Self-reported perceptions of Registered Nurses working in Australian hospitals

Nurses and stress: recognizing causes and seeking solutions

AIMS

To identify, from the perspectives of nurses, occupational stressors and ways in which they may be reduced.

BACKGROUND

Nurses commonly experience high levels of occupational stress, with negative consequences for their physical and psychological health, health-care organisations and community. There is minimal research on reducing occupational stress.

METHOD

Six focus groups were conducted with 38 registered nurses using a qualitative exploratory approach. Participants were asked to identify sources of occupational stress and possible workplace initiatives to reduce stress.

FINDINGS

Sources of occupational stress were: high workloads, unavailability of doctors, unsupportive management, human resource issues, interpersonal issues, patients' relatives, shift work, car parking, handover procedures, no common area for nurses, not progressing at work and patient mental health. Suggestions for reduction included: workload modification, non-ward-based initiatives, changing shift hours, forwarding suggestions for change, music, special events, organisational development, ensuring nurses get breaks, massage therapists, acknowledgement from management and leadership within wards.

CONCLUSION

The findings highlight the need to understand local perspectives and the importance of involving nurses in identifying initiatives to reduce occupational stress.

IMPLICATIONS FOR NURSING MANAGEMENT

Health-care environments can be enhanced through local understanding of the occupational stressors and productively engaging nurses in developing stress reduction initiatives. Nurse managers must facilitate such processes.

Factors affecting nurses' perceptions of patient safety

PURPOSE

Nurses heavily influence patient care quality and safety. This paper aims to examine socioeconomic and organizational/system factors affecting patient safety and quality perceptions.

DESIGN/METHODOLOGY/APPROACH

A questionnaire was constructed to gather demographic, managerial support, information technology implementation and integration information. Data were collected from nurses in five Riyadh hospitals, Saudi Arabia. Registered nurses working in hospital departments participated in the survey. A total of 566 completed questionnaires were returned. Subsequent data were analyzed through binary logistic regression.

FINDINGS

Factors that improve patient safety and the likelihood that nurses use their own facility include: fewer visible errors; ability to communicate suggestions; information technology support and training; and a confidential error reporting system.

RESEARCH LIMITATIONS/IMPLICATIONS

The survey was a cross-sectional study. Consequently, it is difficult to establish causation. Furthermore, nursing in these hospitals is dominated by foreign nationals. Also, as with all surveys, this research may be subject to response bias. Although the questionnaire was randomly distributed, there were no mechanisms to assure privacy and minimize peer influence. The high positive patient safety perceptions may be influenced by either individual or peer biases.

PRACTICAL IMPLICATIONS

Nurses are important communicators; especially about hospital safety and quality. The research informs leaders about areas that need considering and improving. Findings indicate that system factors, including functional feedback, suggestions, and error reporting significantly affect patient safety improvements. Likewise, nurse education to operate their information systems has positive effects. Healthcare leaders need to understand factors that affect patient safety perceptions when creating a patient safety culture.

ORIGINALITY/VALUE

Few international articles examine the factors that influence nurses' patient safety perceptions or examine those factors that affect these perceptions. This paper adds value by researching what influences patient safety perceptions among Riyadh nurses.

Automated drug dispensing system reduces medication errors in an intensive care setting

OBJECTIVES

We aimed to assess the impact of an automated dispensing system on the incidence of medication errors related to picking, preparation, and administration of drugs in a medical intensive care unit. We also evaluated the clinical significance of such errors and user satisfaction.

DESIGN

Preintervention and postintervention study involving a control and an intervention medical intensive care unit.

SETTING

Two medical intensive care units in the same department of a 2,000-bed university hospital.

PATIENTS

Adult medical intensive care patients.

INTERVENTIONS

After a 2-month observation period, we implemented an automated dispensing system in one of the units (study unit) chosen randomly, with the other unit being the control.

MEASUREMENTS AND MAIN RESULTS

The overall error rate was expressed as a percentage of total opportunities for error. The severity of errors was classified according to National Coordinating Council for Medication Error Reporting and Prevention categories by an expert committee. User satisfaction was assessed through self-administered questionnaires completed by nurses. A total of 1,476 medications for 115 patients were observed. After automated dispensing system implementation, we observed a reduced percentage of total opportunities for error in the study compared to the control unit (13.5% and 18.6%, respectively; p<.05); however, no significant difference was observed before automated dispensing system implementation (20.4% and 19.3%, respectively; not significant). Before-and-after comparisons in the study unit also showed a significantly reduced percentage of total opportunities for error (20.4% and 13.5%; p<.01). An analysis of detailed opportunities for error showed a significant impact of the automated dispensing system in reducing preparation errors (p<.05). Most errors caused no harm (National Coordinating Council for Medication Error Reporting and Prevention category C). The automated dispensing system did not reduce errors causing harm. Finally, the mean for working conditions improved from 1.0±0.8 to 2.5±0.8 on the four-point Likert scale.

CONCLUSIONS

The implementation of an automated dispensing system reduced overall medication errors related to picking, preparation, and administration of drugs in the intensive care unit. Furthermore, most nurses favored the new drug dispensation organization.