Attitudes Toward Patient Safety and Tendencies to Medical Error Among Turkish Cardiology and Cardiovascular Surgery Nurses

The effects of perceived organizational support on attitudes toward medical errors in surgical nurses: A cross-sectional study

AIM

This study aims to determine the effects of perceived organizational support on attitudes toward medical errors in surgical nurses.

BACKGROUND

Nurses exhibit high performance in a work environment that supports, satisfies, and motivates them. Organizational support is one of the factors affecting the work environments of nurses. A strong nursing and hospital leadership supports the daily professional practices and well-being of nurses and is important in creating a positive work environment for nurses.

MATERIALS AND METHODS

The population of this cross-sectional study was composed of nurses (N = 414) in the surgical clinics of the Turgut Özal Medical Center. To reach the necessary sample size, the purposive sampling method, which is a nonprobability sampling method, was used. The data were collected using a personal information form, the Perceived Organizational Support Scale and the Scale of Attitudes toward Medical Errors.

RESULTS

It was determined that 91.1% of the participants had positive attitudes toward the importance and reporting of medical errors and moderate perceived organizational support (3.04 ± 0.67). The organizational support perceived by the participants did not have a statistically significant effect on their attitudes toward medical errors (β = 0.015; p = 0.865). The multiple linear regression model established in the study revealed that education level and previous medical error status were significant predictors of the attitudes of the participants toward medical errors.

CONCLUSION

It was determined that surgical nurses had positive attitudes toward the importance and reporting of medical errors and moderate perceived organizational support levels, and perceived organizational support did not significantly affect attitudes toward medical errors in surgical nurses.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY

In this study, it was determined that the perceived organizational support levels of surgical nurses did not have a significant effect on their attitudes toward medical errors. Assuming that adequate organizational support will reduce medical error rates, it is considered important to develop and implement policies to increase organizational support levels. Likewise, the use of safety reporting systems should be expanded to reduce medical error rates, reports should be used only to prevent and reduce risks, and systems and strategies should be developed instead of blaming individuals. In addition to the reporting of confirmed medical errors to ensure patient safety, the reporting of so-called "near misses" is also very important. For this reason, institutional support should be provided regarding the importance of "near miss" events in error reporting. Necessary practices should be provided to identify, report, correct, and prevent these events.

Safety climate in the operating room in the pre-pandemic and pandemic period of COVID-19: A mixed method study

INTRODUCTION

To verify whether the COVID-19 pandemic has had an impact on the safety climate based on the perception of the multiprofessional team in the operating room and to analyze the domains of the safety climate during the pre-pandemic and pandemic period of COVID-19, demonstrating the intersections of quantitative and qualitative approaches.

METHODS

Mixed-method research using a convergent approach strategy, carried out in the operating room of a university hospital, located in Rio de Janeiro, Brazil. The nature of the quantitative phase was cross-sectional, and the nature of the qualitative phase was descriptive. We used the Pillar Integration Process to integrate the data. This research considered the pre-pandemic period was defined as before March 2020 and for the pandemic period, the 2nd and 3rd global waves. Research was approved by the institution's board management and ethics committee.

RESULTS

145 health professionals participated in the quantitative approach, and 20 in the qualitative approach. The impact of the COVID-19 pandemic was highlighted in the domains 'Perceived stress' (p-value = 0.017); 'Working conditions' (p-value = 0.040). Six categories emerged from the qualitative analysis, namely: Stress and professional performance due to COVID-19; Patient safety protocols in the operating room; Responsibility for patient safety, lack of effective communication and performance feedback; Biosafety of the professional staff in the operating room; Security culture maturity; Fair culture, organizational learning, and reporting mistakes. As a result of the data integration, 6 pillars were identified: Perception of communication in the operating room; Evolution of safety culture; Overview of protocol management and implementation; Fair organizational culture; Perception of stress due to COVID-19; Perception of professional performance due to COVID-19.

CONCLUSIONS

The impact that COVID-19 had on the safety climate in the operating room is evident. It underlines the need to implement strategies that support the solidification of attitudes aimed at patient safety, even in emergencies.

Measuring operating theatre nurses' perceptions of safety culture using the SCORE questionnaire

BACKGROUND

Tackling operating theatre waiting lists may focus healthcare organisations' attention on increased productivity while downplaying safety concerns.

AIM

To explore safety culture in a perioperative department from operating theatre practitioners' perspective.

METHOD

Cross-sectional pen-and-paper survey among nurses in an operating theatre department in Malta using the Safety, Communication, Operational Reliability and Engagement questionnaire.

FINDINGS

The response rate was 71.2% (n = 146). Engagement domains and Organisational Safety Culture domains were perceived to be at an average level, apart from Unit Leadership which was perceived to be low. Burnout domains were perceived to be high or very high. Correlation analysis showed that leaders' recognition of staff feedback and input is associated with improved safety culture perceptions.

CONCLUSION

An organisational win-win situation is achievable, whereby safety culture perceptions are improved, not necessarily by decreasing job demands such as tackling waiting lists, but by recognising operating theatre staff's input and involving them in work-related decisions.

Evolutionary game theory and simulations based on doctor and patient medical malpractice under government regulation

Physicians-patients are the two crucial participants in medical malpractice. The government, as the central authority responsible for addressing medical malpractices, plays a pivotal role in this matter. Guided by governmental agencies, its regulations, administrative orders, and policies serve as the primary governance mechanisms to address medical malpractice, providing an effective means to balance the doctor-patient relationship and foster social harmony and stable development. A doctor-patient evolutionary game model developed based on the principles of information asymmetry and finite rationality. The study explores the strategic decision-making process of these two players within the context of medical malpractice. Through the manipulation of various parameters, the model's evolutionary equilibrium strategy is demonstrated using Vensim PLE Version 6.4 simulation. The findings reveal that government regulation, patient cognition, and the benefits associated with standardized medical practices are the pivotal factors influencing the doctor-patient evolutionary game system under government regulation. It is possible to mitigate medical malpractice through adjusting relative weights of differing strategic options, adding penalties for unlawful conduct, and normalizing malpractice charges on the basis of physicians' income from standardized practice. To effectively address medical malpractice, proposed measures include adjusting the regulatory framework, reasonably determining the strength of regulations regarding medical practitioners' illegal practices and patient medical malpractice behavior, diversifying regulatory approaches, establishing comprehensive physician-patient management systems for information to resolve medical malpractices.

The Perception of the Patient Safety Climate by Health Professionals during the COVID-19 Pandemic-International Research

The patient safety climate is a key element of quality in healthcare. It should be a priority in the healthcare systems of all countries in the world. The goal of patient safety programs is to prevent errors and reduce the potential harm to patients when using healthcare services. A safety climate is also necessary to ensure a safe working environment for healthcare professionals. The attitudes of healthcare workers toward patient safety in various aspects of work, organization and functioning of the ward are important elements of the organization’s safety culture. The aim of this study was to determine the perception of the patient safety climate by healthcare workers during the COVID-19 pandemic. Methods: The study was conducted in five European countries. The Safety Attitude Questionnaire (SAQ) short version was used for the study. A total of 1061 healthcare workers: physicians, nurses and paramedics, participated in this study. Results: All groups received the highest mean results on the stress recognition subscale (SR): nurses 98.77, paramedics 96.39 and physician 98.28. Nurses and physicians evaluated work conditions (WC) to be the lowest (47.19 and 44.99), while paramedics evaluated perceptions of management (PM) as the worst (46.44). Paramedics achieved statistically significantly lower scores compared to nurses and physicians in job satisfaction (JS), stress recognition (SR) and perception of management (PM) (p < 0.0001). Paramedics compared to nurses and physicians rank better in working conditions (WC) in relation to patient safety (16.21%). Most often, persons of lower seniority scored higher in all subscales (p = 0.001). In Poland, Spain, France, Turkey, and Greece, healthcare workers scored highest in stress recognition (SR). In Poland, Spain, France, and Turkey, they assessed working conditions (WC) as the worst, while in Greece, the perception of management (PM) had the lowest result. Conclusion: Participant perceptions about the patient safety climate were not at a particularly satisfactory level, and there is still a need for the development of patient safety culture in healthcare in Europe. Overall, positive working conditions, good management and effective teamwork can contribute to improving employees’ attitudes toward patient safety. This study was carried out during the COVID-19 pandemic and should be repeated after its completion, and comparative studies will allow for a more precise determination of the safety climate in the assessment of employees.

Intravenous medication errors in the emergency department, knowledge, tendency to make errors and affecting factors: An observational study

BACKGROUND

Intravenous medication errors are common in hospital settings particularly emergency department. This study aimed to determine intravenous medication preparation and administration errors, contributing factors, tendency towards making errors and knowledge level of emergency department healthcare workers.

METHODS

A cross-sectional study using a structured, direct observation method was conducted. It was conducted with 23 emergency healthcare workers working in the emergency department of a university hospital in Turkey. Data were collected by questionnaires: Knowledge Test on Intravenous Medication Administration, Intravenous Drug Administration Standard Observation Form, Drug and Transfusion Administration Sub-Dimension scale, Perceived Stress Scale and Pittsburgh Sleep Quality Index.

RESULTS

It was determined that the knowledge level of the emergency healthcare workers about intravenous medication administration was moderate, and the tendency mistakes regarding drug and transfusion applications was very low. There was no relationship between education level, years of work, years of work in the emergency department, perceived stress level and sleep quality, and the tendency of making mistakes in drug and transfusion applications.

CONCLUSION

It is important for patient safety to prevent medication errors by determining the factors affecting intravenous medication administration, tendency to make mistakes and knowledge levels, which are frequently used in emergency department.

Student nurses' perceptions of a patient safety culture: A descriptive and cross-sectional study

PURPOSE

The aim of this study was to evaluate nursing students' perceptions of a patient safety culture in one university in Turkey.

DESIGN AND METHODS

The sample of this descriptive cross-sectional study consisted of 299 undergraduate nursing students. Data were collected by having participants complete the Patient Safety Culture Scale (PSCS) and a personal information form.

FINDINGS

Participants' scores on the PSCS were found to be moderate, and no significant differences were found between participants' study levels. Female students and students who had willingly chosen the nursing profession obtained statistically significantly higher scores on the PSCS, indicating positive perceptions of a patient safety culture.

PRACTICE IMPLICATIONS

The inclusion of patient safety education and training of nurses in the nursing curriculum may contribute to students' development of a patient safety culture.

The Effect of Personal Protective Equipment Use on Nurses' Tendencies to Make Medical Errors and Types of Their Medical Errors: A Cross-Sectional Study

This study was conducted to determine the effect of nurses' use of Personal Protective Equipment (PPE) during their care practices on their tendency to make medical errors and types of medical errors. The study was conducted with 505 nurses in Turkey between May 2021 and June 2021. Descriptive statistics, Kruskal-Wallis H test, Spearman's correlation test, and Mann-Whitney U test were used to analyze the data. During the COVID-19 pandemic, nurses often used PPE on different levels. A significant relationship was determined between the type of PPE used by the nurses and falls, hospital infections and patient monitoring/material safety (p < 0.05). The conclusions in this study reveal the necessity of increasing the usability, safety and effectiveness of PPE used by nurses in health institutions.

Patient Safety Attitudes among Doctors and Nurses: Associations with Workload, Adverse Events, Experience

Patient safety concept has achieved more attention from healthcare organizations to improve the safety culture. This study aimed to investigate patient safety attitudes among doctors and nurses and explore associations between workload, adverse events, and experience with patient safety attitudes. The study used a descriptive cross-sectional design and the Turkish version of the Safety Attitudes Questionnaire. Participants included 73 doctors and 246 nurses working in two private hospitals in Northern Cyprus. The participants had negative perceptions in all patient safety domains. The work conditions domain received the highest positive perception rate, and the safety climate domain received the lowest perception rate among the participants. Nurses showed a higher positive perception than doctors regarding job satisfaction, stress recognition, and perceptions of management domains. There were statistically significant differences between experiences, workloads, adverse events, and total mean scores of patient safety attitudes. Policymakers and directors can improve the quality of care of patients and patient safety by boosting the decision-making of health care providers on several domains of safety attitudes. Patient safety needs to be improved in hospitals through in-service education, management support, and institutional regulations.

Analysis of influencing factors of nurse-patient disputes based on patient characteristics: A cross-sectional study

Aim

To explore the prevalence of nurse‐patient disputes and the influencing factors based on an analysis of patient characteristics.

Design

A cross‐sectional study.

Methods

This study used the convenience sampling method. Three self‐designed questionnaires based on clinical experience and literature review were used to collect the current status of nurse‐patient disputes and to assess patients’ humanistic qualities and patients’ recognition of nursing work. The Big Five personality questionnaire was used to assess the five personality traits of patients.

Results

Of the patients, 9.6% reported having a dispute with nurses. The results of binary logistic regression analysis indicated that patients’ humanistic quality, recognition of nursing work and agreeableness in personality traits had a negative predictive effect on nurse‐patient disputes, while family monthly income and neuroticism in personality traits positively predicted disputes.

The effect of the clinical nurses' compassion levels on tendency to make medical error: A cross-sectional study

BACKGROUND

Compassion is considered the cornerstone of nursing practices and professionalism. However, a decrease in compassion may increase medical errors and adversely affect patient safety.

AIMS

The study was conducted to determine clinical nurses' compassion levels and their tendency to make medical errors, and to find whether their compassion levels affect their tendency to make medical errors.

METHODS

A cross-sectional, descriptive and correlational design was used. The study was conducted with 309 nurses working at a university hospital. The study data were collected by using the Compassion Scale and Medical Error Tendency Scale in Nursing.

RESULTS

The nurses' compassion levels were moderate, and their medical error tendency levels were low. The comparison of the mean scores obtained from the Compassion Scale and Medical Error Tendency Scale in Nursing revealed a weak positive significant relationship (p < .001). No statistically significant difference was determined between the mean scores obtained from the Compassion Scale by the participants who made medical errors at least once during their professional life and the mean scores obtained by the participants who did not (p > .05). It was found that the mean score for the mindfulness subscale of the Compassion Scale and the length of service were determined to be the factors that significantly affected the participants' tendency to make medical errors (R = 0.42, R² = 0.181, F = 3.771, p = .000).

CONCLUSION

The nurses' tendency to make medical errors decreased as their compassion levels increased, and that compassion was an important predictor of tendency to make medical errors.

Patient Safety Attitude of Nurses Working in Surgical Units: A Cross-Sectional Study in Turkey

PURPOSE

To determine the attitudes of nurses working in surgical units toward patient safety.

DESIGN

A descriptive and cross-sectional study.

METHODS

The sample in this study was 207 nurses (92% of all the nurses) working in surgical units in a training and research hospital in Turkey, all of whom agreed to participate in this study between April 30 and June 25, 2019. Study data were collected using a demographic characteristics form and the Patient Safety Attitude Questionnaire. Number, mean, SD, percentage calculations, Kruskal-Wallis test, Mann-Whitney U test, and the Spearman correlation test were used to analyze the study data.

FINDINGS

The mean total attitude score of the nurses was 176.30 ± 26.92. Nurses who previously received training on patient safety had statistically higher attitude scores than those who did not (U = 3883.000; P = .01).

CONCLUSIONS

Nurses working in surgical units had a positive attitude toward patient safety, and previous training on patient safety significantly improved their attitude scores. A recommendation is to conduct effective in-service training programs for patient safety in hospitals and to encourage participation by nurses in training programs such as courses and conferences that will result in attitude improvement.

Attitudes towards patient safety culture among postgraduate nursing students in China: A cross-sectional study

Patient safety is crucial to healthcare quality. It is important to assess the nursing students' safety attitudes to identify the weaknesses for developing education program and fostering students' engagement in patient safety practices. This study aimed to assess attitudes towards patient safety culture among postgraduate nursing students in China, and explore the factors that affect their safety attitudes and the relationships of safety attitudes and safety-related behaviors. This study used a cross-sectional survey design. A convenience sample of 231 postgraduate nursing students from ten medical universities in China completed the Chinese version of Safety Attitude Questionnaire, including six domains: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions and stress recognition. The mean scores of the six domains ranged from 65.22 to 70.75 on a 100-point scale. Percentages of positive responses for the six domains were below 55%, with the two lowest percentages for working conditions (35.9%) and safety climate (30.7%). Significantly lower domain scores were found in students with younger age, no work experience, higher workload and received safety education. There were positive correlations between the six domains and safety-related behaviors except for stress recognition. Nursing educators should focus more on the improvement of patient safety education and establishment of supportive work environment to enhance postgraduate nursing students' attitudes towards safety culture.