Nursing Home Patient Safety Culture Perceptions Among US and Immigrant Nurses

Factors influencing the transition of foreign-educated nurses to the US healthcare setting: A systematic review

AIM

This literature review examined the impact of the orientation or onboarding programs on the transition of foreign-educated nurses to a US healthcare setting and factors influencing their transition.

BACKGROUND

Recruitment of foreign-educated nurses has been a solution to the ongoing nursing workforce shortage in the United States. However, they face various challenges in their transition to employment in the United States. Adequate orientation and continued support are needed for the successful transition of foreign-educated nurses.

METHODS

A systematic literature search was conducted in 2022 across PubMed, CINAHL, Academic Search Complete, Google Scholar, and MEDLINE databases. This review selected only articles published between 2015 and 2022 in English that addressed foreign-educated nurses' transition issues in US healthcare settings. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the articles was appraised using the John Hopkins Evidence-based Practice tool.

RESULTS

This review of 14 articles revealed that the quality of orientation and organizational support were positively associated with foreign-educated nurses' job satisfaction and turnover. Factors influencing foreign-educated nurses' transition included peer support, job assignment and workload, credentialing, communication and cultural adjustment, psychological factors, safety perceptions, work environment, and coping strategies.

DISCUSSION

There was a lack of literature that evaluated orientation or onboarding programs for foreign-educated nurses. Further research is needed to explore the effectiveness of supportive programs in promoting their smooth transition.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Efficient onboarding or orientation programs and policies for foreign-educated nurses are crucial, considering the factors influencing their transition. Good programs and policies that prioritize the support, integration, and professional development of FENs will help maximize their contributions to health care.

Internationally Educated Nursing Staff Caring for Older Adults: A Scoping Study

INTRODUCTION

Internationally Educated Nursing staff (IENs) are born and obtained their initial educational preparation in their home country before relocating to work in high-income countries (e.g., United States). Older adults are recipients of IENs' care. The study purpose was to synthesize relevant findings on IENs' experiences caring for older adults in various settings.

METHOD

Arksey and O'Malley's framework approach to Scoping studies was employed. The PubMed, CINAHL, PsycINFO, Web of Science, and Google Scholar databases were searched. A labor and employment relations researcher and a health science librarian were consulted.

RESULTS

Three main themes (transitional challenges; IENs' experiences working with older adults; factors affecting IEN service delivery) and seven subthemes emerged.

DISCUSSION

Cultural beliefs and communication barriers posed particular challenges to IENs as they worked with Western peers, older adults, and families. Facilitating factors revealed can inform administrative leaders of practice initiatives. Research gaps and limitations identified can guide future study approaches.

Patient safety measurement tools used in nursing homes: a systematic literature review

Background

An increase in the number of older adults has highlighted the important issue of the safety of residents in nursing homes. This review aimed to review previous studies on patient safety of older adults living in nursing homes, analyze the tools used to measure it, and identify factors affecting patient safety of older adult residents in nursing homes.

Methods

A literature search was conducted using EMBASE, PubMed, CINHAL, and COCHRANE. The main search terms were “nursing home” or “skilled nursing facility” or “long-term care facility” and “patient safety.” In total, 13,586 articles were identified. Two authors independently assessed the quality of each selected study using the Crowe Critical Appraisal Tool.

Results

Twenty-five studies were included in the analysis. There were a total of seven tools used to measure patient safety in nursing homes: the Nursing Home Survey on Patient Safety Culture (10 studies) and Hospital Survey on Patient Safety Culture (nine studies). Furthermore, the Nursing Home Survey on Patient Safety Culture-China, Safety Attitudes Questionnaire, Safety Attitudes Questionnaire in a Skilled Nursing Facility, Safety Attitudes Questionnaire-Ambulatory Version, and Modified Stanford Patient Safety Culture Survey Instrument were used in one study each. The most used tool among them was the Nursing Home Survey on Patient Safety Culture. Most tools used to measure patient safety in nursing homes were related to patient safety culture and employee attitudes.

Conclusion

Organizational factors, such as the staff education system and the composition of appropriate personnel, should be strengthened to establish a patient safety culture in nursing homes, for which policy support is crucial.

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.

A cross-validation study of the incident-reporting attitude scale for staff in long-term care facilities-A cross-sectional study

AIMS AND OBJECTIVES

To test the construct and concurrent validity and reliability of the incident-reporting attitude scale used for staff in long-term care facilities (IRA-LTC) by the two-phase cross-validation method.

BACKGROUND

Lack of accurate measurement on incident-reporting attitude might hinder improvements of safety practice in long-term care facilities.

DESIGN/METHODS

A two-phase cross-sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long-term care facilities were randomly selected that included 20 and 15 long-term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N = 207) for testing the validity and reliability of the newly developed scale and for cross-validation of the scale at the second phase (N = 251). The scale of IRA-LTC was a self-developed structured questionnaire consisting of 31 items. The data were analysed using spss for Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach's α, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1).

RESULTS

The IRA-LTC scale comprised two dimensions: "cognition and intention to report" and "barriers to report." The two-factor structure explained 60.20%-61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA-LTC scale was satisfied. Cronbach's α for the scale and subscales was 0.94-0.97.

CONCLUSIONS

This IRA-LTC scale is valid and reliable and can be recommended to evaluate the incident-reporting attitude among all kinds of staff in long-term care facilities.

RELEVANCE TO CLINICAL PRACTICE

Positive incident-reporting attitude can lead to positive incident-reporting behaviour. Using the IRA-LTC scale for assessing staff's incident-reporting attitude is recommended as the first step to enhance staff's safety performance in long-term care facilities.