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Mullen JE, Reynolds MR. Implementation of Nurse Integrated Rounds Improves Interdisciplinary Communication in the Pediatric Intensive Care Unit. AACN Adv Crit Care 2024; 35:180-186. [PMID: 38848560 DOI: 10.4037/aacnacc2024707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Affiliation(s)
- Jodi E Mullen
- Jodi E. Mullen is Senior Quality Improvement Specialist, Department of Clinical Quality and Patient Safety, UF Health Shands Hospital, 3300 SW Williston Rd, Gainesville, FL 32608
| | - Melissa R Reynolds
- Melissa R. Reynolds is Registered Nurse, Department of Nursing and Patient Services, UF Health Shands Hospital, Gainesville, Florida
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Sarwar F, Ring D, Donovan E. Clinician communication strategies to navigate differences of opinion with patients. PATIENT EDUCATION AND COUNSELING 2024; 123:108185. [PMID: 38340633 DOI: 10.1016/j.pec.2024.108185] [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: 06/06/2023] [Revised: 01/20/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE We investigated communication strategies clinicians reported using to navigate differences of opinion with patients regarding medical decisions. METHODS Twenty physicians of various specialties participated in semi-structured interviews regarding their strategies for maintaining mutual respect when disagreeing with a patient. Reflexive thematic analysis was applied. Enrollment concluded upon theme saturation. RESULTS In an attempt to limit disagreements, physicians learned to gauge patient values, often deferring to clinicians being the expert on medicine and patients being the expert on themselves. Physicians noticed that disagreements were reinforced by prioritizing educational approaches. Strengthening the relationship by validating patient emotions was seen as a more effective strategy. Clinicians found it difficult to weigh relative potential for benefit to the relationship and feelings of moral distress in capitulating to patient preferences they disagreed with. CONCLUSION Physicians recognized the value of moving from educational to relationship building strategies to help limit and navigate disagreements. Key strategies include prioritizing gauging the patient's values and validating their emotions. PRACTICE IMPLICATIONS Anticipating disagreement, training clinicians to limit teaching, and instead prioritize a strong relationship to maintain trust and collaboration has the potential to improve patient health, with more limited resource use, and better experiences of care.
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Affiliation(s)
- Faiza Sarwar
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Austin, TX 78712, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Austin, TX 78712, USA.
| | - Erin Donovan
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Austin, TX 78712, USA
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Miner DC, Ailey SH, Thompson RA, Squires A, Adarlo A, Brown H. "We have met the enemy and it is us": Healthcare professionals as the barrier to health equity for people with intellectual and developmental disability. Res Nurs Health 2024; 47:269-273. [PMID: 38415432 DOI: 10.1002/nur.22376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Dianne C Miner
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
| | - Sarah H Ailey
- Rush University College of Nursing, Chicago, Illinois, USA
| | - Roy A Thompson
- Preparing Future Faculty for Inclusive Excellence Postdoctoral Fellow, Sinclair School of Nursing, University of Missouri, Kansas City, Missouri, USA
| | - Allison Squires
- NYU Rory Meyers College of Nursing, New York, New York, USA
- Department of General Internal Medicine, Grossman School of Medicine, New York City, New York, USA
- National Academy of Medicine, Washington, District of Columbia, USA
| | - Amyela Adarlo
- Loma Linda University, School of Nursing, Loma Linda, California, USA
- Gamma Alpha Chapter of Sigma Theta Tau International, Indianapolis, Indiana, USA
| | - Holly Brown
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
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4
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Zhou X, Du F, Peng W, Bai L, Peng L, Hou X. Building Medication Profiles in the Elderly: a Qualitative Study Based on Medication Information Literacy in a Long-Term Care Facility. Clin Interv Aging 2024; 19:779-793. [PMID: 38751855 PMCID: PMC11095403 DOI: 10.2147/cia.s454620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents. Material and Methods In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants' understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents. Results The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile. Conclusion This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.
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Affiliation(s)
- Xiaoyu Zhou
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
| | - Fei Du
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
| | - Wei Peng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, People’s Republic of China
| | - Li Bai
- Hospital of Zigong Mental Health Central, Sichuan, 643021, People’s Republic of China
| | - Leyi Peng
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
| | - Xiaorong Hou
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
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5
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Boyer TJ, Mitchell SA. Thank you artificial intelligence: Evidence-based just-in-time training via a large language model. Am J Surg 2024:S0002-9610(24)00224-1. [PMID: 38609743 DOI: 10.1016/j.amjsurg.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Tanna J Boyer
- Department of Anesthesia at Indiana University School of Medicine, United States.
| | - Sally A Mitchell
- Department of Anesthesia at Indiana University School of Medicine, United States
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6
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Fullaondo A, Erreguerena I, Keenoy EDM. Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain). BMC Health Serv Res 2024; 24:364. [PMID: 38515068 PMCID: PMC10958960 DOI: 10.1186/s12913-024-10810-w] [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: 01/28/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19. METHODS A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. RESULTS The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented. CONCLUSIONS The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.
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Affiliation(s)
- Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
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Guthrie E, Levy D, Del Carmen G. The Operating and Anesthetic Reference Assistant (OARA): A fine-tuned large language model for resident teaching. Am J Surg 2024:S0002-9610(24)00106-5. [PMID: 38365551 DOI: 10.1016/j.amjsurg.2024.02.016] [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: 09/30/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE This study aimed to fine-tune a large language model (LLM) for domain-specific text generation in surgical and anesthesia residency education. SUMMARY BACKGROUND DATA With growing interest in artificial intelligence (AI) for medical training, the potential of LLMs to transform residency education is explored. METHODS The 7-billion parameter base model "Vicuna v1.5" was trained on 266,342 lines of text from 821 peer-reviewed documents. We evaluated the model with 150 surgical or anesthesia queries and assessed accuracy, token count, and inference speed across various reasoning tasks. Tests of significance were conducted using ANOVA and chi-square analysis. RESULTS Our model achieved 65.3% accuracy, excelling in surgical case-based tasks. We found no significant difference in accuracy between knowledge domains (P=0.081), though longer response generation demonstrated poorer accuracy, with significant accuracy variation based on output length (P = 0.002). CONCLUSIONS LLMs show potential in enhancing residency education. Our model's efficiency and task-specific accuracy highlights such promise, though limits in parameter count diminishes accuracy of longer response generation. Our findings showcase how AI may be integrated effectively within future residency training.
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Affiliation(s)
- Estefania Guthrie
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dominique Levy
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gabriel Del Carmen
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
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Talyshinskii A, Naik N, Hameed BMZ, Juliebø-Jones P, Somani BK. Potential of AI-Driven Chatbots in Urology: Revolutionizing Patient Care Through Artificial Intelligence. Curr Urol Rep 2024; 25:9-18. [PMID: 37723300 PMCID: PMC10787686 DOI: 10.1007/s11934-023-01184-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE OF REVIEW Artificial intelligence (AI) chatbots have emerged as a potential tool to transform urology by improving patient care and physician efficiency. With an emphasis on their potential advantages and drawbacks, this literature review offers a thorough assessment of the state of AI-driven chatbots in urology today. RECENT FINDINGS The capacity of AI-driven chatbots in urology to give patients individualized and timely medical advice is one of its key advantages. Chatbots can help patients prioritize their symptoms and give advice on the best course of treatment. By automating administrative duties and offering clinical decision support, chatbots can also help healthcare providers. Before chatbots are widely used in urology, there are a few issues that need to be resolved. The precision of chatbot diagnoses and recommendations might be impacted by technical constraints like system errors and flaws. Additionally, issues regarding the security and privacy of patient data must be resolved, and chatbots must adhere to all applicable laws. Important issues that must be addressed include accuracy and dependability because any mistakes or inaccuracies could seriously harm patients. The final obstacle is resistance from patients and healthcare professionals who are hesitant to use new technology or who value in-person encounters. AI-driven chatbots have the potential to significantly improve urology care and efficiency. However, it is essential to thoroughly test and ensure the accuracy of chatbots, address privacy and security concerns, and design user-friendly chatbots that can integrate into existing workflows. By exploring various scenarios and examining the current literature, this review provides an analysis of the prospects and limitations of implementing chatbots in urology.
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Affiliation(s)
- Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Thota B, Rabinowitz A, Guttman O. Taking Up the Challenge to Improve Name and Role Recognition in the Operating Room. J Patient Saf 2024; 20:45-47. [PMID: 37922239 DOI: 10.1097/pts.0000000000001177] [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: 11/05/2023]
Abstract
ABSTRACT The rise of the #TheatreCapChallenge in 2017, which saw participants donning surgical caps labeled with their names and roles, promises to be a seemingly simple intervention aimed at improving operating theater communication and patient safety. This narrative review strives to expand upon the perceived and studied benefits of this intervention and address potential concerns that have arisen with the use of these name and role-labeled surgical caps.
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Affiliation(s)
- Bhavana Thota
- From the Sidney Kimmel Medical College, Thomas Jefferson University
| | - Anna Rabinowitz
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Oren Guttman
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Yerstein MC, Sundararaj D, McLean M, Kroll DS. Anticipating Patient Safety Events in Psychiatric Care. J Psychiatr Pract 2024; 30:68-72. [PMID: 38227731 DOI: 10.1097/pra.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Although suicide prevention often dominates patient safety efforts in psychiatry and behavioral health, patients who seek such services are also prone to other kinds of adverse events. The purpose of this study was to more fully characterize the types of safety events that occur in the context of psychiatric care. METHODS This was a retrospective study of safety events that had been reported to a hospital-based psychiatry department during a 4-year period. The authors reviewed each incident, developed new and more precise event categories, and assigned each report to a category. Events that could not be categorized were assigned to an "Other" category. The percentages of categorizable events between the new and old frameworks were compared. RESULTS A total of 366 reports were filed. In the updated framework, 324 events (89%) could be categorized compared to 225 (61%) in the original registry. CONCLUSIONS Understanding the kinds of safety events that clinicians are likely to encounter in the context of psychiatric care may help to expand patient safety efforts beyond suicide risk prevention.
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11
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Sanders HM, Seyferth AV, Chung KC. Science of Collaboration. Plast Reconstr Surg 2023; 152:1145-1151. [PMID: 38019687 DOI: 10.1097/prs.0000000000010885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Hayley M Sanders
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Anne V Seyferth
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
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Kulesa JT, Tyris JN, McQuiston-Lane K, Herstek J, Rush ML. Increasing Nurse-Physician Family-Centered Rounds Communication: A Quality Improvement Pilot Project. J Nurs Care Qual 2023; 38:304-311. [PMID: 36827695 DOI: 10.1097/ncq.0000000000000701] [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: 02/26/2023]
Abstract
BACKGROUND High-quality nurse-physician communication during family-centered rounds (FCRs) can increase patient safety. LOCAL PROBLEM In our hospital, interdisciplinary team members perceived that nurse-physician communication during FCRs declined during the COVID-19 pandemic. METHODS Using quality improvement methodology, we measured nurses' perceived awareness of components of the shared mental model, nurses' attendance during FCRs, compliance with completing FCR summaries, and average time spent per FCR encounter. INTERVENTIONS A structured resident huddle took place prior to an FCR. Residents used a tool to send individualized alerts to bedside nurses to prepare them for an FCR. Residents developed comprehensive summaries after each FCR encounter and sent a summary text to nurses who were unable to attend the FCR. RESULTS We assessed 40 FCRs over 16 weeks. Nurses' perceived awareness increased from 70% to 87%. Nurse attendance increased from 53% to 75%. CONCLUSIONS We successfully piloted multiple interventions to improve nurse perceived awareness after an FCR.
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Affiliation(s)
- John T Kulesa
- Division of Hospital Medicine (Drs Kulesa Tyris, Herstek, and Rush) and Department of Pediatrics (Ms McQuiston-Lane), Children's National Hospital, Washington, District of Columbia
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Choi S. Enhancing nursing education to bolster nurse governance: insights from nurse managers. Front Med (Lausanne) 2023; 10:1254428. [PMID: 37731715 PMCID: PMC10508344 DOI: 10.3389/fmed.2023.1254428] [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: 07/07/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Aim In South Korea, the level of nursing governance is moving toward shared governance. This study sought to explore nursing education contents in undergraduate nursing programs necessary to improve the governance of nurses from the perspectives of nurse managers. Methods The study employs thematic analysis following the guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research utilizing a qualitative research design. Our investigation involves general or tertiary hospital nurse managers intending to gain valuable insights and perspectives. Results Interview data from 14 nurse managers were analyzed. A total of one main and four sub-themes were derived from the qualitative data analysis. Analysis revealed the main theme, "occupational socialization." The four sub-themes were education on "nurse-patient and nurse-colleague communicative interaction," "humanity," "career development," and "nurses as politicians." Conclusion The findings are valuable in suggesting critically needed educational content in undergraduate nursing programs to improve nursing governance. Future research should investigate the effects of the abovementioned themes on nursing governance among clinical nurses or nursing students for several years of follow-up data collection.
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Affiliation(s)
- Sujin Choi
- Department of Nursing, College of Medicine, Soonchunhyang University, Asan, Republic of Korea
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Srulovici E, Drach-Zahavy A. Editorial: From structure to agency: understanding nurse's agency in quality and safe care. Front Psychol 2023; 14:1223807. [PMID: 37593654 PMCID: PMC10431938 DOI: 10.3389/fpsyg.2023.1223807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Einav Srulovici
- The Cheryl Spencer Department of Nursing, The University of Haifa, Haifa, Israel
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Ong N, Lucien A, Long JC, Weise J, Walton M, Burgess A. What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis. BMJ Open 2023; 13:e071494. [PMID: 37491102 PMCID: PMC10373726 DOI: 10.1136/bmjopen-2022-071494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient safety experiences of their child in hospital. DESIGN Qualitative study. SETTING We conducted semi-structured interviews and focus groups of staff of tertiary children's hospitals based on the domains of the Patient Safety Education Framework and using the framework methodology for data analysis. PARTICIPANTS There were 29 female and 7 male staff aged between 27 and 70 years from a range of departments and specialties including ancillary staff. INTERVENTION Questions based on the patient safety framework were developed from consultation with parents, researchers and clinicians exploring staff views and experiences of safety and quality care of these children in hospital. During April 2021 to May 2022, 22 interviews and 3 focus groups were conducted of staff who have had experience caring for children and young people with intellectual disability in the last 12 months in the hospital. RESULTS Key themes elicited include Definition of Safety, Need to consider additional vulnerabilities of children and young people with intellectual disability in hospital, Communication is key to safe care, Parent and family perspectives on safe care, Management challenges compromising safety and Service system gaps in preventing, identifying and managing risk. CONCLUSIONS Staff need to consider additional vulnerabilities, mitigate negative attitudes and biases towards better engagement and relationships with parents, children and young people of this population. Improvement of current systems that prevent the identification, prevention and management of risk and safety issues for this population need to be undertaken. Future developments include combining data from parent interviews, academic and grey literature in developing safety competencies in this population for training and education of staff across the health system.
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Affiliation(s)
- Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Child Development Unit, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, School of Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Merrilyn Walton
- Office of Teaching and Learning in Medicine, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Annette Burgess
- Medical Education, Education Office, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Thomas YT, Chary AN, Suh MI, Samaei M, Dobiesz V, Kalantari A, Buehler G, Das D, Wolfe J. The development of an educational workshop to reframe and manage professional conflict via a sex and gender lens. AEM EDUCATION AND TRAINING 2023; 7:e10872. [PMID: 37261219 PMCID: PMC10227172 DOI: 10.1002/aet2.10872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 06/02/2023]
Abstract
Background Conflict is inevitable in the emergency department, and conflict resolution is an essential skill for emergency providers to master. Effective conflict management can optimize patient care and enhance professional satisfaction. To communicate effectively in high-stress, high-impact situations, sex- and gender-based differences need to be considered. Methods Nine resident, fellow, junior, and senior faculty members of the Academy for Women in Academic Emergency Medicine collaborated to design a 4-h workshop. The focus was on professional communication and conflict resolution in emergency medicine (EM), with special attention on how sex and gender can influence these processes. Results The final educational workshop utilized a variety of formats focused on communication and effective conflict resolution including: traditional didactics, facilitated small groups with case-based learning, expert panel discussion, and an experiential learning session. The consideration of how sex- and gender-associated factors might contribute additional complexity or challenges to conflictual interactions were interwoven into each session to highlight alternative vantage points. Conclusions Effective conflict resolution is an important skill for success in EM. We developed a workshop that went beyond typical communication-based programming to consider how sex- and gender-related factors influence communication and conflict resolution.
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Affiliation(s)
- Ynhi T. Thomas
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Anita N. Chary
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Michelle I. Suh
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Mehrnoosh Samaei
- Emory Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Valerie Dobiesz
- Department of Emergency MedicineSTRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Harvard Humanitarian InitiativeBostonMassachusettsUSA
| | - Annahieta Kalantari
- Department of Emergency MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Greg Buehler
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Devjani Das
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jeannette Wolfe
- Department of Emergency MedicineUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMassachusettsUSA
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Hess CW, Rosen MA, Simons LE. Looking inward to improve pediatric chronic pain outcomes: a call for team science research. Pain 2023; 164:690-697. [PMID: 36637136 PMCID: PMC10879964 DOI: 10.1097/j.pain.0000000000002836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/22/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Courtney W. Hess
- Stanford University School of Medicine; Department of Anesthesiology, Perioperative, & Pain Medicine
| | - Michael A. Rosen
- Johns Hopkins University School of Medicine; Department of Anesthesiology and Critical Care Medicine
| | - Laura E. Simons
- Stanford University School of Medicine; Department of Anesthesiology, Perioperative, & Pain Medicine
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Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework. PLoS One 2022; 17:e0278549. [PMID: 36480568 PMCID: PMC9731462 DOI: 10.1371/journal.pone.0278549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION While numerous guidelines do not recommend preoperative tests for low risk patients undergoing low risk surgeries, they are often routinely performed. Canadian data suggests preoperative tests (e.g. ECGs and chest x-rays) preceded 17.9%-35.5% of low-risk procedures. Translating guidelines into clinical practice can be challenging and it is important to understand what is driving behaviour when developing interventions to change it. AIM Thus, we completed a theory-based investigation of the perceived barriers and enablers to reducing unnecessary preoperative tests for low-risk surgical procedures in Newfoundland, Canada. METHOD We used snowball sampling to recruit surgeons, anaesthesiologists, or preoperative clinic nurses. Interviews were conducted by two researchers using an interview guide with 31 questions based on the theoretical domains framework. Data was transcribed and coded into the 14 theoretical domains and then themes were identified for each domain. RESULTS We interviewed 17 surgeons, anaesthesiologists, or preoperative clinic nurses with 1 to 34 years' experience. Overall, while respondents agreed with the guidelines they described several factors, across seven relevant theoretical domains, that influence whether tests are ordered. The most common included uncertainty about who is responsible for test ordering, inability to access patient records or to consult/communicate with colleagues about ordering decisions and worry about surgery delays/cancellation if tests are not ordered. Other factors included workplace norms that conflicted with guidelines and concerns about missing something serious or litigation. In terms of enablers, respondents believed that clear institutional guidelines including who is responsible for test ordering and information about the risk of missing something serious, supported by improved communication between those involved in the ordering process and periodic evaluation will reduce any unnecessary preoperative testing. CONCLUSION These findings suggest that both health system and health provider factors need to be addressed in an intervention to reduce pre-operative testing.
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Iranpour A, Mirafzali S, Borhaninejad V, Alizadeh S. Communication barriers to education to referrals from the perspective of referrals to health centers and health care providers. J Public Health Res 2022; 11:22799036221127634. [PMID: 36310826 PMCID: PMC9608057 DOI: 10.1177/22799036221127634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction One of the most important factors affecting the increase of clients' satisfaction is how health care providers (HCP) communicate with clients. On the other hand, different factors can hinder proper communication and thus education, which is one of the main tasks of HCP. Therefore, the purpose of this study was to investigate communication barriers to education to referrals from the perspective of referrals to health centers (RHC) and HCP. Method This descriptive-analytical study was conducted on RHC and HCP in Kerman in 2021. Using a multi-stage sampling method, 162 HCP and 414 RHC were included in the study. The data collection tool was two researcher-made questionnaires. Data were analyzed using SPSS 16. Findings From the perspective of RHC and HCP, most communication barriers were related to environmental and then socio-cultural factors. Among the demographic variables of HCP, level of education showed a significant relationship with the physical-psychological, verbal-non-verbal, and informational domains. And in relation to RHC, a significant relationship was found between education and job in the socio-cultural field and environmental barriers (p < 0.05). Conclusion HCP face a variety of barriers in educating people, most of which are related to environmental factors. Given the cost-effectiveness of education to the public, it is essential that planners and policymakers use strategies to eliminate environmental factors as well as the placement of indigenous HCP in health facilities to reduce communication barriers.
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Affiliation(s)
- Abedin Iranpour
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Vahidreza Borhaninejad
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Alizadeh
- Department of Health Education and Promotion, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran,Somayeh Alizadeh, Department of Health Education and Promotion, School of Public Health, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, 7616913555, Iran.
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20
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Transparency in Error Reporting. JOURNAL OF INFUSION NURSING 2022; 45:243-244. [PMID: 36112870 DOI: 10.1097/nan.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Szeto MD, Barber C, Ranpariya VK, Anderson J, Hatch J, Ward J, Aguilera MN, Hassan S, Hamp A, Coolman T, Dellavalle RP. Emojis and Emoticons in Health Care and Dermatology Communication: Narrative Review. JMIR DERMATOLOGY 2022; 5:e33851. [PMID: 36405493 PMCID: PMC9642845 DOI: 10.2196/33851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/24/2022] [Accepted: 06/21/2022] [Indexed: 12/19/2022] Open
Abstract
Background Emoticons and emojis have become staple additions to modern-day communication. These graphical icons are now embedded in daily society through the various forms of popular social media and through users’ personal electronic conversations. With ever-increasing use and inclusivity, exploration of the possible health care and dermatology applications of these tools is imperative. Objective The goal of this narrative review was to provide and evaluate an up-to-date literature survey examining the utility of emoticons and emojis in medicine. Special attention was paid to their existing and potential uses in the field of dermatology, especially during the COVID-19 pandemic. Methods A PubMed search of peer-reviewed publications was performed in mid-2021 to collect articles with emoticon or emoji keywords in combination with other health care–relevant or dermatology-relevant keywords. Screening of publications and described studies was performed by the authors with education and research experience in health care, dermatology, social media, and electronic communication trends. Selected articles were grouped based on common subjects for qualitative analysis and presentation for in-depth discussion. Results From this extensive search, researchers were able to identify a wide variety of publications detailing the use of emoticons and emojis in general health care, pediatric health care, public health, and dermatology. Key subject areas that emerged from the investigation included the ability of emoticons and emojis to improve communication within pediatric health care, enhance mood and psychological assessment or mental health screening in adults, develop interventions to improve patient medication adherence, complement novel means of public health and COVID-19 surveillance, and bolster dermatology-specific applications. Conclusions This review illuminated the repurposing of emojis and emoticons for a myriad of advantageous functions in health care and public health, with applications studied in many populations and situations. Dermatology-specific uses were relatively sparse in the literature, highlighting potential opportunities for growth in future studies and practices. The importance of diversity and inclusivity has extended to emojis, with the recent introduction of skin color customization and new emojis better representing the comprehensive spectrum of users’ experiences. A continuously evolving and technology-driven population creates a unique niche for emoticons and emojis to ease worldwide communication and understanding, transcending the barriers of age, language, and background. We encourage future studies and innovations to better understand and expand their utility.
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Affiliation(s)
- Mindy D Szeto
- Department of Dermatology University of Colorado Aurora, CO United States
| | - Cara Barber
- Department of Dermatology Good Samaritan Regional Medical Center/Silver Falls Dermatology Salem, OR United States
| | - Varun K Ranpariya
- Robert Wood Johnson Medical School Rutgers University Piscataway, NJ United States
| | | | - Jonny Hatch
- Texas College of Osteopathic Medicine University of North Texas Health Science Center Fort Worth, TX United States
| | - Jordan Ward
- Paul L Foster School of Medicine Texas Tech University Health Sciences Center El Paso El Paso, TX United States
| | - Megan N Aguilera
- School of Medicine University of Colorado Anschutz Medical Campus Aurora, CO United States
| | - Shahzeb Hassan
- Feinberg School of Medicine Northwestern University Chicago, IL United States
| | - Austin Hamp
- Abrazo Health Network Goodyear, AZ United States
| | - Tyler Coolman
- Department of Dermatology Case Western Reserve University Hospitals Cleveland, OH United States
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22
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Seo JK, Lee SE. Hospital management and supervisor support and nurse speaking-up behaviors: The mediating role of safety culture perception. J Nurs Manag 2022; 30:3160-3167. [PMID: 35815819 DOI: 10.1111/jonm.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Abstract
AIMS This study aimed to (a) elucidate the effects of hospital management and unit supervisor support for patient safety on nurse speaking-up behaviors and (b) identify potential mediators of this relationship. BACKGROUND Speaking-up behavior among nurses has emerged as a critical source of patient safety. Fuller understanding of the developmental mechanisms contributing to nurses' speaking-up behaviors could help to enhance patient safety in healthcare organizations. METHODS A correlational approach was used to conduct a secondary analysis of cross-sectional survey data collected from 450 staff nurses in Korea. Path analysis was performed to test potential mediation effects. RESULTS After controlling for nurses' hospital and unit tenure, hospital management and supervisor support for patient safety had significant direct and indirect effects on nurses' speaking-up (promotive and prohibitive voice) behaviors through their perceptions of response to error and communication openness. CONCLUSIONS Study findings indicate that when hospital management and supervisors emphasize patient safety and provide necessary resources, nurses are likely to perceive the hospital's safety culture more positively, in turn enhancing their speaking-up behaviors. IMPLICATIONS FOR NURSING MANAGEMENT Hospital administrators and nurse managers should clearly display hospital management and supervisory support for patient safety through implementation of related policies, resources, and communication standards.
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Affiliation(s)
- Ja-Kyung Seo
- Department of Psychology, Graduate School, Yonsei University, Seoul, South Korea
| | - Seung Eun Lee
- College of Nursing, Yonsei University, Seoul, South Korea
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Watson BM, Wu XI. Sentinel Events and Miscommunication What do we know in 2021: A Language and Social Psychology Framework. HEALTH COMMUNICATION 2022:1-10. [PMID: 35209746 DOI: 10.1080/10410236.2022.2031451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The paper explored the extent to which hospital appointed official root cause analysis (RCA) panels consider antecedent and proximal events when they investigate communication related sentinel events (CRSEs) in hospitals. It also explored which CRSEs are most common in the hospital setting in Hong Kong and the communication modes most commonly associated with CRSEs. The data consisted of Risk Alert and Annual Report on SEs issued by the Hong Kong Hospital Authority from October 2007 to September 2017. Over the period studied, there were 379 reported sentinel events (SEs). In 186 of these SEs we identified communication as a contributing factor. We examined the RCA panels' reports on contributing factors and subsequent recommendations in these 186 SEs and found that their recommendations only highlighted the proximal contributing factors and not antecedent factors that may be relevant. RCA panels most often recommended that communication should be enhanced or documentation improved. We propose that it is time to review the RCA process to recognize that many CRSEs may occur because of antecedent factors that result from the complex hospital organizational structure and its associated hierarchical culture. We suggest two ways forward, 1) applying a language and social psychology perspective to the investigations of CRSEs and, 2) the involvement of experts from different disciplines who can work with clinicians during RCA investigations.
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Affiliation(s)
- Bernadette M Watson
- Department of English and Communication, The International Research Centre for the Advancement of Health Communication, The Hong Kong Polytechnic University
| | - Xiaoyan Ivy Wu
- Department of English and Communication, The International Research Centre for the Advancement of Health Communication, The Hong Kong Polytechnic University
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Harris A, Lane R, Higgins M. Improving perceptions of communication, collaboration, and teamwork using structured nurse-surgeon bedside rounds. Nursing 2022; 52:56-59. [PMID: 35085199 DOI: 10.1097/01.nurse.0000806180.71822.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Adrienne Harris
- At Emory Johns Creek Hospital in Johns Creek, Ga., Adrienne Harris is the director of the surgical unit and Rosemary Lane is a unit charge nurse. Melinda Higgins is a biostatistician in the Office of Nursing Research at Emory University's School of Nursing
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Neville B, Miltner RS, Shirey MR. Clinical Team Training and a Structured Handoff Tool to Improve Teamwork, Communication, and Patient Safety. J Healthc Qual 2021; 43:365-373. [PMID: 34734920 DOI: 10.1097/jhq.0000000000000291] [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: 11/25/2022]
Abstract
BACKGROUND Effective communication among healthcare teams is essential for ensuring handoff-related safety and quality care outcomes. PURPOSE The aim of this project was to improve patient safety through the reduction of communication-related errors on an acute hemodialysis unit (AHU) in an academic medical center. A target was set to reduce by 50 percent the communication-related errors using strategies to improve teamwork and communication. METHODS Acute hemodialysis unit team members attended Clinical Team Training (CTT) informational sessions on teamwork and communication. A structured handoff tool was implemented in the AHU to improve nurse communication and reduce communication-related patient safety events. Descriptive statistics and comparison of means were conducted to assess the differences between preimplementation and postimplementation audit and safety event data. RESULTS There was a statistically significant difference between the preintervention and postintervention groups of handoff tool usage and completion as well as a consistent decrease in handoff-related safety events after implementation. CONCLUSIONS/IMPLICATIONS Findings suggest that CTT and a structured handoff tool used to guide nurse-to-nurse care transitions lead to a reduction in communication-related safety events during handoffs in an AHU.
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Health Literacy-Related Safety Events: A Qualitative Study of Health Literacy Failures in Patient Safety Events. Pediatr Qual Saf 2021; 6:e425. [PMID: 34235353 PMCID: PMC8225367 DOI: 10.1097/pq9.0000000000000425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Communication failures are the leading root cause of safety events. Although much communication research focuses on the healthcare team, there is little focus on communication with patients and families. It is not known what deficits in health literate patient communication lead to patient safety events. We aimed to identify themes of health literacy-related safety events to describe the impact of health literate communication on patient safety. Methods The safety events were entered into a system-wide self-reported safety event collection database. A patient safety specialist trained in health literacy prospectively tagged events for health literacy. The authors retrospectively queried the database for all health literacy tagged events during 9 months (September 2017-May 2018). The authors reviewed and independently coded health literacy-associated safety events. Qualitative content analysis of events facilitated by software (NVivo) was completed to identify the health literacy-related safety event themes. Results Health literacy events comprised 4% (152/3911) of self-reported safety events during the 9 months. Main themes of the health literacy safety events related to (1) medication; (2) system processes; and (3) discharge/transition. Subthemes of each of the events further described the event types. Health literacy-associated safety events encompass all safety event outcomes (near miss, precursor, and serious safety events). Conclusions Health literacy-related safety events occur in the healthcare environment. This review characterizing health literacy-related safety events prioritizes areas to implement health literate safety practices. Many opportunities exist to address communication-related safety events around medication, system processes, and discharge using health literate best practices.
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Villar VCFL, Duarte SDCM, Martins M. Patient safety in hospital care: a review of the patient's perspective. CAD SAUDE PUBLICA 2020; 36:e00223019. [PMID: 33331556 DOI: 10.1590/0102-311x00223019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/17/2020] [Indexed: 11/22/2022] Open
Abstract
The goal was to review the literature on incidents and adverse events and their contributing factors in hospital care, described according to the patient's perspective. A review was carried out of articles published in the MEDLINE, Scopus and LILACS databases between 2008 and 2019. From the 2,686 studies initially found, 167 were pre-selected for reading and then 24 were selected and classified based on a thematic analysis of their content. Four categories resulted from the information extracted from the 24 articles: terminology used to define incidents and adverse events, especially different terms such as error and medical error; incidents and adverse events identified by patients, family members and caregivers related to medication, surgery, health care-related infections, falls and pressure injuries; patients' perception of factors that contribute to unsafe care, especially problems related to communication, hand washing and patient identification; suggestions from patients to prevent the occurrence of incidents and adverse events, including training staff, drawing up checklists, listening to patients and adapting the environment. Patients were able to identify incidents, adverse events and contributing factors in health care. Alongside information from staff, their reports can potentially contribute to the provision of safer health care.
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Affiliation(s)
- Vanessa Cristina Felippe Lopes Villar
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Mônica Martins
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Abstract
This article explores the role of human factors engineering in patient safety in surgery. The authors discuss the history and evolution of human factors and the role of human factors in patient safety and provide a description of human factors methods used to study and improve patient safety.
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Affiliation(s)
- Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8215, Los Angeles, CA 90048, USA
| | - Bruce L Gewertz
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8215, Los Angeles, CA 90048, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars-Sinai Medical Center, 8635 West Third Street, West Medical Office Tower, Suite 650-W, Los Angeles, CA 90048, USA.
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Towbin AJ, Smith RL, Smith EA, Brown J, Care MM, Calvo-Garcia MA, Coley BD, Dillman JR, England D, Gramke M, Howard B, Koch BL, Kraus SJ, Leopard AC, Li Y, Merrow AC, O’Brien S, Schmitz JA, Sharp SE, Szabados A, Vogelsang TA, Walton K, Wieland CA, Wiesman BA. RESPECT: Radiology Employees Striving for Productive and Effective Communication. Radiographics 2020; 40:2068-2079. [DOI: 10.1148/rg.2020200041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander J. Towbin
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
| | - Rachel L. Smith
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
| | - Ethan A. Smith
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
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Abstract
PURPOSE OF REVIEW Anesthesia outside the operating room is rapidly expanding for adult and pediatric patients. Anesthesia clinicians practicing in this area need a good understanding of the challenges of the NORA environment and the anesthetic risks and perioperative implications of practice so that they can deliver safe care to their patients. RECENT FINDINGS Recent reports from large patient databases have afforded anesthesiologists a greater understanding of the risk of NORA when compared to anesthesia in the operating room. Descriptions of advances in team training with the use of simulation have allowed the development of organized procedural teams. With an emphasis on clear communication, an understanding of individual roles, and a patient-centered focus, these teams can reliably develop emergency response procedures, so that critical moments are not delayed in an environment remote from usual assistance. SUMMARY With appropriate attention to organizational concerns (i.e. team environment, safety protocols) and unrelenting focus on patient safety, anesthesiologists can assist in safely providing the benefit of cutting-edge technical advancements to pediatric patients in these challenging environments.
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Schwappach DLB, Niederhauser A. Speaking up about patient safety in psychiatric hospitals - a cross-sectional survey study among healthcare staff. Int J Ment Health Nurs 2019; 28:1363-1373. [PMID: 31609065 PMCID: PMC6919932 DOI: 10.1111/inm.12664] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 12/02/2022]
Abstract
Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up-related behaviour and climate for the first time in psychiatric hospitals. A cross-sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up-related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up-related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%-65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13-25% of HCWs, and speaking up was reported by 53%-72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self-reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure.
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Affiliation(s)
- David L B Schwappach
- Swiss Patient Safety Foundation, Zürich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University Bern, Bern, Switzerland
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32
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Goldschmidt K. Smartphone Use in Pediatric Settings. J Pediatr Nurs 2019; 49:101-103. [PMID: 31451294 DOI: 10.1016/j.pedn.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022]
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Kim MS, Kim CH. Canonical correlations between individual self-efficacy/organizational bottom-up approach and perceived barriers to reporting medication errors: a multicenter study. BMC Health Serv Res 2019; 19:495. [PMID: 31311542 PMCID: PMC6636092 DOI: 10.1186/s12913-019-4194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background Individual and organizational factors correlate with perceived barriers to error reporting. Understanding medication administration errors (MAEs) reduces confusion about error definitions, raises perceptions of MAEs, and allows healthcare providers to report perceived and identified errors more frequently. Therefore, an emphasis must be placed on medication competence, including medication administration knowledge and decision-making. It can be helpful to utilize an organizational approach, such as collaboration between nurses and physicians, but this type of approach is difficult to establish and maintain because patient-safety culture starts at the highest levels of the healthcare organization. This study aimed to examine the canonical correlations of an individual self-efficacy/bottom-up organizational approach variable set with perceived barriers to reporting MAEs among nurses. Methods We surveyed 218 staff nurses in Korea. The measurement tools included a questionnaire on knowledge of high-alert medication, nursing decision-making, nurse-physician collaboration satisfaction, and barriers to reporting MAEs. Descriptive statistics, t-tests, analysis of variance (ANOVA), Pearson’s correlation coefficient, and canonical correlations were used to analyze results. Results Two canonical variables were significant. The first variate indicated that less knowledge about medication administration (− 0.83) and a higher perception of nurse-physician collaboration (0.42) were related to higher disagreement over medication error (0.64). The second variate showed that intuitive clinical decision-making (− 0.57) and a higher perception of nurse-physician collaboration (0.84) were related to lower perceived barriers to reporting MAEs. Conclusions Enhancing positive collaboration among healthcare professionals and promoting analytic decision-making supported by sufficient knowledge could facilitate MAE reporting by nurses. In the clinical phase, providing medication administration education and improving collaboration may reduce disagreement about the occurrence of errors and facilitate MAE reporting. In the policy phase, developing an evidence-based reporting system that informs analytic decision-making may reduce the perceived barriers to MAE reporting.
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Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, 599-1, Daeyeon 3 dong, Namgu, Busan, 48513, South Korea
| | - Chul-Hoon Kim
- College of Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan, 49201, South Korea.
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