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Kumar S. Psychological Safety: What It Is, Why Teams Need It, and How to Make It Flourish. Chest 2024; 165:942-949. [PMID: 37977265 DOI: 10.1016/j.chest.2023.11.016] [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: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
In health care, transforming individuals with diverse skills into an effective, cohesive team is fundamental to delivering and advancing patient care. All teams, however, are not created the same. Psychological safety has emerged as a critical feature of high-performing teams across many industries, including health care. It facilitates patient safety, quality improvement, learning, and innovation. This review presents an overview of psychological safety in medicine, describing its impact on learning, patient safety, and quality improvement. The review also explores interventions and essential leadership behaviors that foster psychological safety in teams.
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Affiliation(s)
- Santhi Kumar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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2
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Chan SCC. The Power of Positive Reinforcement in Health Care. J Patient Saf 2024; 20:e1-e2. [PMID: 37948055 DOI: 10.1097/pts.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
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Padigos J, Reid S, Kirby E, Anstey C, Broom J. Nursing experiences in antimicrobial optimisation in the intensive care unit: A convergent analysis of a national survey. Aust Crit Care 2023; 36:769-781. [PMID: 36404269 DOI: 10.1016/j.aucc.2022.09.005] [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: 06/02/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied. OBJECTIVE The objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia. METHODS An anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated. RESULTS A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement. CONCLUSION The multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles.
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Affiliation(s)
- Junel Padigos
- Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Simon Reid
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney NSW, 2052, Australia
| | - Chris Anstey
- School of Medicine and Dentistry, Griffith University, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Jennifer Broom
- Infectious Diseases Research Network, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
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Kenner C, Boykova M. Burnout and Resilience in Neonatal Nurses. J Perinat Neonatal Nurs 2023; 37:178-180. [PMID: 37494683 DOI: 10.1097/jpn.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Carole Kenner
- Carol Kuser Loser Dean/Professor of the School of Nursing, Health, and Exercise Science, The College of New Jersey, Ewing, New Jersey, Chief Executive Officer, Council of International Neonatal Nurses, Inc (COINN), Yardley, Pennsylvania
| | - Marina Boykova
- Associate Professor, School of Nursing and Health Professions, Holy Family University, Philadelphia, Pennsylvania, Non-executive Board Member, Council of International Neonatal Nurses, Inc. (COINN), Yardley, Pennsylvania
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Mulvey T, Cámpoli M, Lundmark V. Establishing a Pathway to Excellence® Research Agenda: A Delphi Study to Identify Research Priorities for Evaluating Positive Practice Environments. J Nurs Adm 2023; 53:189-196. [PMID: 36916787 PMCID: PMC10026953 DOI: 10.1097/nna.0000000000001269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The aim of this study was to develop research priorities for positive practice environments identified by Pathway to Excellence® (Pathway) leaders and appraisers. BACKGROUND Identifying research priorities achieves 2 goals: 1) advancing research agendas that impact improving practice environments, and nurse and patient outcomes; and 2) informing nursing leaders, researchers, and funders of potential research projects to conduct and support. METHODS Research topics related to the 6 Pathway standards were developed and then rated for importance through 3 rounds of a Delphi survey by leaders at Pathway-designated organizations and Pathway appraisers. RESULTS Twenty research priorities were identified from the initial 54 research topics. The top 2 priorities were building and maintaining shared governance participation (91.9%) and nurse participation in performance improvement and evidence-based practice activities (90.7%). CONCLUSIONS Establishing a Pathway research agenda will guide nursing leadership, researchers, and funders in selecting impactful research priorities to help bolster positive practice environments that engage and empower nurses.
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Hitchner L, Yore M, Burk C, Mason J, Sawtelle Vohra S. The resident experience with psychological safety during interprofessional critical event debriefings. AEM EDUCATION AND TRAINING 2023; 7:e10864. [PMID: 37013133 PMCID: PMC10066498 DOI: 10.1002/aet2.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
Objectives Interprofessional feedback and teamwork skills training are important in graduate medical education. Critical event debriefing is a unique interprofessional team training opportunity in the emergency department. While potentially educational, these varied, high-stakes events can threaten psychological safety for learners. This is a qualitative study of emergency medicine resident physicians' experience of interprofessional feedback during critical event debriefing to characterize factors that impact their psychological safety. Methods The authors conduced semistructured interviews with resident physicians who were the physician team leader during a critical event debriefing. Interviews were coded and themes were generated using a general inductive approach and concepts from social ecological theory. Results Eight residents were interviewed. The findings suggest that cultivating a safe learning environment for residents during debriefings involves the following: (1) allowing space for validating statements, (2) supporting strong interprofessional relationships, (3) providing structured opportunities for interprofessional learning, (4) encouraging attendings to model vulnerability, (5) standardizing the process of debriefing, (6) rejecting unprofessional behavior, and (7) creating the time and space for the process in the workplace. Conclusions Given the numerous intrapersonal, interpersonal, and institutional factors at play, educators should be sensitive to times when a resident cannot engage due to unaddressed threats to their psychological safety. Educators can address these threats in real time and over the course of a resident's training to enhance psychological safety and the potential educational impact of critical event debriefing.
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Affiliation(s)
- Lily Hitchner
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Mackensie Yore
- UCLA National Clinician Scholars Program, Department of Emergency MedicineGreater Los Angeles VA Medical CenterCaliforniaLos AngelesUSA
| | - Charney Burk
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Jessica Mason
- Department of Emergency MedicineJohn Peter Smith HospitalFort WorthTexasUSA
| | - Stacy Sawtelle Vohra
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
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Lackie K, Hayward K, Ayn C, Stilwell P, Lane J, Andrews C, Dutton T, Ferkol D, Harris J, Houk S, Pendergast N, Persaud D, Thillaye J, Mills J, Grant S, Munroe A. Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers. J Interprof Care 2023; 37:187-202. [PMID: 35403551 DOI: 10.1080/13561820.2022.2052269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.
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Affiliation(s)
| | | | | | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University
| | | | | | - Tanya Dutton
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
| | - Doug Ferkol
- Centre for Collaborative Clinical Learning and Research
| | | | | | | | | | | | | | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University
| | - Andrew Munroe
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
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Murray JS, Kelly S, Hanover C. Promoting Psychological Safety in Healthcare Organizations. Mil Med 2022; 187:808-810. [PMID: 35247055 DOI: 10.1093/milmed/usac041] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/17/2022] Open
Abstract
Healthcare organizations across the United States have begun the journey to high reliability as one method for improving patient safety. Being a High Reliability Organization (HRO) requires constant vigilance for ensuring the delivery of system-wide excellence in patient quality and safety. Establishing a foundation for high reliability requires the engagement of personnel across the organization from frontline staff to executive leadership. Staff must feel comfortable voicing concerns in order to be fully engaged. However, we believe this is easier said than done. The purpose of this article is to describe the importance of psychological safety along the journey to becoming an HRO. Additionally, strategies for promoting a psychologically safe work environment are provided.
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Affiliation(s)
| | - Sarah Kelly
- Veterans Affairs Providence Health Care System, Providence, RI 02908-4738, USA
| | - Christine Hanover
- Veterans Affairs Providence Health Care System, Providence, RI 02908-4738, USA
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Bushell H, Lee S, Keppich-Arnold S, Anderson S, Batu G, Hopkins L. How Do Mental Health Nurses Define Success? A Comparative Study of Bed-Based and Community-Based Services. Issues Ment Health Nurs 2021; 42:836-844. [PMID: 33539193 DOI: 10.1080/01612840.2020.1871133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nursing is the single largest professional group within both hospital and community mental health care services, however the role of mental health nurses in under-defined. The nursing workforce is also coming under increasing pressure from internal and external requirements, and nurses themselves are on the frontline of providing patient care in what can be a risky and unpredictable workplace environment. This project explored via interview the ways in which mental health nurses experience and reflect on their personal and professional feelings of nursing success. Participants were 19 nurses who were employed in a range of bed-based and community mental health services in inner south eastern Melbourne. This study complies with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The findings of the project align with existing evidence from the literature. Factors which helped mental health nurses feel successful included: therapeutic success; good teamwork; targeted education; and feedback. Barriers to success included: patients/clients do not engage or recover; poor communication amongst staff; lack of psychological safety in the workplace; and lack of respect from management. Nurses in community settings were more able than nurses in bed-based settings to: make effective use of clinical supervision; make use of targeted training and educational offerings; and practice therapeutically and holistically. Project results offer an opportunity to understand nurses' motivations and reward systems. Better understanding of these issues can improve the way mental health care services manage their workforce planning, maintain staff personal wellbeing, increase staff retention and ultimately improve patient/client care.
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Affiliation(s)
- Hannah Bushell
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia
| | - Stuart Lee
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, VIC, Australia.,Victorian Institute for Forensic Mental Health (Forensicare), Fairfield, VIC, Australia
| | | | | | - Gamze Batu
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia
| | - Liza Hopkins
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia
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Hungerford C, Cleary M. 'High Trust' and 'Low Trust' Workplace Settings: Implications for Our Mental Health and Wellbeing. Issues Ment Health Nurs 2021; 42:506-514. [PMID: 33016852 DOI: 10.1080/01612840.2020.1822480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Michell Cleary
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
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Remtulla R, Hagana A, Houbby N, Ruparell K, Aojula N, Menon A, Thavarajasingam SG, Meyer E. Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC Health Serv Res 2021; 21:269. [PMID: 33761958 PMCID: PMC7988250 DOI: 10.1186/s12913-021-06232-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological safety is the concept by which individuals feel comfortable expressing themselves in a work environment, without fear of embarrassment or criticism from others. Psychological safety in healthcare is associated with improved patient safety outcomes, enhanced physician engagement and fostering a creative learning environment. Therefore, it is important to establish the key levers which can act as facilitators or barriers to establishing psychological safety. Existing literature on psychological safety in healthcare teams has focused on secondary care, primarily from an individual profession perspective. In light of the increased focus on multidisciplinary work in primary care and the need for team-based studies, given that psychological safety is a team-based construct, this study sought to investigate the facilitators and barriers to psychological safety in primary care multidisciplinary teams. METHODS A mono-method qualitative research design was chosen for this study. Healthcare professionals from four primary care teams (n = 20) were recruited using snowball sampling. Data collection was through semi-structured interviews. Thematic analysis was used to generate findings. RESULTS Three meta themes surfaced: shared beliefs, facilitators and barriers to psychological safety. The shared beliefs offered insights into the teams' background functioning, providing important context to the facilitators and barriers of psychological safety specific to each team. Four barriers to psychological safety were identified: hierarchy, perceived lack of knowledge, personality and authoritarian leadership. Eight facilitators surfaced: leader and leader inclusiveness, open culture, vocal personality, support in silos, boundary spanner, chairing meetings, strong interpersonal relationships and small groups. CONCLUSION This study emphasises that factors influencing psychological safety can be individualistic, team-based or organisational. Although previous literature has largely focused on the role of leaders in promoting psychological safety, safe environments can be created by all team members. Members can facilitate psychological safety in instances where positive leadership behaviours are lacking - for example, strengthening interpersonal relationships, finding support in silos or rotating the chairperson in team meetings. It is anticipated that these findings will encourage practices to reflect on their team dynamics and adopt strategies to ensure every member's voice is heard.
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Affiliation(s)
- Ridhaa Remtulla
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Arwa Hagana
- Imperial College London, School of Medicine, London, UK
| | - Nour Houbby
- Imperial College London, School of Medicine, London, UK
| | | | | | - Anannya Menon
- Imperial College London, School of Medicine, London, UK
| | | | - Edgar Meyer
- Leeds University Business School, University of Leeds, Leeds, UK
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Toews AJ, Martin DE, Chernomas WM. Clinical debriefing: A concept analysis. J Clin Nurs 2021; 30:1491-1501. [PMID: 33434382 DOI: 10.1111/jocn.15636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition. BACKGROUND Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting. DESIGN Concept analysis. METHODS Walker and Avant's eight-step approach to concept analysis. RESULTS The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing. CONCLUSION Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings. RELEVANCE TO CLINICAL PRACTICE A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development.
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Affiliation(s)
- Andrea J Toews
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Donna E Martin
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Wanda M Chernomas
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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Vessey JA, Williams L. Addressing Bullying and Lateral Violence in the Workplace: A Quality Improvement Initiative. J Nurs Care Qual 2021; 36:20-24. [PMID: 32168113 DOI: 10.1097/ncq.0000000000000480] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bullying and lateral violence are pervasive in the nursing workforce and have profound psychosocial, physical, safety, and financial consequences for nurses, their patients, and the overall health care organization. PROBLEM Unit-based nursing leaders may be aware of bullying and lateral violence but be unsure of the best approaches to address it. APPROACH An iterative, multimodal quality improvement initiative was crafted on the basis of the available evidence and principles of transformational, adult learning. Six units were designed to foster didactic, affective, and psychomotor learning specific to bullying and lateral violence and their prevention. Each unit consisted of formal lecture content, practice exercises, and reflection. OUTCOMES This quality improvement project was well received by participants; a unit-based action plan resulted. Project materials are being reworked and new evidence integrated for deployment across the department. CONCLUSIONS This initiative has demonstrated the necessary properties and is appropriate for adoption by other nursing units.
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Affiliation(s)
- Judith A Vessey
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts (Dr Vessey); Medicine Patient Services, Boston Children's Hospital, Boston, Massachusetts (Dr Vessey); and Experimental Therapeutics Unit, and Interventional Trials and Experimental Therapeutics, Boston Children's Hospital, Boston, Massachusetts (Dr Williams)
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