Light for Nurses' Work in the 21st Century: A Review of Lighting, Human Vision Limitations, and Medication Administration

Does a Welcoming Environment Influence Women Veterans' Primary Care Experiences?

BACKGROUND

A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8-10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes.

PROCEDURES

We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016-2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans' optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers.

MAIN FINDINGS

Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal.

PRINCIPAL CONCLUSIONS

Ensuring a welcoming environment may improve women veterans' primary care experiences.

Selected Medication Safety Risks to Manage in 2016—Part II Methylergonovine Errors in Obstetrics

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Is There Light? Well It Depends--A Grounded Theory Study of Nurses, Lighting, and Medication Administration

OBJECTIVE

We know that human vision has limitations, medication administration is a high-risk activity, and some nurses work in environments that do not meet recommended lighting standards. The goal of this study was to inform safe medication administration practices and add evidence for establishing guidelines for lighting decisions by understanding registered nurses' (RNs') decision making about lighting during medication administration.

METHODS

Grounded theory methodology was followed (n = 16). Theoretical sampling was used to ensure that participants represented a variety of backgrounds and hospital settings. Results were validated by three expert researchers. Two of the researchers had significant expertise in medication administration errors.

RESULTS

Data analysis culminated in the substantive theory It Depends. This theory describes a process of frequently automatic decision making about lighting, whose aspects include assessing variation, balancing safety and healing, and RN bias. All RNs expressed concerns about perceived risks in relation to lighting, but had difficulty describing how they confirmed when the correct decision about lighting was made.

CONCLUSIONS

Nurses are often unaware of their reasons for lighting decisions, and there is a need for education and other measures to increase the likelihood that lighting decisions that enhance patient safety are made by nurses.