. This paper explores the concept of mentorship for newly appointed physicians in their first substantive senior post, and specifically its utilization to enhance patient safety.

METHODS

Semi-structured face to face and telephone interviews with Medical Directors (n = 5), Deputy Medical Directors (n = 4), and Clinical Directors (n = 6) from 9 acute NHS Trusts in the Yorkshire and Humber region in the north of England. A focused thematic analysis was used.

RESULTS

A number of beneficial outcomes were associated with mentorship for newly appointed physicians including greater personal and professional support, organizational commitment, and general well-being. Providing newly appointed senior physicians with support through mentorship was considered to enhance the safety of patient care. Mentorship may prevent or reduce active failures, be used to identify threats in the local working environment, and in the longer term, address latent threats to safety within the organization by encouraging a healthier safety culture.

CONCLUSIONS

Offering mentorship to all newly appointed physicians in their first substantive post in health care may be a useful strategy to support the development of their clinical, professional, and personal skills in this transitional period that may also enhance the safety of patient care.

Patient safety and ethics: a conflict of goods

Nurses often face ethical dilemmas when providing care to patients with cancer. Although "doing the right thing" may seem obvious in the decision-making process, nurses are frequently challenged with a conflict of doing good regarding patient safety and patient advocacy versus maintaining collegial relationships.

Making the move: from bedside to camera-side

The tele-intensive care unit (tele-ICU) uses sophisticated telemedicine technology and a remote team of critical care experts, including nurses, to provide continuous monitoring, assessment, and interventional services to a large number of patients across multiple ICUs. This new practice environment offers experienced critical care nurses an opportunity for career and knowledge expansion while reducing some of the physical and emotional risks encountered at the bedside. The role of the tele-ICU is still evolving but focuses on 4 areas of responsibility: performing virtual rounds, managing patient alerts, providing ICU support, and coaching or providing teaching moments. The transition from the bedside into the tele-ICU role can be complex as tele-ICU nurses encounter ICU acceptance barriers and a lack of or a change in professional identity. A formal orientation program focused on competency is necessary for the successful transition from bedside nurse to tele-ICU nurse.

Patient safety: nursing students' perspectives and the role of nursing education to provide safe care

BACKGROUND AND AIM

Nurses as the largest group of healthcare providers are in the best position to improve patient safety. In preparing future nurses, nurse educators have an important role in developing the knowledge, skills and attitudes among nursing students related to patient safety. The aim of this study was to explore Iranian nursing students' perspectives regarding patient safety and the role of nursing education in developing their capabilities to provide safe care.

METHODS

A purposeful sampling strategy was used to recruit 17 junior and senior nursing students for qualitative, semi-structured interviews. Content analysis of the interview transcripts was conducted to identify several relevant themes.

FINDINGS

Three main themes emerged from the data analysis: 'safety as patient comfort', 'not being knowledgeable or experienced enough' and 'being helped to internalise the principles and values of patient safety'. The third theme consisted of two categories: 'adopting a humanistic approach towards patients' and 'practising conscientiously in the workplace'.

CONCLUSION

The present study adds insights on how nursing students understand and may be helped to internalise concepts of patient safety within their practice. Nursing education curriculum designers need to go beyond theoretical concepts of patient safety education and devise strategies to increase the application of safety knowledge and competencies in nursing practice.

The dimensions of nursing surveillance: a concept analysis

AIM

This paper is a report of an analysis of the concept of nursing surveillance.

BACKGROUND

Nursing surveillance, a primary function of acute care nurses, is critical to patient safety and outcomes. Although it has been associated with patient outcomes and organizational context of care, little knowledge has been generated about the conceptual and operational process of surveillance.

DATA SOURCES

A search using the CINAHL, Medline and PubMed databases was used to compile an international data set of 18 papers and 4 book chapters published from 1985 to 2009.

REVIEW METHODS

Rodger's evolutionary concept analysis techniques were used to analyse surveillance in a systems framework. This method focused the search to nursing surveillance (as opposed to other medical uses of the term) and used a theoretical framework to guide the analysis.

RESULTS

The examination of the literature clarifies the multifaceted nature of nursing surveillance in the acute care setting. Surveillance involves purposeful and ongoing acquisition, interpretation and synthesis of patient data for clinical decision-making. Behavioural activities and multiple cognitive processes are used in surveillance in order for the nurse to make decisions for patient safety and health maintenance. A systems approach to the analysis also demonstrates how organizational characteristics and contextual factors influence the process in the acute care environment.

CONCLUSION

This conceptual analysis describes the nature of the surveillance process and clarifies the concept for effective communication and future use in health services research.

Responses to Work Complexity: The Novice to Expert Effect

The purpose of this study was to explore the differences in how advanced beginners, competent, and expert nurses prioritize and reprioritize patient care. This qualitative study had a purposive sample of 23 nurses on cardiac/ telemetry units at five hospitals. Four themes emerged from the data: cognitive strategies, communication, integration of roles, and response to the work environment. As the nurses progressed in expertise, they were better able to organize, more effectively deal with interruptions, anticipate patient needs, integrate varied nursing roles into their work, and communicate effectively. The significance of this study is the identification of factors that affect the nurse’s ability to work productively in today’s care environment. It increases understanding of the graduate nurses’ perception and response to the complexity and work of nursing. An understanding of these factors provides the basis for further research to understand and promote transition of nurses from advanced beginner to expert.

The quest for new innovative care delivery models

In response to growing nurse shortages and heightened attention to patient quality, many healthcare organizational leaders are developing and testing new care delivery models. These models strive to improve patient quality and satisfaction by engaging nurses and other healthcare professionals in different roles across the continuum of care. In this article, the authors profile 5 new care delivery models from their current work sponsored by the Robert Wood Johnson Foundation. In addition, the authors identify common elements underlying the success of the models.

Leading change: the nurse executive's role in implementing new care delivery models

Implementation of innovative patient care delivery models provides an opportunity to examine how effective nurse leaders are leading change in the healthcare system. The trends and pressures that make change imperative, not optional, are discussed in other articles in this issue. The focus of this article is on how chief nursing officers improve patient safety and increase care quality while managing the complexities of the nursing workforce and controlling costs. The authors examine the leader's role in the change process, in particular, the role of nursing leaders. The care delivery model is considered an instrument for change, and the chief nursing officer is a change agent.