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Maddineshat M, Safi-Keykaleh M, Ghaleiha A, Sadeghian E. Speaking Up: Exploring Mental Health Care Workers' Patient Safety Concerns. J Psychosoc Nurs Ment Health Serv 2024:1-9. [PMID: 38709102 DOI: 10.3928/02793695-20240424-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
PURPOSE To explore the perspectives and experiences of mental health care workers (MHCWs) when speaking up about patient safety concerns. METHOD A qualitative study was performed at Farshchian (Sina) Hospital in Iran, involving the purposive sampling of MHCWs from three inpatient psychiatric wards. From July to October 2022, semi-structured interviews were conducted with 23 participants. Data were analyzed using conventional content analysis. RESULTS Three major patient safety themes were identified: (a) Voicing Concerns for Daily Safety (subthemes: daily safety check-ins and speaking up to prevent patient harm); (b) Speaking Up to Save Future Lives (subthemes: whistleblowing, leadership, and being open to communication); and (c) Hesitating to Speak Up (sub-themes: ineffectiveness of raising one's voice and whispering). CONCLUSION MHCWs have various concerns about speaking up or staying silent. Failure to communicate can result in adverse events and missed opportunities to address patient safety. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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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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Shroff FM, Mehta DH. Wellbeing Convene during COVID-19: A pilot intervention for improving wellbeing and social connectedness for staff, students, residents, and faculty. J Clin Transl Sci 2023; 7:e269. [PMID: 38380389 PMCID: PMC10877516 DOI: 10.1017/cts.2023.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024] Open
Abstract
Background Canada is facing its worst crisis among healthcare workers in recent healthcare history. Anxiety, depression, suicidal ideation, and severe burnout are higher than before the COVID-19 pandemic. University Faculties of Medicine (FoMs) are vital to healthcare systems. Not only are they responsible for training personnel, but clinicians and staff from FoMs often work directly within healthcare systems. FoMs include students, staff, residents, faculty members, residents, researchers, and others, many experiencing higher stress levels due to pandemic tensions. Most FoMs emphasize cognitive and psychomotor learning needs. On the other hand, affective learning needs are not as well addressed within most FoMs. Finding innovative means to ameliorate mental and emotional health status, particularly at this critical juncture, will improve health and wellness, productivity, and retention. This article discusses a pilot program, Wellbeing Convene during COVID-19, in a Canadian FoM, which aimed to (1) provide staff, faculty, residents, and students with a toolkit for greater wellbeing and (2) build a sense of community during isolating times. Results Participants found the program beneficial in both regards. We recommend that these kinds of programs be permanently available to all members in FoMs, at no cost. Wellness programs alone, however, will not solve the root causes of mental and emotional stress, often based on concerns related to finances, hierarchical workplace structures, and nature of the work itself, among other factors. Conclusion Addressing the mental and emotional health of people in FoMs is vital to improving productivity and reducing stress of FoMs, healthcare professionals, and, ultimately, patients.
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Affiliation(s)
- Farah M. Shroff
- Maternal and Infant Health Canada, Vancouver,
BC, Canada
- Department of Family Practice, University of British Columbia
Faculty of Medicine, Vancouver, BC,
Canada
- School of Population and Public Health, University of British Columbia Faculty
of Medicine, Vancouver, BC,
Canada
- Harvard HealthLab Accelerators Venture Board
Member, Boston, MA, USA
| | - Darshan H. Mehta
- Harvard Medical School, Boston, MA,
USA
- Benson-Henry Institute for Mind Body Medicine, Massachusetts
General Hospital, Boston, MA,
USA
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4
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Kane J, Munn L, Kane SF, Srulovici E. Defining Speaking Up in the Healthcare System: a Systematic Review. J Gen Intern Med 2023; 38:3406-3413. [PMID: 37670070 PMCID: PMC10682351 DOI: 10.1007/s11606-023-08322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Communication issues have been shown to contribute to healthcare errors. For years healthcare professionals have been told to "speak up." What "speak up" means is unclear, as it has been defined and operationalized in many ways. Thus, this study aimed to systematically review the literature regarding definitions and measurements of speaking up in the healthcare system and to develop a single, comprehensive definition and operationalization of the concept. METHODS PubMed, CINAHL, PsychoInfo, and Communication/Mass Media Complete databases were searched from 1999 to 2020. Publications were included if they mentioned speaking up for patient safety or any identified synonyms. Articles that used the term speaking up concerning non-health-related topics were excluded. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 294 articles met the inclusion criteria, yet only 58 articles focused on speaking up. While the most common synonym terms identified were "speak up" and "raise concern," only 43 articles defined speaking up. Accordingly, a modified definition was developed for speaking up-A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. DISCUSSION Speaking up is considered important for patient safety. Yet, there has been a lack of agreement on the definition and operationalization of speaking up. This review demonstrates that speaking up should be reconceptualized to provide a single definition for speaking up in healthcare.
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Affiliation(s)
- Julia Kane
- School of Nursing, Fayetteville State University, Fayetteville, NC, USA
| | - Lindsay Munn
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shawn F Kane
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
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Chen HW, Wu JC, Kang YN, Chiu YJ, Hu SH. Assertive communication training for nurses to speak up in cases of medical errors: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2023; 126:105831. [PMID: 37121073 DOI: 10.1016/j.nedt.2023.105831] [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: 11/08/2022] [Revised: 04/02/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Several authors have previously assessed the effects of assertive communication training for nurses to speak up in cases of medical errors. Inconsistent results regarding the nurses' attitudes, behaviors, and confidence levels were noticed. OBJECTIVE To identify the effectiveness of assertive communication training on nurses' behaviors, attitudes, and confidence levels for speaking up in cases of medical errors and to identify vital components for success. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, ERIC, Embase, Scopus, and CINAHL were searched up for studies published from the inception of the database to December 16, 2022. METHODS Two researchers independently performed a primary screening of titles and abstracts for relevant studies, followed by a review of full texts if the references met inclusion criteria and quality assessment. Data were retrieved for nurses and nursing students who received medical error-related assertive communication training for speaking up, and learning outcomes for attitudes, behaviors, and confidence levels were reported based on pooled data. Pooled estimates were calculated using a random-effects model. RESULTS A total of eleven studies with 1299 participants were included in systematic review, and among them nine studies with 804 participants were analyzed in meta-analysis. From the pooled results, the intervention group, which received assertive communication training, exhibited substantially improved speaking-up behaviors compared with the control group (SMD = 0.58; 95 % CI, 0.14-1.03). Considerable differences were noted in the nurses' times of speaking up in cases of medical errors between pretest (38 %; 95 % CI, 0.14-0.68) and posttest (78 %; 95 %CI, 0.70-0.85) based on the pooled data. The nurses' attitudes and confidence levels for speaking up varied markedly between pretest and posttest. CONCLUSION Structured assertive communication training may improve nurses' speaking-up behaviors in cases of medical errors. To conduct effective assertive communication training, nursing educators should incorporate multiple teaching approaches into structured training and ensure an adequate training duration.
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Affiliation(s)
- Hui-Wen Chen
- Doctoral Program, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jen-Chieh Wu
- Department of Emergency, Taipei Medical University Hospital, Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yi-No Kang
- Department of Emergency, Taipei Medical University Hospital, Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Sophia H Hu
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
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Jeong JH, Kim SS. South Korean Nurses' Experiences of Speaking up for Patient Safety and Incident Prevention. Healthcare (Basel) 2023; 11:1764. [PMID: 37372881 DOI: 10.3390/healthcare11121764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the importance of speaking up for patient safety, hesitancy to do so remains a major contributing factor to communication failure. This study aimed to investigate the experiences of South Korean nurses in speaking up to prevent patient safety incidents. Twelve nurses responsible for patient safety tasks or with experience in patient safety education were recruited from five hospitals (three university hospitals, two general hospitals) in city "B". Data were collected through open-ended questions and in-depth interviews, transcribed, and analyzed using the inductive content analysis method. The study resulted in the identification of four main categories and nine subcategories that captured commonalities among the experience of the 12 nurses. The four main categories were as follows: the current scenario of speaking up, barriers to speaking up, strategies for speaking, and confidence training. There is a scarcity of research on speaking-up experiences for patient safety among nurses in South Korean. Overall, it is necessary to overcome cultural barriers and establish an environment that encourages speaking up. In addition, developing speaking-up training programs for nursing students and novice nurses is imperative to prevent patient safety incidents.
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Affiliation(s)
- Jeong Hee Jeong
- Department of Nursing Science, Kyungsung University, Busan 48434, Republic of Korea
| | - Sam Sook Kim
- Department of Nursing, Daedong College, Busan 46270, Republic of Korea
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Gamble Blakey A, Anderson L, Smith-Han K, Collins E, Berryman E, Wilkinson TJ. Supporting Bystanders and Other Staff Exposed to Negative Workplace Behaviour: Developing and Testing the IMO Intervention Framework in the Clinical Workplace. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:71-86. [PMID: 36761370 PMCID: PMC9905205 DOI: 10.2147/amep.s379429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or "stand up" to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke) are rarely acknowledged, and neither is the potential for considerable cognitive dissonance should they choose not to. METHODS Drawing on a substantial literature review, we developed an interventional program, initially with medical student bullying in mind, that generally employed a discourse for values cultivation. We implemented and evaluated this program through 6 cycles of action research methodology in 6 different departments of one tertiary teaching hospital. Data include individual interviews, discussions with key participants plus freehand comments from wider staff's workshop evaluations. RESULTS Alongside others, an early serendipitous finding was the "IMO" [Indirect, focus on Me, focus on Outcome] framework, intended for bystanders to student bullying. From using this framework, participants reported developing confidence in tackling negative behaviours, that interactions had better outcomes and that the workplace atmosphere felt more relaxed. It's use also significantly reduced cognitive dissonance. Encouragingly, participants went on to use IMO for staff-staff bullying incidents, and other common negative behaviours. We attribute IMO's utility to its memorability, simplicity and for catering to the many possible causes of bullying, including values issues, without perpetuating or creating conflict. CONCLUSION The IMO framework is offered as a widely usable framework for all staff in a clinical environment - a useful addition to popular frameworks used in the clinical workplace, ideas from which might also help these be further refined. Further evaluation would establish whether IMO invites long-term change and its utility in other contexts.
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Affiliation(s)
| | | | - Kelby Smith-Han
- Medical Education Unit, University of Western Australia, Perth, Australia
| | - Emma Collins
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | | | - Tim J Wilkinson
- Otago Medical School, University of Otago, Dunedin, New Zealand
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A Controlled Adaptive Computational Network Model of a Virtual Coach Supporting Speaking Up by Healthcare Professionals to Optimise Patient Safety. COGN SYST RES 2023. [DOI: 10.1016/j.cogsys.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Gregory ME, MacEwan SR, Sova LN, Gaughan AA, McAlearney AS. A Qualitative Examination of Interprofessional Teamwork for Infection Prevention: Development of a Model and Solutions. Med Care Res Rev 2023; 80:30-42. [PMID: 35758303 PMCID: PMC10278586 DOI: 10.1177/10775587221103973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Health care-associated infections (HAIs), such as central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), are associated with patient mortality and high costs to the health care system. These are largely preventable by practices such as prompt removal of central lines and Foley catheters. While seemingly straightforward, these practices require effective teamwork between physicians and nurses to be enacted successfully. Understanding the dynamics of interprofessional teamwork in the HAI prevention context requires further examination. We interviewed 420 participants (physicians, nursing, others) across 18 hospitals about interprofessional collaboration in this context. We propose an Input-Mediator-Output-Input (IMOI) model of interprofessional teamwork in the context of HAI prevention, suggesting that various organizational processes and structures facilitate specific teamwork attitudes, behaviors, and cognitions, which subsequently lead to HAI prevention outcomes including timeliness of line and Foley removal, ensuring sterile technique, and hand hygiene. We then propose strategies to improve interprofessional teamwork around HAI prevention.
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Affiliation(s)
- Megan E. Gregory
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Sarah R. MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Lindsey N. Sova
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Alice A. Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH
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Lee SE, Kim E, Lee JY, Morse BL. Assertiveness educational interventions for nursing students and nurses: A systematic review. NURSE EDUCATION TODAY 2023; 120:105655. [PMID: 36462396 DOI: 10.1016/j.nedt.2022.105655] [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: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The purpose of this study was three-fold: to (1) synthesize evidence from experimental studies regarding educational interventions for developing nursing students' and nurses' assertiveness, (2) examine such interventions and identify their effective components, and (3) recommend future research considerations in this area. DESIGN A systematic review of the literature. DATA SOURCES Literature searches were conducted using three electronic databases (PubMed, CINAHL, and PsycINFO) in addition to hand searches to identify original research articles published between 2012 and 2022. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for the systematic review and reporting process. Included studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Checklists. RESULTS Fourteen articles were included in this review, with most of the studies conducted in Asian countries. Four intervention methods were used for assertiveness education across the studies: (1) simulation-based learning, (2) classroom-based learning, (3) classroom-based learning with peer support, and (4) hybrid learning. Classroom-based learning interventions were the most common. Among all types of interventions, key concepts included assertiveness, differentiating between assertive and non-assertive behaviors, and assertive communication skills. Most studies measured participants' speaking-up behaviors by self-report. Mixed results were observed in terms of intervention effectiveness, but providing participants with opportunities to practice assertive communication skills benefited their speaking-up. CONCLUSIONS Educational interventions can strengthen the skills, confidence, and capacity of current and future nurses to employ assertive communication. Intervention developers should create programs that involve classroom teaching and provide participants with opportunities for practice, either through simulation or role-play. Also, researchers should observe participants' post-intervention use of assertive communication in simulations or clinical practice as opposed to surveying participants' intention to speak up.
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Affiliation(s)
- Seung Eun Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea.
| | - Eunkyung Kim
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, South Korea
| | - Ji Yea Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Brenna L Morse
- Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Lowell, MA 01854, USA.
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Effectiveness of speak-up training programs for clinical nurses: A scoping review. Int J Nurs Stud 2022; 136:104375. [PMID: 36327680 DOI: 10.1016/j.ijnurstu.2022.104375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Speaking up about patient safety concerns is critical when bedside nurses encounter unsafe situations. Training programs that encourage nurses' speaking up behavior have been introduced, but there is limited evidence regarding whether such training leads to behavior change or improves patient safety. OBJECTIVE The aim of this review was to identify the effectiveness of speak-up training programs for clinical nurses, focusing on program content and outcomes. DESIGN A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to the Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. METHODS This study used bibliographic databases of PubMed, Embase, PsycINFO, Scopus, ProQuest Dissertations and Theses Global for the English language, and NDSL, KCI, RISS, KISS, and DBpia for the Korean language. The literature search used a combination of keywords and subject headings related to speak-up training programs for nurses or any type of nurse training program with an assertiveness component. Training outcomes were evaluated according to the 4-level Kirkpatrick model. RESULTS A total of 4808 references were retrieved, of which 21 articles were selected. These 21 studies were conducted in different parts of the world and published from 1981 to 2020. Speak-up training primarily increased some degree of nurses' levels of assertiveness and speak-up behavior, and also led to secondary outcomes such as job stress, work motivation, and communication conflicts. Most studies (n = 19) applied traditional training formats which consisted of multi-session lectures and practice, whereas three studies applied new methodologies such as high-fidelity simulations and online learning. According to the Kirkpatrick model, five studies assessed reactions to speak-up training (level 1), all studies evaluated learning as a result of training (level 2), two studies measured the effect of speak-up training on nurses' behavior (level 3), and one study evaluated nurses' results (level 4) while no studies evaluated patient-level outcomes. CONCLUSIONS Speak-up training for nurses can improve their levels of assertiveness or speak-up behaviors. Despite inconsistent or mixed findings, speak-up training has the potential to improve nurses' psychological well-being, leading to positive organizational performance. New training methods are directed at specialized education for clinical situations. Future speak-up training should consist of training programs based on real clinical situations in which team members participate together to comprehensively evaluate the effect of training on behavioral changes of health professionals as well as patient safety.
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Violato E. A state-of-the-art review of speaking up in healthcare. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1177-1194. [PMID: 35666354 DOI: 10.1007/s10459-022-10124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Throughout healthcare, including education, the need for voicing of concern by speaking up is a globally recognized issue that has come to the fore in the last ten years. There has been a rapid growth in the number of review articles on the topic. To prevent diffusion of knowledge and support future research it is necessary to gather the existing knowledge in a single place. The purpose of the present article is to bring together the existing reviews on speaking up to create a source of unified knowledge representing the current "State of the Art" to advance future research and practice. A State-of-the-Art review was conducted to synthesize the existing knowledge on speaking up. Six databases were searched. Fourteen review articles spanning 2012 to 2021 were identified. Five main research questions have been investigated in the literature and five common recommendations for improvement are made, the knowledge across all reviews related to the research questions and recommendations was synthesized. Additionally, simulation-based research was frequently identified as an important though limited method. Further issues in the literature are identified and recommendations for improvement are made. A synthesis was successfully developed: knowledge about speaking up and research related to speaking up is in an emergent state with more shortcomings, questions, and avenues for improvement than certitude. The whys and how of speaking up remain open questions.
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Affiliation(s)
- Efrem Violato
- Center for Advanced Medical Simulation, Northern Alberta Institute of Technology, CAT 126, 11762 106 St NW, Edmonton, AB, T5G 2R1, Canada.
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Ortiz-López N, Ponce-Arancibia S, Olea-Gangas C, Chacano-Muñoz R, Arancibia-Carvajal S, Solis I. Determinants of the intention to speak up about medical error in primary healthcare settings in Chile. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1202-e1211. [PMID: 34431150 DOI: 10.1111/hsc.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Medical error frequently occurs in ambulatory care, and healthcare professionals may encounter situations in which they need to speak up to ensure better practice. This study aims to investigate the factors that influenced the intention to speak up about medical errors among healthcare professionals in primary care settings. Data were generated through a national cross-sectional survey of primary healthcare centres in the Republic of Chile. A research instrument was designed using the constructs of the theory of planned behaviour and was analysed using the structural equation model technique. In total, 203 healthcare professionals were recruited between March and May 2020. The model showed that the intention to speak up was directly and positively influenced by attitudes towards speaking up and perceived control (standard deviation [SD] = 0.284 and 0.576, respectively). Subjective norms indirectly and negatively influenced the intention to speak up through attitudes towards speaking up and perceived control (total effect SD = -0.303). The exploratory construct of willingness to change self-behaviour positively influenced the attitude towards behaviour. The intention to speak up strongly influenced the speaking up behaviour (total effect SD = 0.631). The proposed model explained 40% of the variance in behaviour. Based on this model, it was concluded that the intention to speak up strongly influenced the speaking up behaviour and predicted it by 40%. Factors that modify the intention to speak up are expected to influence the occurrence of this behaviour. This knowledge will inform strategies to enhance communication among healthcare professionals, improve speaking up behaviour and improve patient care.
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Affiliation(s)
| | | | | | | | - Sara Arancibia-Carvajal
- Institute of Basic Sciences, Faculty of Engineering and Sciences, Diego Portales University, Santiago, Chile
| | - Ivan Solis
- University of Chile School of Medicine, Santiago, Chile
- Department of Medicine, University of Chile Clinical Hospital, Santiago, Chile
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Heggestad AKT, Konow-Lund AS, Christiansen B, Nortvedt P. A vulnerable journey towards professional empathy and moral courage. Nurs Ethics 2022; 29:927-937. [PMID: 35225056 PMCID: PMC9289973 DOI: 10.1177/09697330221074013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Empathy and moral courage are important virtues in nursing and nursing ethics. Hence, it is of great importance that nursing students and nurses develop their ability to empathize and their willingness to demonstrate moral courage. Research aim: The aim of this article is to explore third-year undergraduate nursing students’ perceptions and experiences in developing empathy and moral courage. Research design: This study employed a longitudinal qualitative design based on individual interviews. Participants and research context: Seven undergraduate nursing students were interviewed during or immediately following their final clinical placement. Ethical considerations: The Norwegian Social Science Data Services (NSD) approved the study. Participants were informed that their participation was voluntary and were assured confidentiality. They were informed that they could withdraw from the study at any time, without providing reasons. Findings: Affective empathy seemed to be strong among third-year undergraduate nursing students. However, they tried to handle the situations in a ‘professional’ way, and to balance their emotions. At the same time, they expressed how difficult it can be to show moral courage when confronted with poor patient care. In addition, they spoke about a lack of role models during clinical practice and supervision. Conclusions: Undergraduate nursing students are in a vulnerable position throughout their journey to become professional and to develop empathy and moral courage. The professional socialisation and forming of professional empathy and moral courage among nursing students, may be seen as a complex interaction of formal and hidden curriculum, where role models play an important role. We argue that the main theme ‘Vulnerable students – a journey towards professional empathy and moral courage’ may cover the longitudinal project as a whole. This vulnerability is something both teachers and supervisors should be aware of when following up with students in their clinical placements.
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Affiliation(s)
- Anne Kari Tolo Heggestad
- Faculty of Health Studies, VID Specialized University, Oslo and Centre for Medical Ethics, University of Oslo, Norway
| | | | - Bjørg Christiansen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Per Nortvedt
- Centre for Medical Ethics, University of Oslo, Oslo
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Lee SE, Choi J, Lee H, Sang S, Lee H, Hong HC. Factors Influencing Nurses' Willingness to Speak Up Regarding Patient Safety in East Asia: A Systematic Review. Risk Manag Healthc Policy 2021; 14:1053-1063. [PMID: 33737846 PMCID: PMC7966392 DOI: 10.2147/rmhp.s297349] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/04/2021] [Indexed: 11/23/2022] Open
Abstract
Speaking up for patient safety among health care professionals is important because it can contribute to the prevention of adverse patient events, such as medication errors, infections, wrong-site surgical procedures, and other sentinel events. This systematic review identified factors that facilitate or inhibit nurses' willingness to speak up regarding patient safety in East Asian hospitals. Following the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four databases, including PubMed, CINAHL, PsycInfo, and Web of Science, were searched. Nine studies were analyzed in this review, including five qualitative and four quantitative studies published between 2014 and 2019. Quality of included studies were evaluated using the Mixed-Method Appraisal Tool. Data synthesis was based upon qualitative-led synthesis adopting two existing multilevel frameworks on safety voice and employee voice signals. Four studies were conducted in Japan, three in South Korea, one in Hong Kong, and one in Taiwan. We organized factors influencing East Asian nurses' willingness to speak up regarding patient safety according to the following four contexts: individual (motivation toward patient safety, organizational commitment, perceived effectiveness and importance of speaking up, and assertive personality), team (positive relationship and team trust, team culture, and mentoring), organizational (hospital administrative support and organizational culture) and sociocultural (hierarchy and power differential and collectivistic culture). However, due to the limited number of studies conducted in East Asian hospitals, further studies with larger cohort samples of nurses in various East Asian countries should be conducted to deepen our understanding of nurses' willingness to voice their concerns for patient safety.
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Affiliation(s)
- Seung Eun Lee
- Mo-Im Kim Nursing Research Institute, Seoul, South Korea.,College of Nursing, Yonsei University, Seoul, South Korea
| | - JiYeon Choi
- Mo-Im Kim Nursing Research Institute, Seoul, South Korea.,College of Nursing, Yonsei University, Seoul, South Korea
| | - Hyunjie Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Somin Sang
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Haesun Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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16
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O'Donovan R, De Brún A, McAuliffe E. Healthcare Professionals Experience of Psychological Safety, Voice, and Silence. Front Psychol 2021; 12:626689. [PMID: 33679547 PMCID: PMC7933795 DOI: 10.3389/fpsyg.2021.626689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Healthcare professionals who feel psychologically safe believe it is safe to take interpersonal risks such as voicing concerns, asking questions and giving feedback. Psychological safety is a complex phenomenon which is influenced by organizational, team and individual level factors. However, it has primarily been assessed as a team-level phenomenon. This study focused on understanding healthcare professionals' individual experiences of psychological safety. We aim to gain a fuller understanding of the influence team leaders, interpersonal relationships and individual characteristics have on individuals' psychological safety and their decisions to engage in voice or silence behavior. Thirty-four interviews were conducted with healthcare professionals from across five teams working within an acute, suburban hospital. Hybrid inductive-deductive thematic analysis focused on identifying themes which captured the complexities of individuals' varied experiences of psychological safety. The themes identified were: "Personal Characteristics," "Past Experiences," "Individual Perceptions of Being Valued," and "Judged Appropriateness of Issues/Concerns." These themes are explored within the context of motivating and inhibiting factors associated with the influence of leadership, interpersonal relationships and individual characteristics on experiences of psychological safety and voice behavior. These results extend existing theoretical frameworks guiding our understanding of psychological safety by accounting for the variation in individuals' experiences and studying these significant influences on voice behavior. Important considerations for the development of interventions to enhance psychological safety are discussed.
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Affiliation(s)
- Róisín O'Donovan
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Jones A, Blake J, Adams M, Kelly D, Mannion R, Maben J. Interventions promoting employee "speaking-up" within healthcare workplaces: A systematic narrative review of the international literature. Health Policy 2021; 125:375-384. [PMID: 33526279 DOI: 10.1016/j.healthpol.2020.12.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/11/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Healthcare systems worldwide increasingly value the contribution of employee voice in ensuring the quality of patient care. Although employees' concerns are often dealt with satisfactorily, considerable evidence suggests that some employees may feel unable to speak-up, and even when they do their concerns may be ignored. As a result, in addition to trans-national and national policies, workplace interventions that support employees to speak-up about their concerns have recently increased. METHODS A systematic narrative review, informed by complex systems perspectives addresses the question: "What workplace strategies and/or interventions have been implemented to promote speaking-up by employees"? RESULTS Thirty-four studies were included in the review. Most studies reported inconclusive results. Researchers explanations for the successful implementation, or otherwise, of speak-up interventions were synthesised into two narrative themes (Braithwaite et al., 2018 (a)) hierarchical, interdisciplinary and cultural relationships and (Francis, 2015 (b)) psychological safety. CONCLUSIONS We strengthen the existing evidence base by providing an in-depth critique of the complex system factors influencing the implementation of speak-up interventions within the healthcare workforce. Although many of the studies were locally unique, there were international similarities in workplace cultures and norms that created contexts inimical to speaking-up interventions. Changing communication behaviours and creating a climate that supports speaking-up is immensely challenging. Interventions can be usurped in practice by complex, emergent and contextual issues, such as pre-existing socio-cultural relationships and workplace hierarchies.
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Affiliation(s)
- Aled Jones
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, CF24 0XB, UK.
| | - Joanne Blake
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, CF24 0XB, UK.
| | - Mary Adams
- King's Improvement Science, Health Service & Population Research Department, King's College London, UK.
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, CF24 0XB, UK.
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, UK.
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18
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Labrague LJ, De los Santos JA. Association between nurse and hospital characteristics and organisational silence behaviours in nurses: A cross‐sectional study. J Nurs Manag 2020; 28:2196-2204. [DOI: 10.1111/jonm.13101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 06/20/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
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Krenz HL, Burtscher MJ. Investigating voice in action teams: a critical review. COGNITION, TECHNOLOGY & WORK (ONLINE) 2020; 23:605-624. [PMID: 34720736 PMCID: PMC8550263 DOI: 10.1007/s10111-020-00646-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/25/2020] [Indexed: 06/13/2023]
Abstract
Team communication is considered a key factor for team performance. Importantly, voicing concerns and suggestions regarding work-related topics-also termed speaking up-represents an essential part of team communication. Particularly in action teams in high-reliability organizations such as healthcare, military, or aviation, voice is crucial for error prevention. Although research on voice has become more important recently, there are inconsistencies in the literature. This includes methodological issues, such as how voice should be measured in different team contexts, and conceptual issues, such as uncertainty regarding the role of the voice recipient. We tried to address these issues of voice research in action teams in the current literature review. We identified 26 quantitative empirical studies that measured voice as a distinct construct. Results showed that only two-thirds of the articles provided a definition for voice. Voice was assessed via behavioral observation or via self-report. Behavioral observation includes two main approaches (i.e., event-focused and language-focused) that are methodologically consistent. In contrast, studies using self-reports showed significant methodological inconsistencies regarding measurement instruments (i.e., self-constructed single items versus validated scales). The contents of instruments that assessed voice via self-report varied considerably. The recipient of voice was poorly operationalized (i.e., discrepancy between definitions and measurements). In sum, our findings provide a comprehensive overview of how voice is treated in action teams. There seems to be no common understanding of what constitutes voice in action teams, which is associated with several conceptual as well as methodological issues. This suggests that a stronger consensus is needed to improve validity and comparability of research findings.
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Affiliation(s)
| | - Michael J. Burtscher
- University of Zurich, Zurich, Switzerland
- ZHAW Zurich University of Applied Sciences, Zurich, Switzerland
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O’donovan R, Mcauliffe E. A systematic review of factors that enable psychological safety in healthcare teams. Int J Qual Health Care 2020; 32:240-250. [DOI: 10.1093/intqhc/mzaa025] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
The current systematic review will identify enablers of psychological safety within the literature in order to produce a comprehensive list of factors that enable psychological safety specific to healthcare teams.
Data sources
A keyword search strategy was developed and used to search the following electronic databases PsycINFO, ABI/INFORM, Academic search complete and PubMed and grey literature databases OpenGrey, OCLC WorldCAT and Espace.
Study selection
Peer-reviewed studies relevant to enablers of psychological safety in healthcare setting that were published between 1999 and 2019 were eligible for inclusion. Covidence, an online specialized systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers.
Data extraction
Thirty-six relevant studies were identified for full review and data extraction. A data extraction template was developed and included sections for the study methodology and the specific enablers identified within each study.
Results of data synthesis
Identified studies were reviewed using a narrative synthesis. Within the 36 articles reviewed, 13 enablers from across organizational, team and individual levels were identified. These enablers were grouped according to five broader themes: priority for patient safety, improvement or learning orientation, support, familiarity with colleagues, status, hierarchy and inclusiveness and individual differences.
Conclusion
This systematic review of psychological safety literature identifies a list of enablers of psychological safety within healthcare teams. This list can be used as a first step in developing observational measures and interventions to improve psychological safety in healthcare teams.
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Affiliation(s)
- Róisín O’donovan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
| | - Eilish Mcauliffe
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
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21
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Patient Safety Over Power Hierarchy: A Scoping Review of Healthcare Professionals' Speaking-up Skills Training. J Healthc Qual 2020; 42:249-263. [PMID: 32149868 DOI: 10.1097/jhq.0000000000000257] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Communication failures in healthcare constitute a major root cause of adverse events and medical errors. Considerable evidence links failures to raise concerns about patient harm in a timely manner with errors in medication administration, hygiene and isolation, treatment decisions, or invasive procedures. Expressing one's concern while navigating the power hierarchy requires formal training that targets both the speaker's emotional and verbal skills and the receiver's listening skills. We conducted a scoping review to examine the scope and components of training programs that targeted healthcare professionals' speaking-up skills. Out of 9,627 screened studies, 14 studies published between 2005 and 2018 met the inclusion criteria. The majority of the existing training exclusively relied on one-time training, mostly in simulation settings, involving subjects from the same profession. In addition, most studies implicitly referred to positional power as defined by titles; few addressed other forms of power such as personal resources (e.g., expertise, information). Almost none addressed the emotional and psychological dimensions of speaking up. The existing literature provides limited evidence identifying effective training components that positively affect speaking-up behaviors and attitudes. Future opportunities include examining the role of healthcare professionals' conflict engagement style or leaders' behaviors as factors that promote speaking-up behaviors.
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O'Donovan R, McAuliffe E. A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour. BMC Health Serv Res 2020; 20:101. [PMID: 32041595 PMCID: PMC7011517 DOI: 10.1186/s12913-020-4931-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background Having psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions. Methods A key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers. Results Fourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions’ ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours. Conclusion To improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams. Prospero registration number CRD42018100659.
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Affiliation(s)
- Róisín O'Donovan
- UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Dublin 4, Ireland.
| | - Eilish McAuliffe
- UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Dublin 4, Ireland
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Levine KJ, Carmody M, Silk KJ. The influence of organizational culture, climate and commitment on speaking up about medical errors. J Nurs Manag 2019; 28:130-138. [PMID: 31733166 DOI: 10.1111/jonm.12906] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/15/2019] [Accepted: 11/13/2019] [Indexed: 12/01/2022]
Abstract
AIM Speaking up about medical errors is an essential behaviour for nurses in pursuit of their goal of maintaining patient safety. This study was designed to understand how a hospital's culture and climate can impact a nurse's active behaviour in this important health care activity. BACKGROUND Research shows that while medical errors happen frequently, there is great variability on whether these errors are reported. As such, organizational culture, climate and commitment as well as employee perceptions associated with the reporting process were investigated to determine their impact on participants' intentions to speak up about medical errors. METHODS Focus groups and one-on-one interviews were used to collect these data and were analysed using content analysis. RESULTS/KEY ISSUES Nurses in the hospital perceive and understand both the benefits and barriers to reporting medical errors. Commonly reported benefits include patient safety, promoting education and awareness, and the improvement of internal processes or systems. Barriers include an inefficient reporting system and organizational influences such as perceived consequences and unequal status/position of the individual who made the error and the person reporting the error. Participants are aware that the organization believes that the responsibility to report medical errors falls to everyone. CONCLUSIONS Results indicate that the organization's existing culture does not facilitate the reporting of medical errors and that the organizational climate interferes with the reporting process. Lastly, organizational commitment is not related to the perception of importance given to the reporting of medical errors by the hospital. IMPLICATIONS FOR NURSING MANAGEMENT Nurses and nurse managers are an essential part of any hospital. In their role, they can effect change on the organization's culture and climate, but often do not realize the connection between organizational culture and patient safety. Results indicate that promoting organizational commitment to speaking up through the creation of a positive organizational culture can both promote speaking up about medical errors and increase patient safety.
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Affiliation(s)
- Kenneth J Levine
- Department of Communication, Michigan State University, East Lansing, Michigan
| | - Molly Carmody
- Department of Communication, Michigan State University, East Lansing, Michigan
| | - Kami J Silk
- Department of Communication, University of Delaware, Newark, Delaware
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24
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Kelly SH. The hidden curriculum: Undergraduate nursing students' perspectives of socialization and professionalism. Nurs Ethics 2019; 27:1250-1260. [PMID: 31757189 DOI: 10.1177/0969733019881714] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Nursing students form a professional identity from their core values, role models, and past experiences, and these factors contribute to the development of their professional identity. The hidden curriculum, a set of ethics and values learned within a clinical setting, may be part of developing a professional identity. Nursing students will develop a professional identity throughout school; however, their identity might be challenged as they attempt to balance their core values with behaviors learned through the hidden curriculum. The purpose of this project was to educate students on the hidden curriculum in the development of their professional identity. MATERIALS AND METHODS A sample of 112 senior nursing students was recruited from a northeastern university in the United States for this study. Pre-post survey design was used, and an educational session was administered prior to the post-survey. Descriptive statistics and a valid percentage were used to describe the data within the surveys. ETHICAL CONSIDERATION Study was approved by the author's University Institutional Review Board. FINDINGS A significant finding was for advocacy as students would speak up if witnessing inappropriate behavior toward patients or families with a mean score increase from 2.50 (pre-survey) to 1.45 (post-survey). Also, over 95% (n = 106) found the educational session beneficial as they learned they had the ability to advocate and speak up for their patients. CONCLUSION Students were able to use their core values and advocate for their patients and families which allows for safer patient care.
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Abstract
BACKGROUND Registered nurses are pivotal in the analysis, recognition, and reporting of patient safety issues before harm occurs to patients. Little has been written about the relationship between the professional responsibility of reporting safety concerns and the processes that exist. PROBLEM More needs to be known about how nurses can best report factors in work environments that impact patient safety. Learning more about processes that exist amidst literature that illuminates the issues related to reporting and patient safety culture is needed. Also, best practice or key exemplars depicting how professional responsibility has been implemented are needed. Limited has been written exploring professional responsibility concern processes in Canada and internationally. APPROACH We completed a case study exploration comprising a public facing Web site scan of information about professional responsibility-like processes across Canada, as well as an extensive literature search exploring factors that are linked with nurse reporting of patient safety concerns. CONCLUSION Themes from related literature identify patient safety culture, leadership qualities, communication, positive nurse factors, speaking up, and whistle-blowing as important aspects that facilitate, or are related to, the ability for nurses to express professional responsibility concerns. Alberta has a well-developed system of reporting such concerns; however, the lack of research and literature on these topics requires additional focus in nursing internationally.
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Mansour M, Mattukoyya R. Development of assertive communication skills in nursing preceptorship programmes: a qualitative insight from newly qualified nurses. Nurs Manag (Harrow) 2019; 26:29-35. [PMID: 31468827 DOI: 10.7748/nm.2019.e1857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Being able to speak up is a prerequisite for establishing safe communication in healthcare settings. The nursing preceptorship programme represents an opportunity for newly qualified nurses to develop and practise assertive communication skills. AIM To examine newly qualified nurses' views on how nursing preceptorship programmes contribute to shaping their assertive communication skills. METHOD 42 newly qualified nurses from four acute hospital trusts in east England completed open-ended questions included in a cross-sectional survey. Participants' qualitative comments were analysed using thematic analysis. FINDINGS Three themes related to speaking up during the nursing preceptorship programme emerged: enthusiastic versus sceptical, the role of a supportive working culture, and logistical challenges. CONCLUSION Nursing preceptorship programmes can develop newly qualified nurses life-enhancing assertive communication skills if they provide inspiring preceptors who act as role models, create a supportive working culture and support nursing preceptors to deliver effective preceptorship. It is imperative that nursing preceptorship programmes are adapted to enable newly qualified nurses to learn and practise assertive communication skills.
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Affiliation(s)
- Mansour Mansour
- Fundamentals of Nursing, College of Nursing Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Roslyn Mattukoyya
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, England
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27
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Salih ZNI, Draucker CB. Facilitators of and barriers to successful teamwork during resuscitations in a neonatal intensive care unit. J Perinatol 2019; 39:974-982. [PMID: 31097759 PMCID: PMC6592772 DOI: 10.1038/s41372-019-0380-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Effective teamwork is essential in high-risk healthcare delivery environments. In this study, we aimed to identify facilitators of and barriers to successful teamwork during resuscitations in the NICU Study Design: 36 in-situ interprofessional simulation sessions were held in a level 4 NICU. Each session was followed by a debriefing where staff talked about the simulation scenario but also about their prior experiences during resuscitations in the NICU. Using content analysis, we analyzed the transcriptions of debriefings to address the study aims. RESULT Participant responses yielded three major themes: communicating well, getting tasks done well, and working well together. Each main theme had subthemes. CONCLUSION Teamwork is a complex process that is enhanced and hindered by a variety of factors. The factors identified in this study can be used to enhance relationship-based teamwork training programs. Future research is needed to determine which teamwork behaviors are most associated with patient outcomes.
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28
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Training novice anaesthesiology trainees to speak up for patient safety. Br J Anaesth 2019; 122:767-775. [DOI: 10.1016/j.bja.2019.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/01/2019] [Accepted: 01/11/2019] [Indexed: 11/18/2022] Open
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Omura M, Levett‐Jones T, Stone TE. Evaluating the impact of an assertiveness communication training programme for Japanese nursing students: A quasi-experimental study. Nurs Open 2019; 6:463-472. [PMID: 30918697 PMCID: PMC6419109 DOI: 10.1002/nop2.228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/06/2018] [Accepted: 11/12/2018] [Indexed: 11/06/2022] Open
Abstract
AIM To examine the impact of an assertiveness communication training programme on Japanese nursing students' level of assertiveness and intention to speak up when concerned about patient safety. DESIGN A quasi-experimental design with two parallel groups was used. METHODS Third-year nursing students from two Japanese educational institutions were allocated to an intervention and control group. The intervention group completed the Theory of Planned Behaviour-Assertive Communication Questionnaire and the Japanese version of the Rathus Assertiveness Schedule after attending assertive communication workshops. The second group completed the surveys before attending the workshop and were referred as the control group. Data were collected in December 2017-January 2018. RESULTS A total of 123 out of 150 nursing students completed the surveys. Following the assertiveness communication training programme, a higher percentage of students from the intervention group demonstrated the intention to speak up. The intervention group also displayed higher levels of assertiveness, although the results were not statistically significant.
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Affiliation(s)
- Mieko Omura
- School of Nursing and Midwifery, Faculty of Health and MedicineThe University of NewcastleCallaghanNew South WalesAustralia
| | - Tracy Levett‐Jones
- Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
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Omura M, Levett‐Jones T, Stone TE. Design and evaluation of an assertiveness communication training programme for nursing students. J Clin Nurs 2019; 28:1990-1998. [DOI: 10.1111/jocn.14813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Mieko Omura
- School of Nursing and Midwifery, Faculty of Health and Medicine The University of Newcastle Callaghan New South Wales Australia
| | - Tracy Levett‐Jones
- Faculty of Health University of Technology Sydney Ultimo New South Wales Australia
| | - Teresa E. Stone
- Faculty of Nursing Chiang Mai University Chiang Mai Thailand
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31
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Horwood CR, Moffatt-Bruce SD, Fitzgerald M, Rayo MF. A qualitative analysis of clinical decompensation in the surgical patient: Perceptions of nurses and physicians. Surgery 2018; 164:1311-1315. [DOI: 10.1016/j.surg.2018.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
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Mansour M, Mattukoyya R. A Cross-Sectional Survey of British Newly Graduated Nurses' Experience of Organization Empowerment and of Challenging Unsafe Practices. J Contin Educ Nurs 2018; 49:474-481. [DOI: 10.3928/00220124-20180918-08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
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Edrees HH, Ismail MNM, Kelly B, Goeschel CA, Berenholtz SM, Pronovost PJ, Al Obaidli AAK, Weaver SJ. Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates. Int J Qual Health Care 2018; 29:948-960. [PMID: 29186417 DOI: 10.1093/intqhc/mzx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. Design, setting, participants, intervention A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Main outcome measures Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. Results A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. Conclusions Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.
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Affiliation(s)
- Hanan H Edrees
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,National Guard Health Affairs, Quality and Patient Safety/King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Mohd Nasir Mohd Ismail
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
| | - Bernadette Kelly
- SEHA (Abu Dhabi Health Services Company), Das Tower, Sultan Bin Zayed St, Abu Dhabi, UAE
| | - Christine A Goeschel
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.,Medstar Health, 3007 Tilden St NW, Washington, DC 20008, USA
| | - Sean M Berenholtz
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Peter J Pronovost
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | | | - Sallie J Weaver
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
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Jones C, Durbridge M. Culture, silence and voice: The implications for patient safety in the operating theatre. J Perioper Pract 2018; 26:281-284. [PMID: 29328767 DOI: 10.1177/175045891602601204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022]
Abstract
Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or 'voice'. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.
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Affiliation(s)
- Ceri Jones
- University Hospitals Leicester and University of Cardiff, UK
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The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. Int J Nurs Stud 2017; 76:120-128. [DOI: 10.1016/j.ijnurstu.2017.09.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/19/2017] [Accepted: 09/03/2017] [Indexed: 11/21/2022]
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Aini SN, Mulatsih S, Lasmani PS. The Effect of Education on Parents' "Speak Up" Knowledge Regarding Patients Safety in Hospital. JURNAL NERS 2017. [DOI: 10.20473/jn.v12i2.4688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Safety is a global issue in hospitals. Unexpected events or errors related to health services occur in children, and about 75% are associated with medical procedures. Parental involvement becomes one of the strategies used to improve patient safety. Families who know patient safety can educate themselves to prevent and detect errors that occur during treatment. Education can improve the general knowledge about patient safety. The Speak Up program is recommended by JCAHO to improve effective communication, and this program has a preventive impact on human error. This study aims to determine the effect of education on parent’s ‘speaking up’ knowledge regarding patient safety in the Children's Wards of Dr. Sardjito Hospital in Yogyakarta.Methods: This research study was quasi-experimental using a one group pre-test and post-test design. The intervention in this research was education. The consecutive sampling technique was used with a total of 62 respondents selected. The Speak Up questionnaire and observation sheet to get to know the changes in the knowledge of Speak Up was used to collect the data. The data analysis used a Paired Sample T-Test.Result: The result of the paired T-test showed a p-value <0,001 (p <0,05) which means that there was a significant influence by way of education on parent’s speak up knowledge regarding patient safety.Conclusion: Education improved the parents' speak up knowledge about patient safety.
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Williams B, Beovich B, Flemming G, Donovan G, Patrick I. Exploration of difficult conversations among Australian paramedics. Nurs Health Sci 2017. [PMID: 28631343 DOI: 10.1111/nhs.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies indicate that healthcare professionals find it challenging to engage in difficult conversations regarding concerning behavior of colleagues. As a result, these conversations are often avoided. The inability to have these difficult conversations is associated with poorer patient outcomes, staff commitment, discretionary effort, and employee satisfaction. This descriptive study used an online questionnaire to examine responses of paramedics employed by Ambulance Victoria (Australia) regarding difficult conversations between colleagues about concerning behavior of co-workers. The results suggest that, like other healthcare professions, many paramedics find it challenging to raise these concerns. To the best knowledge of the authors, this is the first study of its type to be undertaken within the paramedic profession and provides a platform for further research within this and other health professions.
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Affiliation(s)
- Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | - Bronwyn Beovich
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | | | | | - Ian Patrick
- Clinical and Community Services Ambulance Victoria, Victoria, Australia
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Ginsburg L, Bain L. The evaluation of a multifaceted intervention to promote “speaking up” and strengthen interprofessional teamwork climate perceptions. J Interprof Care 2017; 31:207-217. [DOI: 10.1080/13561820.2016.1249280] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Liane Ginsburg
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Lorna Bain
- Coordinator Interprofessional Collaboration and Education,Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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„Speaking Up“ statt tödlichem Schweigen im Krankenhaus. GIO-GRUPPE-INTERAKTION-ORGANISATION-ZEITSCHRIFT FUER ANGEWANDTE ORGANISATIONSPSYCHOLOGIE 2016. [DOI: 10.1007/s11612-016-0343-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Omura M, Maguire J, Levett-Jones T, Stone TE. Effectiveness of assertive communication training programs for health professionals and students. ACTA ACUST UNITED AC 2016; 14:64-71. [DOI: 10.11124/jbisrir-2016-003158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Aydon L, Hauck Y, Zimmer M, Murdoch J. Factors influencing a nurse's decision to question medication administration in a neonatal clinical care unit. J Clin Nurs 2016; 25:2468-77. [PMID: 27264690 DOI: 10.1111/jocn.13277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. BACKGROUND Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. DESIGN A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. RESULTS One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. CONCLUSIONS Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. RELEVANCE TO CLINICAL PRACTICE The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to appropriately question aspects around medication administration.
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Affiliation(s)
- Laurene Aydon
- Neonatal Clinical Care Unit, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia. .,Department Nursing and Midwifery Education and Research, Women and Newborn Health Service, Subiaco, WA, Australia. .,Centre for Research and Neonatal Education, School of Child and Paediatric Health, University of Western Australia, Perth, WA, Australia.
| | - Yvonne Hauck
- School of Nursing and Paramedicine, Curtin University, Perth, WA, Australia.,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia
| | - Margo Zimmer
- Neonatal Clinical Care Unit/Department Nursing and Midwifery Education and Research, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia
| | - Jamee Murdoch
- Neonatal Clinical Care Unit/Department Nursing and Midwifery Education and Research, King Edward Memorial Hospital WNHS, Subiaco, WA, Australia
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Schwappach DLB. [When silence is dangerous: "Speaking-up" about safety concerns]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 114:5-12. [PMID: 27566265 DOI: 10.1016/j.zefq.2016.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Open and direct communication ("speaking-up") about errors, bypassed safety rules and risky behaviours among hospital staff is required to avoid patient harm, and it is an essential characteristic of an established safety culture. In German-speaking countries, little is known about speaking-up behaviour among health care professionals (HCPs) in hospitals. METHOD Safety concerns and speaking-up behaviours among HCPs of nine oncological units of eight hospitals were assessed using a self-administered survey. A vignette was embedded to assess hypothetical speaking-up and its predictors. The association of hierarchical position and speaking-up was investigated. 1,013 physicians and nurses completed the survey (65 % response rate). RESULTS 53 % of the HCPs reported having concerns about patient safety at their unit, "sometimes", "frequently", or "very frequently". Colleagues bypassing important safety rules at least "sometimes" were reported by 30 %. A considerable fraction of responders reported episodes of withholding of voice. Nearly 20 % said they did not communicate safety problems at their unit at least sometimes. 73 % of higher-ranking staff and 60 % among those at lower ranks said they had never withheld information which could have reduced threats to patients (OR=1.8, p≤0.001). Many responders felt that speaking-up is often difficult and challenging. 32 % responded that they would not speak-up about a missed hand disinfection towards a colleague assessing the wound of a recently operated oncological patient. CONCLUSIONS HCPs in hospital frequently experience safety concerns and often withhold them. An important resource for better patient safety is lost. The development of interventions to improve speaking-up culture is warranted.
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Affiliation(s)
- David L B Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
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Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy. J Nurs Care Qual 2016; 30:53-62. [PMID: 25084469 DOI: 10.1097/ncq.0000000000000081] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although speaking up to protect patients is a key ethical and moral mandate for nurses, silence still prevails in many situations. On the basis of concepts of safety culture, generational theory, personal cultural literature, advocacy theory, oppressed group theory, and moral distress theory, the author conducted a literature review and offers a new theoretical framework. The proposed theory identifies primary factors of speaking up: generational, personal culture, and organizational.
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45
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Kim MY, Kim YM, Kang SW. A survey and multilevel analysis of nursing unit tenure diversity and medication errors. J Nurs Manag 2016; 24:634-45. [DOI: 10.1111/jonm.12366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Min Young Kim
- College of Nursing; Jeju National University; Jeju City Korea
| | - Young Mee Kim
- Department of Nursing; Seoul National University Hospital; Seoul Korea
| | - Seung-Wan Kang
- College of Business; Gachon University; Sujeong-gu Seongnam City Gyeonggi-do Korea
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Robb A, White C, Cordar A, Wendling A, Lampotang S, Lok B. A comparison of speaking up behavior during conflict with real and virtual humans. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2015.05.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Martinez W, Etchegaray JM, Thomas EJ, Hickson GB, Lehmann LS, Schleyer AM, Best JA, Shelburne JT, May NB, Bell SK. ‘Speaking up’ about patient safety concerns and unprofessional behaviour among residents: validation of two scales. BMJ Qual Saf 2015. [DOI: 10.1136/bmjqs-2015-004253] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Law BYS, Chan EA. The experience of learning to speak up: a narrative inquiry on newly graduated registered nurses. J Clin Nurs 2015; 24:1837-48. [DOI: 10.1111/jocn.12805] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Engle Angela Chan
- School of Nursing; The Hong Kong Polytechnic University; Hung Hom Hong Kong
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Schwappach DLB, Gehring K. Frequency of and predictors for withholding patient safety concerns among oncology staff: a survey study. Eur J Cancer Care (Engl) 2014; 24:395-403. [PMID: 25287114 DOI: 10.1111/ecc.12255] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 11/28/2022]
Abstract
Speaking up about patient safety is vital to avoid errors reaching the patient and to improve a culture of safety. This study investigated the prevalence of non-speaking up despite concerns for safety and aimed to identify predictors for withholding voice among healthcare professionals (HCPs) in oncology. A self-administered questionnaire assessed safety concerns, speaking up beliefs and behaviours among nurses and doctors from nine oncology departments. Multiple regression analysis was used to identify predictors for withholding safety concerns. A total of 1013 HCPs returned the completed survey (response rate 65%). Safety concerns were common among responders. Fifty-four per cent reported to recognise their colleagues making potentially harmful errors at least sometimes. A majority of responders reported at least some episodes of withholding concerns about patient safety. Thirty-seven per cent said they remained silent at least once when they had information that might have helped prevent an incident. Respondents believed that a high level of interpersonal, communication and coping skills are necessary to speak up about patient safety issues at their workplace. Higher levels of perceived advocacy for patient safety and psychological safety significantly decreased the frequency of withholding voice. Remaining silent about safety concerns is a common phenomenon in oncology. Improved strategies are needed to support staff in effective communication and make cancer care safer.
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Affiliation(s)
- D L B Schwappach
- Swiss Patient Safety Foundation, Zuerich, Switzerland; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Aydon L, Martin K, Nathan E. Examination of the perception of communication and collaboration in a neonatal intensive care unit: a decade on, has it changed? AUST HEALTH REV 2014; 38:350-3. [PMID: 24807289 DOI: 10.1071/ah13150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 01/27/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to ascertain the perception of communication and collaboration within and between the groups of medicine and nursing in a neonatal unit. METHODS The study used an analytical cross-sectional design involving both doctors and nursing staff in the neonatal clinical care unit (NCCU). A quantitative questionnaire using a Likert scale format, accompanied by an open-ended question, provided a snapshot of the perception of communication and collaboration within the NCCU. RESULTS Significant differences were noted between the two disciplines. Medical staff were satisfied overall with the communication. They perceived communication was more open, timely and that a mutual understanding existed. They thought teamwork was good. As time of employment in NCCU lengthened, the understanding between the groups lessened. Problems with the handover information emerged for both medical and nursing staff. Both groups felt problems were due to the hierarchical system. CONCLUSION Within the NCCU the perception of communication and collaboration is rated more highly by doctors. This has implications for the overall care of babies and for safety issues. Education is needed in the neonatal unit to identify and bridge gaps in communication and enhance teamwork.
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Affiliation(s)
- Laurene Aydon
- Neonatal Clinical Care Unit, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA 6008, Australia.
| | - Kathy Martin
- Neonatal Clinical Care Unit, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA 6008, Australia.
| | - Elizabeth Nathan
- Women and Infants Research Foundation Western Australia, 374 Bagot Road, Subiaco, WA 6008, Australia.
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