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Prothero MM, Huefner K, Sorhus M. Nurse Leader Attitudes and Beliefs Regarding Medical Errors. J Nurs Adm 2024; 54:10-15. [PMID: 38051909 DOI: 10.1097/nna.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study aimed to explore nurse leader attitudes and beliefs about medical errors. BACKGROUND The perfectibility model suggests errors are avoidable if nurses are trained and follow safety guidelines. This impacts how nurse leaders approach medical errors. Nurse leaders (NLs) may be the first person to whom a nurse reports an error. Leaders support nurses through the investigation process and subsequent recovery. METHODS A cross-sectional quantitative study was conducted to determine NL attitudes toward medical errors using the Medical Error Attitude Scale (MEAS). RESULTS MEAS scores were high in all categories. Medical error perception was significant for NLs with institutional support programs and when compared with job titles. Medical error approach and perception were significant for NLs with direct reports who had committed a medical error. CONCLUSION This study provides insight into NLs' views on medical errors, awareness of NLs who have had nurses involved in medical errors, and formal caregiver support programs.
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Affiliation(s)
- Marie M Prothero
- Author Affiliations: Assistant Professor (Dr Prothero) and Registered Nurses (Huefner and Sorhus), College of Nursing, Brigham Young University, Provo, Utah
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Fernandes MA, Rocha DDM, Ribeiro HKP, Sousa CDCM. Riscos ocupacionais e intervenções que promovem segurança para a equipe de enfermagem oncológica. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2021. [DOI: 10.1590/2317-6369000000319] [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
Resumo Objetivo: analisar as evidências científicas relacionadas aos riscos ocupacionais e às intervenções que promovem segurança no trabalho para a equipe de enfermagem oncológica. Métodos: revisão de literatura realizada nas bases de dados MEDLINE, Web of Science, Scopus, LILACS, IBECS e BDENF. Resultados: a busca identificou 17 estudos primários, publicados em inglês, no período de 2008 a 2017. Dentre os fatores que configuram riscos ocupacionais, destacam-se: o déficit no conhecimento; a pouca disponibilidade de equipamentos de proteção individual para manuseio dos medicamentos antineoplásicos; o estresse; e a ansiedade. Quanto às intervenções que promovem a segurança, evidenciam-se: a manutenção do ambiente laboral favorável ao desempenho da assistência; a disponibilidade de insumos; o bom relacionamento interpessoal; a organização do trabalho; o dimensionamento profissional adequado; o conhecimento, a disponibilidade e o incentivo ao uso dos equipamentos de proteção; e a compreensão dos riscos ocupacionais aos quais os profissionais estão expostos. Conclusão: o estudo possibilitou a identificação de fatores associados à atividade laboral que comprometem a saúde da equipe de enfermagem oncológica, demonstrando a necessidade de intervenções voltadas para a melhoria das relações interprofissionais, a capacitação dos profissionais e o oferecimento de um ambiente de trabalho seguro e condições organizacionais que promovam a saúde dos trabalhadores.
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Karius DL, Colvin CM. Managing Chemotherapy Extravasation Across Transitions of Care: A Clinical Nurse Specialist Initiative. JOURNAL OF INFUSION NURSING 2021; 44:14-20. [PMID: 33394869 DOI: 10.1097/nan.0000000000000411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chemotherapy extravasation can lead to serious patient harm in patients with cancer. For nurses who administer vesicant chemotherapy, extravasation is a primary concern. Regardless of nurse experience level and despite prevention strategies, extravasations occur. Literature related to nurse management of chemotherapy extravasation beyond initial treatment is lacking, and no descriptors are available for a formalized process. Communication gaps and a lack of standardized follow-up within a 1400-bed, quaternary care academic medical institution contributes to challenges in care continuity when patients transition between hospital and ambulatory settings. With chemotherapy extravasation, the site does not immediately exhibit signs of tissue injury, leading to a false sense of security. As a result, tissue damage can be significant by the time the patient returns for his or her regular appointment. Two oncology clinical nurse specialists (CNSs) recognized an opportunity to bridge the gap and overcome the challenges by addressing patient needs postextravasation. Between 2015 and 2016, a formal consult process was designed, approved, and implemented to observe, manage, and make recommendations for timely care and follow-up. Since implementation of the process, the oncology CNSs have received multiple requests for consultations. Nursing staff report increased comfort levels with this process in place. A formalized process for managing chemotherapy extravasations increases patient safety and patient and nurse satisfaction.
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Affiliation(s)
- Diana L Karius
- Cleveland Clinic, Cleveland, Ohio
- Diana L. Karius, MS, APRN, CNS, AOCN® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of the Oncology Nursing Society (ONS), she has presented nationally at ONS Annual Congress and Infusion Nurses Society (INS) National Academy Conference. She has published and presented on a variety of topics, such as improving chemotherapy safety, pain management, delirium, and palliative care. Ms Karius is also the recipient of the 2011 ONS Excellence in Cancer Nursing Education Award. Karius entered the profession of nursing in 1979, and her extensive career includes health care organizations such as the College of Nursing at Valparaiso University, the University of Chicago Medical Center, University Hospital Home Care in Cleveland, and the Cleveland Clinic Taussig Cancer Institute. Throughout her career she has worked as a clinical teaching assistant, research clinical specialist, case manager, and oncology clinical nurse specialist. With research and evidence-based practice at the forefront of her patient care philosophy, Karius is a member of several national and local industry associations, has served as a publication content reviewer, and is a well-versed presenter. She has also taught as an adjunct faculty member at 3 Northeast Ohio schools of nursing
- Christina M. Colvin, MSN, APRN, AOCNS®, CRNI® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of ONS and INS, she has published on topics concerning nurses' safe handling of chemotherapy drugs and care of patients undergoing cancer treatment. Ms Colvin has presented nationally at the INS National Academy Conference
| | - Christina M Colvin
- Cleveland Clinic, Cleveland, Ohio
- Diana L. Karius, MS, APRN, CNS, AOCN® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of the Oncology Nursing Society (ONS), she has presented nationally at ONS Annual Congress and Infusion Nurses Society (INS) National Academy Conference. She has published and presented on a variety of topics, such as improving chemotherapy safety, pain management, delirium, and palliative care. Ms Karius is also the recipient of the 2011 ONS Excellence in Cancer Nursing Education Award. Karius entered the profession of nursing in 1979, and her extensive career includes health care organizations such as the College of Nursing at Valparaiso University, the University of Chicago Medical Center, University Hospital Home Care in Cleveland, and the Cleveland Clinic Taussig Cancer Institute. Throughout her career she has worked as a clinical teaching assistant, research clinical specialist, case manager, and oncology clinical nurse specialist. With research and evidence-based practice at the forefront of her patient care philosophy, Karius is a member of several national and local industry associations, has served as a publication content reviewer, and is a well-versed presenter. She has also taught as an adjunct faculty member at 3 Northeast Ohio schools of nursing
- Christina M. Colvin, MSN, APRN, AOCNS®, CRNI® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of ONS and INS, she has published on topics concerning nurses' safe handling of chemotherapy drugs and care of patients undergoing cancer treatment. Ms Colvin has presented nationally at the INS National Academy Conference
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CPR to the Rescue!: An Interprofessional Pilot Program: Cultivating Practices for Resilience (CPR) Camp. CLIN NURSE SPEC 2020; 34:63-69. [PMID: 32068634 DOI: 10.1097/nur.0000000000000506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE/OBJECTIVES The hCATS (health Colleges Advancing Team Skills) to CPR (Cultivating Practices for Resilience) Camp was an interprofessional pilot program to promote resilience, introduce strategies for coping with stress, cultivate compassion, and promote work-life balance to prevent burnout among health profession students, faculty, and healthcare professionals who team to provide patient care. PROGRAM DESCRIPTION The University of Kentucky (UK) College of Nursing received funding to partner with the UK Center for Interprofessional Health Education for immersive weekend activities utilizing KORU and Mindfulness Based Stress Reduction models, conducted by certified UK faculty experts in self-stewardship techniques such as mindfulness practices. OUTCOMES Thirty-nine participants from 7 UK colleges and UK HealthCare participated in 4 distinct CPR Camps, completed program assessments, and created team projects. Mean scores from each cohort significantly increased in a retrospective pre/post analysis of student perception of knowledge in all of the following categories: (1) habits and practices for resilient people, (2) strategies for building resilience and preventing/coping with stress/burnout in self and others, and (3) work-life balance (with the exception of cohort 4, for work-life balance). Students indicated on open-response items specific strategies they were willing to adopt going forward. These outcomes met our objectives for developing participants' understanding of resilience practices and adopting useful stress reduction practices. Planning and implementation of team projects successfully brought different professions together to advance learning in resilience. CONCLUSION The CPR Camp initiative is an effective model for promoting and sustaining resilience-building strategies among health profession students. Similar programming conducted and/or attended by academic and/or health system leaders, such as clinical nurse specialists, can help cultivate practices for resilience among the members of the interprofessional workforce, enabling teams to better cope with stress, prevent burnout, and ultimately improve team-based care delivery for patients and their families.
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Abstract
The best policies are evidence-based, providing feasible solutions to healthcare issues to prevent unintended consequences. Nurse researchers need to generate evidence with which to create policy. The obligation to monitor the impact of policies and standards rests on nurse leaders who have the duty to advocate when policies fail. Nurses providing direct care are beholden to report failed policies. Advocacy in the situation of a failed policy often requires moral courage to prevent moral distress amongst the ranks of nurses who enact policies at the intersect of care. In this article, the impact of three healthcare policy issues on nursing end-users will be evaluated: aid in dying, titration of vasoactive medications, and the Center for Medicare and Medicaid Services 30-minute rule.
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Affiliation(s)
- Judy E Davidson
- Department of Psychiatry, University of California San Diego School of Medicine, University of California San Diego Health, La Jolla, California
| | - Mary Faith Marshall
- Center for Biomedical Ethics and Humanities, School of Medicine, School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Jonathan H Watanabe
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California
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Morales CL, Brown MM. Creating a Care for the Caregiver Program in a Ten-Hospital Health System. Crit Care Nurs Clin North Am 2019; 31:461-473. [PMID: 31685112 DOI: 10.1016/j.cnc.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Critical care clinicians involved serious adverse events may experience a constellation of distressing emotions that may interfere with home and work life. Offering support after a serious adverse event may restore a clinician's ability to cope with the event, reestablish emotional balance and assist a clinician to function capably in the workplace and at home. A description of a care for the caregiver program implementation at a 10-hospital health system provides a roadmap to implement this program in other hospitals and health systems.
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Affiliation(s)
- Crystal L Morales
- High Reliability and Safety, Medstar Institute for Quality and Safety, 3007 Tilden Street, Northwest, Suite 5N, Washington, DC 20008, USA
| | - Mary-Michael Brown
- Nursing Practice Innovation, Medstar Health, 10980 Grantchester Place, 6101, Columbia, MD 21044, USA.
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Testing of A Caregiver Support Team. Explore (NY) 2019; 15:19-26. [DOI: 10.1016/j.explore.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 11/23/2022]
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Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN, Tutty MA, West CP, Shanafelt TD. Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clin Proc 2018; 93:1571-1580. [PMID: 30001832 PMCID: PMC6258067 DOI: 10.1016/j.mayocp.2018.05.014] [Citation(s) in RCA: 350] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate physician burnout, well-being, and work unit safety grades in relationship to perceived major medical errors. PARTICIPANTS AND METHODS From August 28, 2014, to October 6, 2014, we conducted a population-based survey of US physicians in active practice regarding burnout, fatigue, suicidal ideation, work unit safety grade, and recent medical errors. Multivariate logistic regression and mixed-effects hierarchical models evaluated the associations among burnout, well-being measures, work unit safety grades, and medical errors. RESULTS Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001). In multivariate modeling, perceived errors were independently more likely to be reported by physicians with burnout (odds ratio [OR], 2.22; 95% CI, 1.79-2.76) or fatigue (OR, 1.38; 95% CI, 1.15-1.65) and those with incrementally worse work unit safety grades (OR, 1.70; 95% CI, 1.36-2.12; OR, 1.92; 95% CI, 1.48-2.49; OR, 3.12; 95% CI, 2.13-4.58; and OR, 4.37; 95% CI, 2.06-9.28 for grades of B, C, D, and F, respectively), adjusted for demographic and clinical characteristics. CONCLUSION In this large national study, physician burnout, fatigue, and work unit safety grades were independently associated with major medical errors. Interventions to reduce rates of medical errors must address both physician well-being and work unit safety.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Timothy I Morgenthaler
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Daniel V Satele
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Colin P West
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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