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Studenmund C, Lyndon A, Stotts JR, Peralta-Neel C, Sharma AE, Bardach NS. What do patients and families observe about pediatric safety?: A thematic analysis of real-time narratives. J Hosp Med 2024. [PMID: 38741257 DOI: 10.1002/jhm.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Data on inpatient safety are documented by hospital staff through incident reporting (IR) systems. Safety observations from families or patients are rarely captured. The Family Input for Quality and Safety (FIQS) study created a mobile health tool for pediatric patients and their families to anonymously report safety observations in real time during hospitalization. The study objectives were to describe these observations and identify domains salient to safety. METHODS In this observational study, we analyzed pediatric patient safety reports from June 2017 to April 2018. Participants were: English-speaking family members and hospitalized patients ≥13 years old. The analysis had two stages: 1) assessment of whether narratives met established safety event criteria and whether there were companion IRs; 2) thematic analysis to identify domains. RESULTS Of 248 enrolled participants, 58 submitted 120 narrative reports. Of the narratives, 68 (57%) met safety event criteria, while only one (0.8%) corresponded to a staff-reported IR. 25% of narratives shared positive feedback about patient safety efforts; 75% shared constructive feedback. We identified domains particularly salient to safety: 1) patients and families as safety actors; 2) emotional safety; 3) system-centered care; and 4) shared safety domains, including medication, communication, and environment of care. Some domains capture data that is otherwise difficult to obtain (#1-3), while others fit within standard healthcare safety domains (#4). CONCLUSIONS Patients and families observe and report salient safety events that can fill gaps in IR data. Healthcare leaders should consider incorporating patient and family observations-collected with an option for anonymity and eliciting both positive and constructive comments.
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Affiliation(s)
- Christine Studenmund
- Department of Pediatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - James R Stotts
- Department of Quality and Patient Safety, University of California, San Francisco, California, USA
| | - Caroline Peralta-Neel
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Anjana E Sharma
- Department of Family & Community Medicine, University of California, San Francisco, California, USA
| | - Naomi S Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, California, USA
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Mitchell P, Cribb A, Entwistle V. Patient Safety and the Question of Dignitary Harms. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2023; 48:33-49. [PMID: 36592336 PMCID: PMC9935492 DOI: 10.1093/jmp/jhac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety as a field of practice. We argue that dignitary harms in health care are-at least sometimes-preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality.
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Secunda KE, Kruser JM. Patient-Centered and Family-Centered Care in the Intensive Care Unit. Clin Chest Med 2022; 43:539-550. [PMID: 36116821 PMCID: PMC9885766 DOI: 10.1016/j.ccm.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Patient-centered and family-centered care (PFCC) is widely recognized as integral to high-quality health-care delivery. The highly technical nature of critical care puts patients and families at risk of dehumanization and renders the delivery of PFCC in the intensive care unit (ICU) challenging. In this article, we discuss the history and terminology of PFCC, describe interventions to promote PFCC, highlight limitations to the current model, and offer future directions to optimize PFCC in the ICU.
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Affiliation(s)
- Katharine E Secunda
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pennsylvania
| | - Jacqueline M Kruser
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
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Leese J, Zhu S, Townsend AF, Backman CL, Nimmon L, Li LC. Ethical issues experienced by persons with rheumatoid arthritis in a wearable-enabled physical activity intervention study. Health Expect 2022; 25:1418-1431. [PMID: 35303379 PMCID: PMC9327860 DOI: 10.1111/hex.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Using wearables to self‐monitor physical activity is a promising approach to support arthritis self‐management. Little is known, however, about the context in which ethical issues may be experienced when using a wearable in self‐management. We used a relational ethics lens to better understand how persons with rheumatoid arthritis (RA) experience their use of a wearable as part of a physical activity counselling intervention study involving a physiotherapist (PT). Methods Constructivist grounded theory and a relational ethics lens guided the study design. This conceptual framework drew attention to benefits, downsides and tensions experienced in a context of relational settings (micro and macro) in which participants live. Fourteen initial and eleven follow‐up interviews took place with persons with RA in British Columbia, Canada, following participation in a wearable‐enabled intervention study. Results We created three main categories, exploring how experiences of benefits, downsides and tensions when using the intervention intertwined with shared moral values placed on self‐control, trustworthiness, independence and productivity: (1) For some, using a wearable helped to ‘do something right’ by taking more control over reaching physical activity goals. Some, however, felt ambivalent, believing both there was nothing more they could do and that they had not done enough to reach their goal; (2) Some participants described how sharing wearable data supported and challenged mutual trustworthiness in their relationship with the PT; (3) For some, using a wearable affirmed or challenged their sense of self‐respect as an independent and productive person. Conclusion Participants in this study reported that using a wearable could support and challenge their arthritis self‐management. Constructing moral identity, with qualities of self‐control, trustworthiness, independence and productivity, within the relational settings in which participants live, was integral to ethical issues encountered. This study is a key step to advance understanding of ethical issues of using a wearable as an adjunct for engaging in physical activity from a patient's perspective. Patient or Public Contribution Perspectives of persons with arthritis (mostly members of Arthritis Research Canada's Arthritis Patient Advisory Board) were sought to shape the research question and interpretations throughout data analysis.
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Affiliation(s)
- Jenny Leese
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Siyi Zhu
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Rehabilitation Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anne F Townsend
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Health Research, Health Innovation One, Lancaster University, Lancaster, UK
| | - Catherine L Backman
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Centre for Health Education Scholarship, P.A. Woodward Instructional Resources Centre (IRC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Siewert B, Swedeen S, Brook OR, Eisenberg RL, Sokol-Hessner L, Kruskal JB. Emotional Harm in the Radiology Department: Analysis of an Underrecognized Preventable Error. Radiology 2021; 302:613-619. [PMID: 34812668 DOI: 10.1148/radiol.2021211846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Emotional harm incidents in health care may result in lost trust and adverse outcomes. However, investigations of emotional harm in radiology departments remain lacking. Purpose To better understand contributors and clinical scenarios in which emotional harm can occur in radiology, to document incidences, and to develop preventative countermeasures. Materials and Methods A large tertiary hospital adverse event reporting system was retrospectively searched for submissions under the category of dignity and respect in radiology between December 2014 and December 2020. Submissions were assigned to one of 14 categories per a previously developed classification system. Root-cause analysis of events was performed with a focus on countermeasures for future prevention. The person experiencing emotional harm (patient or staff) was noted. Results Of all radiology-related submissions, 37 of 3032 (1.2%) identified 43 dignity and respect incidents: failure to be patient centered (n = 23; 54%), disrespectful communication (n = 16; 37%), privacy violation (n = 2; 5%), minimization of patient concerns (n = 1; 2%), and loss of property (n = 1; 2%). Failure to be patient centered (n = 23) was subcategorized into disregard for patient preference (12 of 23; 52%), delay in care (eight of 23; 35%), and ineffective communication (three of 23; 13%). Of the 43 incidents, 32 involved patients (74%) and 11 involved staff (26%). Emotional harm in staff was because of disrespectful communication from other staff (eight of 11; 73%). Seventy-three countermeasures were identified: staff communication training (n = 32; 44%), individual feedback (n = 18; 25%), system innovation (n = 16; 22%), improvement of existing communication processes (n = 3; 4%), process reminders (n = 3; 4%), and unclear (n = 1; 1%). Individual feedback and staff communication training that focused on active listening, asking for the patient's preferences, and closed-loop communication addressed 34 of the 43 incidents (79%). Conclusion Most emotional harm incidents were from disrespectful communication and failure to be patient centered. Providing training focused on active listening, asking for patient's preferences, and closed-loop communication would potentially prevent most of these incidents. © RSNA, 2021 See also the editorial by Bruno in this issue.
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Affiliation(s)
- Bettina Siewert
- From the Departments of Radiology (B.S., S.S., O.R.B., R.L.E., J.B.K.) and Internal Medicine (L.S.H.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Suzanne Swedeen
- From the Departments of Radiology (B.S., S.S., O.R.B., R.L.E., J.B.K.) and Internal Medicine (L.S.H.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Olga R Brook
- From the Departments of Radiology (B.S., S.S., O.R.B., R.L.E., J.B.K.) and Internal Medicine (L.S.H.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Ronald L Eisenberg
- From the Departments of Radiology (B.S., S.S., O.R.B., R.L.E., J.B.K.) and Internal Medicine (L.S.H.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Lauge Sokol-Hessner
- From the Departments of Radiology (B.S., S.S., O.R.B., R.L.E., J.B.K.) and Internal Medicine (L.S.H.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Jonathan B Kruskal
- From the Departments of Radiology (B.S., S.S., O.R.B., R.L.E., J.B.K.) and Internal Medicine (L.S.H.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
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Law AC, Roche S, Reichheld A, Folcarelli P, Cocchi MN, Howell MD, Sands K, Stevens JP. Failures in the Respectful Care of Critically Ill Patients. Jt Comm J Qual Patient Saf 2018; 45:276-284. [PMID: 30170754 DOI: 10.1016/j.jcjq.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The emotional toll of critical illness on patients and their families can be profound and is emerging as an important target for value improvement. One source of emotional harm to patients and families may be care perceived as inadequately respectful. The prevalence and risk factors for types of emotional harms is under-studied. METHODS This prospective cohort study was conducted in nine ICUs at a tertiary care academic medical center in the United States. Prevalence of inadequate respect for (a) the patient and (b) the family, as well as prevalence of perceived lack of control over the care of their loved ones, was assessed by the Family Satisfaction with Care in the Intensive Care Unit instrument. The relationship between these outcomes with demographic and clinical covariates was assessed. Stratification by patient survivorship was performed in sensitivity analysis. RESULTS Of more than 1,500 respondents, 16.9% and 21.8% reported that the patient or the family member, respectively, received inadequate respect. No clinical characteristics of the patients were associated with inadequate respect for either the patient or the family member. By comparison, more than half of respondents reported a lack of control over their loved one's care; this finding was associated with multiple clinical factors. Prevalence and associated factors differed by patient survivorship status. CONCLUSION Care that is inadequately respectful to patients and families in the setting of critical illness is prevalent but does not appear to be associated with clinical characteristics. The incidence of such emotional harms is nuanced, difficult to predict, and deserves further investigation.
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Aycock DM, Sims TT, Florman T, Casseus KT, Gordon PM, Spratling RG. Language Sensitivity, the RESPECT Model, and Continuing Education. J Contin Educ Nurs 2017; 48:517-524. [PMID: 29083460 DOI: 10.3928/00220124-20171017-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
Some words and phrases used by health care providers may be perceived as insensitive by patients, which could negatively affect patient outcomes and satisfaction. However, a distinct concept that can be used to describe and synthesize these words and phrases does not exist. The purpose of this article is to propose the concept of language sensitivity, defined as the use of respectful, supportive, and caring words with consideration for a patient's situation and diagnosis. Examples of how language sensitivity may be lacking in nurse-patient interactions are described, and solutions are provided using the RESPECT (Rapport, Environment/Equipment, Safety, Privacy, Encouragement, Caring/Compassion, and Tact) model. RESPECT can be used as a framework to inform and remind nurses about the importance of sensitivity when communicating with patients. Various approaches can be used by nurse educators to promote language sensitivity in health care. Case studies and a lesson plan are included. J Contin Educ Nurs. 2017;48(11):517-524.
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Sokol-Hessner L, Folcarelli PH, Sands KEF. Emotional harm from disrespect: the neglected preventable harm. BMJ Qual Saf 2015; 24:550-3. [PMID: 26085331 DOI: 10.1136/bmjqs-2015-004034] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/30/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Lauge Sokol-Hessner
- Medicine and Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Kenneth E F Sands
- Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Abstract
OBJECTIVES The purpose of this study was to explore parents' experiences related to events which they believed to be medical errors in their child's care. METHODS In-depth qualitative interviews were conducted with parents who believed their child had experienced a medical error; responses were analyzed using qualitative methods. RESULTS In 35 interviews, parents reported a variety of events that they believed to be errors. They described physical harm, emotional distress, life disruptions, changes in behavior, and damage to the relationship with the provider as a result of these events. Most parents felt that they had received no explanation of what had happened, no acknowledgement of the impact of the event, no apology and no acceptance of responsibility by a provider. Parents wanted providers to offer these responses, to express caring for the patient and to feel remorse. They also wanted to know that steps would be taken to prevent recurrences. CONCLUSIONS Perceived medical errors can impact both the patient and the family in many ways. We recommend that providers acknowledge the full impact of a perceived error and tailor their response to meet the specific needs of the patient and family.
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Rathert C, Brandt J, Williams ES. Putting the 'patient' in patient safety: a qualitative study of consumer experiences. Health Expect 2011; 15:327-36. [PMID: 21624026 DOI: 10.1111/j.1369-7625.2011.00685.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although patient safety has been studied extensively, little research has directly examined patient and family (consumer) perceptions. Evidence suggests that clinicians define safety differently from consumers, e.g. clinicians focus more on outcomes, whereas consumers may focus more on processes. Consumer perceptions of patient safety are important for several reasons. First, health-care policy leaders have been encouraging patients and families to take a proactive role in ensuring patient safety; therefore, an understanding of how patients define safety is needed. Second, consumer perceptions of safety could influence outcomes such as trust and satisfaction or compliance with treatment protocols. Finally, consumer perspectives could be an additional lens for viewing complex systems and processes for quality improvement efforts. OBJECTIVES To qualitatively explore acute care consumer perceptions of patient safety. DESIGN AND METHODS Thirty-nine individuals with a recent overnight hospital visit participated in one of four group interviews. Analysis followed an interpretive analytical approach. RESULTS Three basic themes were identified: Communication, staffing issues and medication administration. Consumers associated care process problems, such as delays or lack of information, with safety rather than as service quality problems. Participants agreed that patients need family caregivers as advocates. CONCLUSIONS Consumers seem acutely aware of care processes they believe pose risks to safety. Perceptual measures of patient safety and quality may help to identify areas where there are higher risks of preventable adverse events.
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Affiliation(s)
- Cheryl Rathert
- Health Services Management, Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, MO 65212, USA.
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Lawton R, Gardner P, Plachcinski R. Using vignettes to explore judgements of patients about safety and quality of care: the role of outcome and relationship with the care provider. Health Expect 2010; 14:296-306. [PMID: 21029278 DOI: 10.1111/j.1369-7625.2010.00622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is a growing body of evidence that safe outcomes and quality care are important to patients. For the patient, evaluations of safety and quality are made on the basis of the interpersonal interactions that they have with health professionals as well as the technical aspects of their care. OBJECTIVE In this study, we investigated the extent to which outcome of care (harm or not) and relationship (good or bad) with the care provider impact on the judgements of responsibility and blame as well as decisions about likelihood of making a complaint. METHOD Ninety-eight mothers made seven ratings of responsibility, blame and action in response to four hypothetical vignettes in a questionnaire. The vignettes described poor quality ante-natal care in which outcome and relationship with the health-care provider were systematically manipulated across different versions of the questionnaire. RESULTS Multivariate analyses showed that participants made significantly more negative ratings in response to vignettes describing a bad outcome and those that described a poor relationship with the health professional. However, whilst ratings of seriousness and likelihood of making a complaint were most influenced by the manipulation of outcome in the vignettes, judgements of blame and responsibility were most effected by the depiction of relationship with the health professional as good or bad. Moreover, for three of the four vignettes, relationship rather than outcome most strongly influenced overall ratings of care. DISCUSSION These findings are discussed in the context of theory and policy developments.
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Affiliation(s)
- Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, UK.
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