1
|
Ibrahim AM. Nurses' ethical responsibilities: Whistleblowing and advocacy in patient safety. Nurs Ethics 2024:9697330241235306. [PMID: 38415609 DOI: 10.1177/09697330241235306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives. AIM This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety. RESEARCH DESIGN A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale. PARTICIPANTS AND RESEARCH CONTEXT The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus. ETHICAL CONSIDERATIONS Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles. RESULTS Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making. CONCLUSION The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector.
Collapse
|
2
|
Barlow M, Watson B, Morse K, Jones E, Maccallum F. React, reframe and engage. Establishing a receiver mindset for more effective safety negotiations. J Health Organ Manag 2023; ahead-of-print. [PMID: 37749761 DOI: 10.1108/jhom-06-2023-0171] [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] [Indexed: 09/27/2023]
Abstract
PURPOSE The response of the receiver to a voiced patient safety concern is frequently cited as a barrier to health professionals speaking up. The authors describe a novel Receiver Mindset Framework (RMF) to help health professionals understand the importance of their response when spoken up to. DESIGN/METHODOLOGY/APPROACH The framework draws on the broader receiver-focussed literature and integrates innovative findings from a series of empirical studies. These studies examined different receiver behaviour within vignettes, retrospective descriptions of real interactions and behaviour in a simulated interaction. FINDINGS The authors' findings indicated that speaking up is an intergroup interaction where social identities, context and speaker stance intersect, directly influencing both perceptions of and responses to the message. The authors' studies demonstrated that when spoken up to, health professionals poorly manage their emotions and ineffectively clarify the speaker's concerns. Currently, targeted training for receivers is overwhelmingly absent from speaking-up programmes. The receiver mindset framework provides an evidence-based, healthcare specific, receiver-focussed framework to inform programmes. ORIGINALITY/VALUE Grounded in communication accommodation theory (CAT), the resulting framework shifts speaking up training from being only speaker skill focussed, to training that recognises speaking up as a mutual negotiation between the healthcare speaker and receiver. This framework provides healthcare professionals with a novel approach to use in response to speaking up that enhances their ability to listen, understand and engage in point-of-care negotiations to ensure the physical and psychological safety of patients and staff.
Collapse
Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Psychology, University of Queensland, St Lucia, Australia
| | - Bernadette Watson
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, China
| | - Kate Morse
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth Jones
- School of Psychology, Monash University Malaysia, Subang Jaya, Malaysia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St Lucia, Australia
| |
Collapse
|
3
|
Ogunfowokan AA, Ayotunde T, Samson-Akpan PE, Salau OR, Garba SN, Olatubi MI, Adeleke AG, Orisadare MA. Intention of Staff and Students to Use Internal Whistleblowing to Report Sexual Violence: A Case Study of a Nigerian University. JOURNAL OF INTERPERSONAL VIOLENCE 2023:8862605231168827. [PMID: 37102564 DOI: 10.1177/08862605231168827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sexual violence with its enormous negative consequences has become an epidemic most especially among the young populations. An effective danger-proof reporting system is necessary for curbing this menace including use of the internal whistleblowing mechanism. The study employed a concurrent (parallel) mixed method descriptive design for explaining the sexual violence experiences of university students, the intention of staff and students to blow the whistle, and their preferred whistleblowing strategies. A total of 167 students and 42 members of staff (69% males and 31% females, respectively) were randomly selected from four academic departments (50%) of a university of technology in Southwest Nigeria. An adapted questionnaire containing three vignettes on sexual violence and a focus group discussion guide were used for data collection. We discovered that 16.1% of the students reported to have experienced sexual harassment, 12.3% had attempted rape, and 2.6% had experienced rape. Tribe (Likelihood-Ratio, LR = 11.16; p = .004) and sex (χ2 = 12.65; p = .001) were strongly associated with sexual violence experiences. Also, 50% staff and 47% students had high intention. Regression analysis showed that industrial and production engineering students will be 2.8 times more likely to have intention to internally blow the whistle more than other students (p = .03; 95% CI [1.1, 6.97]). Female staff had 5.73 odds of intention more than male staff (p = .05; [1.02, 32.1]). Also, we observed that senior staff will 31% less likely blow the whistle than the junior staff (Adjusted Odd Ratio, AOR = 0.04; [0.00, 0.98]; p = .05). In our qualitative findings, courage was mentioned as a factor necessary for blowing the whistle while anonymous reporting was emphasized for successful whistleblowing. However, the students preferred external whistleblowing. The study has implication for the establishment of sexual violence internal whistleblowing reporting system in higher education institutions.
Collapse
|
4
|
Vian T, Agnew B, McInnes K. Whistleblowing as an anti-corruption strategy in health and pharmaceutical organizations in low- and middle-income countries: a scoping review. Glob Health Action 2022; 15:2140494. [PMID: 36356311 PMCID: PMC9661981 DOI: 10.1080/16549716.2022.2140494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Whistleblowing can bring suspected wrongdoing to the attention of someone who is in the position to rectify the problem. Whistleblowing research can help improve effectiveness of anti-corruption efforts in the health sector. OBJECTIVE The objective of this scoping review is to understand the extent and type of evidence on whistleblowing as an anti-corruption strategy in health and pharmaceutical organisations in low- and middle-income countries (LMICs). METHODS This scoping review searched the PubMed, Scopus, and EMBASE databases from 2005 to 2020, limited to English language. We also searched websites of multilateral agencies or international non-governmental organisations for policy documents, guidance and reports. Titles and abstracts were screened to remove those where the focus was not on health, pharmaceuticals, whistleblowing, or LMIC context. Articles focused on research misconduct were excluded. Full-text articles were assessed for eligibility on these same criteria. Included sources were analysed thematically, based on five categories including definitions and models; evidence of reporting frequency; factors influencing whistleblowing; cultural context; and outcomes. RESULTS The review found 22 sources including reports, policies, and guidance documents (12, 55%), news articles (4, 18%), policy analyses/reviews (3, 14%), commentaries (2, 9%), and empirical studies (1, 5%). Most sources described whistleblowing policy and system components such as how whistleblowing is defined, who can report, and how confidentiality is assured. Few articles documented types and frequencies of corruption identified through whistleblowing or factors associated with whistleblowing. Several studies mentioned cultural norms as a potential limitation to whistleblowing effectiveness. About one-third of the sources described fear of retaliation and noted the need to strengthen protection for whistleblowers. CONCLUSION Research on whistleblowing is scarce in health and pharmaceutical organisations in LMICs. Documentation of policies, factors associated with whistleblowing, and whistleblowing outcomes is needed and could help countries to mainstream whistleblowing as a sectoral anti-corruption strategy.
Collapse
Affiliation(s)
- Taryn Vian
- Department of Health Professions, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA,WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada,CONTACT Taryn Vian School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA94117, USA
| | - Brianna Agnew
- Department of Health Professions, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
5
|
Wu C, Yan JR, He CY, Wu J, Zhang YJ, Du J, Lin YW, Zhang YH, Heng CN, Lang HJ. Latent profile analysis of security among patients with COVID-19 infection in mobile cabin hospitals and its relationship with psychological capital. Front Public Health 2022; 10:993831. [PMID: 36466444 PMCID: PMC9709271 DOI: 10.3389/fpubh.2022.993831] [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: 07/14/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022] Open
Abstract
Aim COVID-19 patients' security is related to their mental health. However, the classification of this group's sense of security is still unclear. The aim of our research is to clarify the subtypes of security of patients infected with COVID-19, explore the factors affecting profile membership, and examine the relationship between security and psychological capital for the purpose of providing a reference for improving patients' sense of security and mental health. Methods A total of 650 COVID-19 patients in a mobile cabin hospital were selected for a cross-sectional survey from April to May 2022. They completed online self-report questionnaires that included a demographic questionnaire, security scale, and psychological capital scale. Data analysis included latent profile analysis, variance analysis, the Chi-square test, multiple comparisons, multivariate logistical regression, and hierarchical regression analysis. Results Three latent profiles were identified-low security (Class 1), moderate security (Class 2), and high security (Class 3)-accounting for 12.00, 49.51, and 38.49% of the total surveyed patients, respectively. In terms of the score of security and its two dimensions, Class 3 was higher than Class 2, and Class 2 was higher than Class 1 (all P < 0.001). Patients with difficulty falling asleep, sleep quality as usual, and lower tenacity were more likely to be grouped into Class 1 rather than Class 3; Patients from families with a per capita monthly household income <3,000 and lower self-efficacy and hope were more likely to be grouped into Classes 1 and 2 than into Class 3. Psychological capital was an important predictor of security, which could independently explain 18.70% of the variation in the patients' security. Conclusions Security has different classification features among patients with COVID-19 infection in mobile cabin hospitals. The security of over half of the patients surveyed is at the lower or middle level, and psychological capital is an important predictor of the patients' security. Medical staff should actively pay attention to patients with low security and help them to improve their security level and psychological capital.
Collapse
Affiliation(s)
- Chao Wu
- Department of Nursing, Fourth Military Medical University, Shaanxi, China
| | - Jia-ran Yan
- Department of Nursing, Fourth Military Medical University, Shaanxi, China
| | - Chun-yan He
- Department of Nursing, Fourth Military Medical University, Shaanxi, China
| | - Jing Wu
- Department of Nursing, Fourth Military Medical University, Shaanxi, China
| | - Yin-juan Zhang
- Department of Nursing, Fourth Military Medical University, Shaanxi, China
| | - Juan Du
- Department of Nursing, Fourth Military Medical University, Shaanxi, China
| | - Ya-wei Lin
- Department of Nursing, Fourth Military Medical University, Shaanxi, China
| | - Yu-hai Zhang
- Department of Health Statistics, Fourth Military Medical University, Shaanxi, China,*Correspondence: Yu-hai Zhang
| | - Chun-ni Heng
- Department of Endocrinology, Tangdu Hospital, Fourth Military Medical University, Shaanxi, China,Chun-ni Heng
| | - Hong-juan Lang
- Department of Nursing, Fourth Military Medical University, Shaanxi, China,Hong-juan Lang
| |
Collapse
|
6
|
Pavithra A, Mannion R, Sunderland N, Westbrook J. Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals. J Health Organ Manag 2022; ahead-of-print:245-271. [PMID: 36380424 PMCID: PMC10424643 DOI: 10.1108/jhom-04-2022-0129] [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: 04/29/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of employment within their hospital sites, age, gender and their ongoing exposure to unprofessional behaviours. DESIGN/METHODOLOGY/APPROACH Responses to a survey by 4,851 staff across seven sites within a hospital network in Australia were analysed to interrogate whether speaking up by hospital employees is influenced by employees' symbolic capital and situated subjecthood (SS). The authors utilised a Bourdieusian lens to interrogate the relationship between the symbolic capital afforded to employees as a function of their professional, personal and psycho-social resources and their self-reported capacity to speak up. FINDINGS The findings indicate that employee speaking up behaviours appear to be influenced profoundly by whether they feel empowered or disempowered by ongoing and pre-existing personal and interpersonal factors such as their functional roles, work-based peer and supervisory support and ongoing exposure to discriminatory behaviours. ORIGINALITY/VALUE The findings from this interdisciplinary study provide empirical insights around why culture change interventions within healthcare organisations may be successful in certain contexts for certain staff groups and fail within others.
Collapse
Affiliation(s)
- Antoinette Pavithra
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
| | - Russell Mannion
- Australian Institute of Health Innovation
, Sydney,
Australia
- Health Services Management Centre
,
University of Birmingham
, Birmingham,
UK
| | - Neroli Sunderland
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
| |
Collapse
|
7
|
Kearns AJ. The principle of double effect and external whistleblowing in nursing. Nurs Outlook 2022; 70:807-819. [PMID: 36400577 DOI: 10.1016/j.outlook.2022.09.001] [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: 06/20/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.
Collapse
Affiliation(s)
- Alan J Kearns
- School of Theology, Philosophy, and Music, Dublin City University, Dublin, Ireland.
| |
Collapse
|
8
|
Wang D, Zhan C. Why Not Blow the Whistle on Health Care Insurance Fraud? Evidence from Jiangsu Province, China. Risk Manag Healthc Policy 2022; 15:1897-1915. [PMID: 36268183 PMCID: PMC9577100 DOI: 10.2147/rmhp.s379300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To identify the factors that influence whistleblowing behavior as it relates to health care insurance fraud in Jiangsu Province, China. Methods To construct a factor model and formulate research hypotheses using the Motivation–Opportunity–Ability framework. We designed a questionnaire containing 24 items and distributed it on-site to 2081 respondents in Jiangsu Province, China. Afterward, we applied structural equation modeling to validate the research hypotheses. Results Policy awareness negatively contributes to whistleblowing behavior, risk perception does not reduce the incentive to blow the whistle, and an inability to recognize fraud is another critical barrier to converting whistleblowing intentions into behavior. Conclusion Practices that are likely to promote citizen whistleblowing on insurance fraud may focus on the constraints identified by the comprehensive Motivation–Opportunity–Ability framework.
Collapse
Affiliation(s)
- Dandan Wang
- School of Management, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Changchun Zhan
- School of Management, Jiangsu University, Zhenjiang, People’s Republic of China,Correspondence: Changchun Zhan, Tel +86-15952808385, Email
| |
Collapse
|
9
|
McGurgan PM, Calvert KL, Nathan EA, Narula K, Celenza A, Jorm C. Why Is Patient Safety a Challenge? Insights From the Professionalism Opinions of Medical Students' Research. J Patient Saf 2022; 18:e1124-e1134. [PMID: 35617637 DOI: 10.1097/pts.0000000000001032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Despite increased emphasis on education and training for patient safety in medical schools, there is little known about factors influencing decision making regarding patient safety behaviors. This study examined the nature and magnitude of factors that may influence opinions around patient safety-related behaviors as a means of providing insights into how Australian doctors and medical students view these issues relative to members of the public. METHODS A national, multicenter, prospective, cross-sectional survey was conducted using responses to hypothetical patient safety scenarios involving the following: fabricating results, personal protective equipment, presenteeism, and reporting concerns.Australian enrolled medical students, medical doctors, and members of the public were surveyed.Participant responses were compared for the different contextual variables within the scenarios and the participants' demographic characteristics. RESULTS In total, 2602 medical student, 809 doctors, and 503 members of the Australian public participated. The 3 demographic groups had significantly differing opinions on many of the patient safety dilemmas. Doctors were more tolerant of medical students not reporting concerning behaviors and attending placements despite recent illness. Medical students' opinions frequently demonstrated a "transition effect," bridging between the doctors and publics' attitudes, consistent with professional identity formation. CONCLUSIONS Opinions on the acceptability of medical students' patient safety-related behaviors were influenced by the demographics of the cohort and the contextual complexity of the scenario. Although the survey used hypothetical scenarios, doctors and medical students' opinions seem to be influenced by cognitive dissonances, biases, and heuristics, which may negatively affect patient safety.
Collapse
Affiliation(s)
- Paul M McGurgan
- From the Division of Obstetrics and Gynaecology, University of Western Australia
| | | | | | | | - Antonio Celenza
- Division of Emergency Medicine, University of Western Australia, Perth
| | - Christine Jorm
- Health and Medical Research Office, Australian Government Department of Health, Canberra, Australia
| |
Collapse
|
10
|
Speaking-up for patient safety: A scoping narrative review of international literature and lessons for radiography in Ghana and other resource-constrained settings. Radiography (Lond) 2022; 28:919-925. [PMID: 35820354 DOI: 10.1016/j.radi.2022.06.018] [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: 01/20/2022] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Employees 'speaking-up', or raising concerns about unsafe practices, has gained traction across healthcare, however, the topic has not been widely discussed within radiography generally or within resource-constrained healthcare settings. A systematic scoping narrative review identified the experiences of radiographers in speaking-up about safety concerns, which was extended to healthcare professionals more broadly. The scope of the review was further extended to cover speaking-up in non-healthcare resource-constrained settings in Africa. KEY FINDINGS Sixty-three studies were included in the review. The majority originated from westernised and/or higher resource health systems, with a dearth of literature from Africa and other resource-constrained settings. Several studies identified barriers and enablers confronting healthcare workers wishing to speak-up. While 'speaking-up' as a concept has gained international interest, most studies are, however, focussed on nursing and medical practice contexts, overlooking other healthcare professions, including radiography. The findings are synthesised into a series of key lessons for healthcare and radiography practitioners in Ghana and other resource-constrained settings. CONCLUSION The topic has been largely overlooked by policy makers, both within healthcare generally and specifically within radiography in Ghana. This is particularly concerning given the many complexities and risks inherent to radiography. A radiography and a healthcare workforce lacking in voice is poorly positioned to improve workers' safety and patient safety. More generally, promoting speaking up could enhance Ghana's ambitions to deliver a high-quality health care system and Universal Health Coverage (UHC) in the future. IMPLICATIONS FOR PRACTICE National and regional policy makers need to implement speaking-up processes and procedures reflecting the lessons of the literature review, such as ensuring no detriment as result of speaking-up and making staff feel that their concerns are not futile. Speaking-up processes should be implemented by individual organisations, alongside staff training and monitoring.
Collapse
|
11
|
Abstract
Background Moral courage means courage to act according to individual’s own ethical
values and principles despite the risk of negative consequences for them.
Research about the moral courage of whistle-blowers in health care is
scarce, although whistleblowing involves a significant risk for the
whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association
with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing
Nurses Moral Courage Scale©, a video vignette of the wrongdoing
situation with an open question about the vignette, and several background
variables. Data were analysed statistically and inductive content analysis
was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public
health nurses, midwives, and nurse paramedics) were recruited from the
membership register of the Nurses’ Association via email in 2019. A total of
454 nurses responded. The research context was simulated using a
vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the
Nurses’ Moral Courage Scale© was obtained from the copyright
holder. The ethical approval and permission to conduct the study were
obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual
Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point
Likert scale. Potential whistle-blowers’ moral courage was associated with
their socio-demographics, education, work, personality and social
responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous
actors. The results offer opportunities for developing interventions,
practices and education to support and encourage healthcare professionals in
their whistleblowing. Research is needed for developing a theoretical
construction to eventually increase whistleblowing and decrease and prevent
wrongdoing.
Collapse
Affiliation(s)
- Johanna Wiisak
- 8058University of Turku, Department of Nursing Science, Turku, Finland
| | - Riitta Suhonen
- University of Turku, Department of Nursing Science and Director of Nursing, 60652Turku University Hospital, and City of Turku, Welfare Services Division, Finland
| | - Helena Leino-Kilpi
- University of Turku, Department of Nursing Science and Director of Nursing, 60652Turku University Hospital, Finland
| |
Collapse
|
12
|
The Construction and Effect Analysis of Nursing Safety Quality Management Based on Data Mining. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6560452. [PMID: 35694599 PMCID: PMC9184199 DOI: 10.1155/2022/6560452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
Data mining belongs to knowledge discovery, which is the process of revealing hidden, unknown, and valuable information from a large amount of fuzzy application data. The potential information revealed by data mining can help decision-makers adjust market strategies and reduce market risks. The information mined can be the discovery of a particular study and little known, which must be based on the principle of truth. Nursing safety means that during nursing work, the nursing staff must strictly follow the nursing system and operating procedures, accurately execute doctor's orders, implement nursing plans, and ensure that patients get physical and mental safety during treatment and recovery. This paper aims to explore the construction of nursing safety quality management system and its effect analysis based on data mining. It is hoped that improvements in hospital nursing processes will provide better nursing services for patients using data mining techniques. This paper uses the FP algorithm to mine the data set and generates frequent itemsets, proposes and implements the association rule mining algorithm, and obtains the association rules with practical reference value. This article analyzes the current status and existing problems of nursing management, and puts forward some problems existing in the current nursing management staff's own quality, nursing quality system standards, and nursing management system. The experimental results in this article show that there are 42 cases of poor nursing due to lack of basic medical knowledge, accounting for 52%; there are 12 cases of poor nursing due to their own diseases, accounting for 15%; there were 7 cases of poor nursing due to lack of communication, accounting for 9%; there were 15 cases of poor nursing caused by unreasonable use of restraint devices, accounting for 19%. From these data, it can be seen that patients need to have basic medical knowledge and act in strict accordance with doctors' orders. Family members also need to accompany the patients more and cooperate with all parties in order to maximize the effectiveness of care.
Collapse
|
13
|
Violato E, Witschen B, Violato E, King S. A behavioural study of obedience in health professional students. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:293-321. [PMID: 34807358 PMCID: PMC9117351 DOI: 10.1007/s10459-021-10085-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
Interprofessional Education and Collaborative Practice (IPECP) is a field of study suggested to improve team functioning and patient safety. However, even interprofessional teams are susceptible to group pressures which may inhibit speaking up (positive deviance). Obedience is one group pressure that can inhibit positive deviance leading to negative patient outcomes. To examine the influence of obedience to authority in an interprofessional setting, an experimental simulated clinical scenario was conducted with Respiratory Therapy (RT) (n = 40) and Advanced Care Paramedic (ACP) (n = 20) students. In an airway management scenario, it was necessary for students to challenge an authority, a senior anesthesiologist, to prevent patient harm. In a 2 × 2 design cognitive load and an interventional writing task designed to increase positive deviance were tested. The effect of individual characteristics, including Moral Foundations, and displacement of responsibility were also examined. There was a significant effect for profession and cognitive load: RT students demonstrated lower levels of positive deviance in the low cognitive load scenario than students in other conditions. The writing task did not have a significant effect on RT or ACP students' behaviour. The influence of Moral Foundations differed from expectations, In Group Loyalty was selected as a negative predictor of positive deviance while Respect for Authority was not. Displacement of responsibility was influential for some participants thought not for all. Other individual variables were identified for further investigation. Observational analysis of the simulation videos was conducted to obtain further insight into student behaviour in a compliance scenario. Individual differences, including experience, should be considered when providing education and training for positive deviance. Simulation provides an ideal setting to use compliance scenarios to train for positive deviance and for experimentation to study interprofessional team behaviour.
Collapse
Affiliation(s)
- Efrem Violato
- Department of Educational Psychology, Faculty of Education, University of Alberta, Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada.
| | - Brian Witschen
- School of Health and Life Sciences, Northern Alberta Institute of Technology, Edmonton, Canada
| | - Emilio Violato
- Department of Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sharla King
- Department of Educational Psychology, Faculty of Education, University of Alberta, Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
| |
Collapse
|
14
|
Application of Intelligent Archives Management Based on Data Mining in Hospital Archives Management. JOURNAL OF ELECTRICAL AND COMPUTER ENGINEERING 2022. [DOI: 10.1155/2022/6217328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Data mining belongs to knowledge discovery, which is the process of revealing implicit, unknown, and valuable information from a large amount of fuzzy application data. The potential information revealed by data mining can help decision makers adjust market strategies and reduce market risks. The information excavated must be real and not universally known, and it can be the discovery of a specific problem. Data mining algorithms mainly include the neural network method, decision tree method, genetic algorithm, rough set method, fuzzy set method, association rule method, and so on. Archives management, also known as archive work, is the general term for various business works, in which archives directly manage archive entities and archive information and provide utilization services. It is also the most basic part of national archives. Hospital archives are an important part of hospital management, and hospital archives are the accumulation of work experience and one of the important elements for building a modern hospital. Hospital archives are documents, work records, charts, audio recordings, videos, photos, and other types of documents, audio-visual materials, and physical materials, such as certificates, trophies, and medals obtained by hospitals, departments, and individuals. The purpose of this paper is to study the application of intelligent archives management based on data mining in hospital archives management, expecting to use the existing data mining technology to improve the current hospital archives management. This paper investigates the age and educational background of hospital archives management workers and explores the relationship between them and the quality of archives management. Based on the decision number algorithm, on the basis of the database, the hospital data is classified and analyzed, and the hospital file data is classified and processed through the decision number algorithm to improve the system data processing capability. The experimental results of this paper show that among the staff working in the archives management department of the hospital, 20-to-30-year-olds account for 46.2% of the total group. According to the data, the staff in the archives management department of the hospital also tends to be younger. Among the staff under the age of 30, the file pass rate was 98.3% and the failure rate was 1.7%. Among the staff over 50 years old, the file pass rate was 99.9% and the failure rate was 0.1%. According to the data, the job is related to the experience of the employee.
Collapse
|
15
|
Pavithra A, Sunderland N, Callen J, Westbrook J. Unprofessional behaviours experienced by hospital staff: qualitative analysis of narrative comments in a longitudinal survey across seven hospitals in Australia. BMC Health Serv Res 2022; 22:410. [PMID: 35351097 PMCID: PMC8962235 DOI: 10.1186/s12913-022-07763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Unprofessional behaviours of healthcare staff have negative impacts on organisational outcomes, patient safety and staff well-being. The objective of this study was to undertake a qualitative analysis of narrative responses from the Longitudinal Investigation of Negative Behaviours survey (LION), to develop a comprehensive understanding of hospital staff experiences of unprofessional behaviours and their impact on staff and patients. The LION survey identified staff experiences and perceptions related to unprofessional behaviours within hospitals. METHODS Two open-ended questions within the LION survey invited descriptions of unprofessional staff behaviours across seven hospitals in three Australian states between December 2017 and November 2018. Respondents were from medical, nursing, allied health, management, and support services roles in the hospitals. Data were qualitatively analysed using Directed Content Analysis (DCA). RESULTS From 5178 LION survey responses, 32% (n = 1636) of participants responded to the two open-ended questions exploring staff experiences of unprofessional behaviours across the hospital sites surveyed. Three primary themes and 11 secondary themes were identified spanning, i) individual unprofessional behaviours, ii) negative impacts of unprofessional behaviours on staff well-being, psychological safety, and employee experience, as well as on patient care, well-being, and safety, and iii) organisational factors associated with staff unprofessional behaviours. CONCLUSION Unprofessional behaviours are experienced by hospital staff across all professional groups and functions. Staff conceptualise, perceive and experience unprofessional behaviours in diverse ways. These behaviours can be understood as enactments that either negatively impact other staff, patients or the organisational outcomes of team cohesion, work efficiency and efficacy. A perceived lack of organisational action based on existing reporting and employee feedback appears to erode employee confidence in hospital leaders and their ability to effectively address and mitigate unprofessional behaviours.
Collapse
Affiliation(s)
- Antoinette Pavithra
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Neroli Sunderland
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Joanne Callen
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
16
|
Mawuena EK, Mannion R. Implications of resource constraints and high workload on speaking up about threats to patient safety: a qualitative study of surgical teams in Ghana. BMJ Qual Saf 2022; 31:662-669. [DOI: 10.1136/bmjqs-2021-014287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/15/2021] [Indexed: 12/16/2022]
Abstract
BackgroundAlthough under-resourcing of healthcare facilities and high workload is known to undermine patient safety, there is a dearth of evidence about how these factors affect employee voice and silence about unsafe care. We address this gap in the literature by exploring how resource constraints and high workload influence the willingness of staff to speak up about threats to patient safety in surgical departments in Ghana.MethodSemistructured interviews with a purposeful sample of 91 multidisciplinary professionals drawn from a range of specialities, ranks and surgical teams in two teaching hospitals in Ghana. Conservation of Resources theory was used as a theoretical frame for the study. Data were processed and analysed thematically with the aid of NVivo 12.ResultsEndemic resource constraints and excessive workload generate stress that undermines employee willingness to speak up about unsafe care. The preoccupation with managing scarce resources predisposes managers in surgical units to ignore or downplay concerns raised and not to instigate appropriate remedial actions. Resource constraints lead to rationing and improvising in order to work around problems with inadequate infrastructure and malfunctioning equipment, which in turn creates unsupportive environments for staff to air legitimate concerns. Faced with high workloads, silence was used as a coping strategy by staff to preserve energy and avoid having to take on the burden of additional work.ConclusionUnder-resourcing and high workload contribute significantly towards undermining employee voice about unsafe care. We highlight the central role that adequate funding and resourcing play in creating safe environments and that supporting ‘hearer’ courage may be as important as supporting speaking up in the first place.
Collapse
|
17
|
Powell M. The whistleblower stages model in British National Health Service Inquiries. J Health Organ Manag 2021; ahead-of-print. [PMID: 34713673 DOI: 10.1108/jhom-10-2020-0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This article applies the whistleblowing stages model to whistleblowing journeys as seen in British National Health Service (NHS) Inquiries. DESIGN/METHODOLOGY/APPROACH It provides a qualitative analysis of Inquiry Reports since 2001, using Interpretive Content Analysis to allocate material to stages. FINDINGS It is found that the Inquiry Reports show a wide variety of reporting mechanisms, but that most persons initially report internally. It seems to confirm recent suggestions that WB is often not a "one off" or simple and linear process, but a protracted process. While the simple stages model may be appropriate for individual "whistle-blowing incident" by a single whistleblower, it needs to be revised for the protracted process of raising concerns in a variety of ways by different people as shown in the Inquiry Reports. RESEARCH LIMITATIONS/IMPLICATIONS The evidence is confined to the publicly available material that was presented in the Inquiry Reports. PRACTICAL IMPLICATIONS It provides a template to apply to cases of whistleblowing, and provides some baseline material. ORIGINALITY/VALUE This paper is one of the first to explore the whistleblowing stages model using qualitative material to one setting over time.
Collapse
Affiliation(s)
- Martin Powell
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| |
Collapse
|
18
|
Nicholls AR, Fairs LRW, Toner J, Jones L, Mantis C, Barkoukis V, Perry JL, Micle AV, Theodorou NC, Shakhverdieva S, Stoicescu M, Vesic MV, Dikic N, Andjelkovic M, Grimau EG, Amigo JA, Schomöller A. Snitches Get Stitches and End Up in Ditches: A Systematic Review of the Factors Associated With Whistleblowing Intentions. Front Psychol 2021; 12:631538. [PMID: 34675830 PMCID: PMC8523783 DOI: 10.3389/fpsyg.2021.631538] [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: 11/20/2020] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Blowing the whistle on corruption or wrongdoing can facilitate the detection, investigation, and then prosecution of a violation that may have otherwise gone undetected. The purpose of this systematic review was to identify the factors that are associated with intentions to blow the whistle on wrongdoing. We searched Academic Search Premier, CINAHL Complete, Education Research Complete, ERIC, Medline, PsycARTICLES, PsycINFO, Regional Business News, and SPORTDiscus in January 2020. The quality of evidence was assessed using the Cochrane risk of bias tool. Of the 9,136 records identified, 217 studies were included in this systematic review. We identified 8 dimensions, 26 higher-order themes, and 119 lower-order themes. The whistleblowing dimensions were personal factors, organizational factors, cost and benefits, outcome expectancies, the offense, reporting, the wrongdoer, and social factors. Based on the findings, it is apparent that organizations should empower, educate, protect, support, and reward those who blow the whistle, in order to increase the likelihood on individuals blowing the whistle on corruption and wrongdoing. A combined approach may increase whistleblowing intentions, although research is required to test this assertion. From a policy perspective, more consistent protection is required across different countries.
Collapse
Affiliation(s)
- Adam R. Nicholls
- Department of Sport, Health, and Exercise Science, University of Hull, Hull, United Kingdom
| | - Lucas R. W. Fairs
- Department of Sport, Health, and Exercise Science, University of Hull, Hull, United Kingdom
| | - John Toner
- Department of Sport, Health, and Exercise Science, University of Hull, Hull, United Kingdom
| | - Luke Jones
- Department of Sport, Health, and Exercise Science, University of Hull, Hull, United Kingdom
| | - Constantine Mantis
- Department of Sport, Health, and Exercise Science, University of Hull, Hull, United Kingdom
| | - Vassilis Barkoukis
- Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John L. Perry
- Department of Psychology, Mary Immaculate College, Limerick, Ireland
| | | | | | | | - Marius Stoicescu
- Faculty of Physical Education and Sport, National University of Physical Education and Sports, Bucharest, Romania
| | | | - Nenad Dikic
- Anti-Doping Agency of Serbia, Belgrade, Serbia
| | | | | | - Javier A. Amigo
- Agencia Española de Protección de la Saluden el Deporte, Madrid, Spain
| | - Anne Schomöller
- International Council of Sport Science and Physical Education, Berlin, Germany
| |
Collapse
|
19
|
Gauld R, Horsburgh S. Did healthcare professional perspectives on the quality and safety environment in New Zealand public hospitals change from 2012 to 2017? J Health Organ Manag 2021; 34:775-788. [PMID: 32979044 DOI: 10.1108/jhom-11-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017. DESIGN/METHODOLOGY/APPROACH Three questions were included in a national New Zealand health professional workforce survey conducted in 2012 and again in 2017. All registered health professionals employed with DHBs were invited to participate in an online survey. Areas of interest included teamwork amongst professionals; involvement of patients and families in efforts to improve patient care and ease of speaking up when a problem with patient care is perceived. FINDINGS In 2012, 57% of respondents (58% in 2017) agreed health professionals worked as a team; 71% respondents (73% in 2017) agreed health professionals involved patients and families in efforts to improve patient care and 69% (65% in 2017) agreed it was easy to speak up in their clinical area, with none of these changes being statistically significant. There were some response differences by respondent characteristics. PRACTICAL IMPLICATIONS With no change over time, there is a demand for improvement. Also for leadership in policy, management and amongst health professionals if goals of improving quality and safety are to be delivered upon. ORIGINALITY/VALUE This study provides a simple three-question method of probing perceptions of quality and safety and an important set of insights into progress in New Zealand DHBs.
Collapse
Affiliation(s)
- Robin Gauld
- Dean's Office and Centre for Health Systems and Technology, School of Business, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Preventive and Social Medicine and Centre for Health Systems and Technology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
20
|
Kuilman L, Jansen G, Mulder LB, Roodbol P. Facilitating and motivating factors for reporting reprehensible conduct in care: A study among nurse practitioners and physician assistants in the Netherlands. J Eval Clin Pract 2021; 27:776-784. [PMID: 32816369 PMCID: PMC8359255 DOI: 10.1111/jep.13462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The aims of this study are as follows: (a) to establish whether a relationship exists between the importance that healthcare professionals attach to ethics in care and their likelihood to report reprehensible conduct committed by colleagues, and (b) to assess whether this relationship is moderated by behavioural control targeted at preventing harm. METHOD In this cross-sectional study, which was based on a convenience sample (n = 155) of nurse practitioners (NPs) and physician assistants (PAs) in the Netherlands, we measured ethics advocacy (EA) as a motivating factor (reflecting the importance that healthcare professionals attach to ethics and care) and "behavioral control targeted at preventing harm" (BCPH) as a facilitating factor. "Reporting reprehensible conduct" (RRC) was measured as a context-specific indicator of whistleblowing intentions, consisting of two vignettes describing morally questionable behaviour committed by colleagues. RESULTS The propensity to report reprehensible conduct was a function of the interaction between EA and BCPH. The only group for which EA predicted RRC consisted of individuals with above-average levels of perceived BCPH. CONCLUSION The results suggest that the importance that healthcare professionals attach to ethical aspects in care is not sufficient to ensure that they will report reprehensible conduct. Such importance does not induce reporting behaviour unless the professionals also perceive themselves as having a high level of BCPH. We suggest that these insights could be helpful in training healthcare providers to cope with ethical dilemmas that they are likely to encounter in their work.
Collapse
Affiliation(s)
- Luppo Kuilman
- Nursing Research Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Physician Assistant Studies, Northern Arizona University, College of Health and Human Services, Phoenix BMC, Arizona, USA
| | - Gerard Jansen
- Nursing Research Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laetitia B Mulder
- Department of Human Resource Management & Organizational Behaviour, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Petrie Roodbol
- Nursing Research Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
21
|
Dungarwalla M, Bailey E. Dentistry and aviation engineering - behind the scenes at operations in a UK-based airline. Br Dent J 2021; 230:835-840. [PMID: 34172871 PMCID: PMC8232987 DOI: 10.1038/s41415-021-3127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022]
Abstract
The healthcare industry is commonly compared to the aviation industry with emphasis on human factors and the decision-making processes undertaken by pilots and clinicians alike. The authors have been given exclusive access to meet the head of the maintenance team behind one of the UK's most popular airlines. An open-ended interview took place which was audio-transcribed for thematic analysis. Data were initially coded to identify basic patterns in the transcript. Once this was completed, themes were identified and agreed between the authors which could be compared to healthcare and dentistry. These themes were: regulation, occupational health, maintenance of equipment, use of checklists, reporting, just culture, burnout and disturbances. The aviation engineering industry requires the combination of a skilled workforce working under time pressure often in a financially restricted environment in a similar way to healthcare, especially dentistry. The two industries share common risks, although introduction of risk management tools such as checklists have been prevalent in aviation since the 1930s. Recognition of said risks and themes can lead to shared learning opportunities to benefit both sectors. There has been substantive focus on human factors and their interaction with decision-making in healthcare. The authors present themes garnered from an interview with a base maintenance manager from one of the UK's largest airlines. There are clear overlaps between engineering and dentistry, specifically pertaining to equipment regulation, checklists and working directives.
Collapse
Affiliation(s)
- Mohammed Dungarwalla
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Oral & Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, UK.
| | - Edmund Bailey
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Oral & Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, UK
| |
Collapse
|
22
|
Enhancing patient safety by integrating ethical dimensions to Critical Incident Reporting Systems. BMC Med Ethics 2021; 22:26. [PMID: 33685473 PMCID: PMC7941704 DOI: 10.1186/s12910-021-00593-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Critical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS. METHODS A six-step approach combined the analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts' experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics. RESULTS Four main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance. CONCLUSION The developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations' presence and effectiveness. The proposed enhancement could contribute to hospitals' ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction.
Collapse
|
23
|
Violato E, King S, Bulut O. A multi-method exploratory study of health professional students' experiences with compliance behaviours. BMC MEDICAL EDUCATION 2020; 20:359. [PMID: 33046072 PMCID: PMC7552343 DOI: 10.1186/s12909-020-02265-4] [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: 06/17/2020] [Accepted: 09/28/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Research in healthcare, including students as participants, has begun to document experiences with negative compliance, specifically conformity and obedience. There is a growing body of experimental and survey literature, however, currently lacking is a direct measure of the frequency at which health professional students have negative experiences with conformity and obedience integrated with psychological factors, the outcomes of negative compliance, and students' perceptions. METHODS To develop empirical knowledge about the frequency of negative compliance and student perceptions during health professional education a multi-methods survey approach was used. The survey was administered to health professional students across ten disciplines at four institutions. RESULTS The results indicated students regularly experience obedience and conformity and are influenced by impression management and displacement of responsibility. Moral distress was identified as a consistent negative outcome. Student self-reported experiences aligned with the empirical findings. CONCLUSIONS The findings of the present study demonstrate the pervasiveness of experiences with negative compliance during health professional's education along with some attendant psychological factors. The findings have educational and practical implications, as well as pointing to the need for further integration of social and cognitive psychology in explaining compliance in healthcare. The results are likely generalizable to a population level however replication is encouraged to better understand the true frequency of negative compliance at a health professional population level.
Collapse
Affiliation(s)
- Efrem Violato
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada.
| | - Sharla King
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
| | - Okan Bulut
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
| |
Collapse
|