Influence of workplace demands on nurses' perception of patient safety

Stress, Professional Burnout, and Employee Efficiency in the Greek National Organization for the Provision of Health Services

BACKGROUND

Workplace stress and burnout in the Greek healthcare system had been considered severe even before the high pressure of the COVID-19 pandemic. We aimed to investigate occupational quality of life and burnout effects on workplace errors among the administrative staff in the Greek healthcare system.

METHODS

We enrolled 120 administrative healthcare employee participants between April and May 2019. Occupational burnout was assessed using the Maslach Burnout Inventory-Human Services Survey and the Hospital Anxiety and Depression Scale.

FINDINGS

Inadequate staffing, a low sense of well-being, exhaustion, and low family income were associated with workplace errors. Increased workload and staff shortages were associated with occupation related quality of life.

CONCLUSIONS

Targeted interventions supporting healthcare staff mental health are warranted.

APPLICATION TO PRACTICE

Wellness and professional burnout can affect professional efficiency and are associated with workplace errors in the healthcare sector. Targeted interventions are warranted to support the mental health of healthcare staff during work and to prevent incidents of post-traumatic stress. Shortages of staffing may lead to an increase in the cost of the provided services.

Linking transformational leadership, patient safety culture and work engagement in home care services

Aim

To assess the relationship between transformational leadership, job demands, job resources, patient safety culture and work engagement in home care services.

Design

Cross-sectional survey.

Methods

Healthcare professionals in Norwegian home care services participated in the study (N = 139). Multiple regression analyses with patient safety culture and work engagement as outcomes and transformational leadership, job demands, job resources as predictors were conducted.

Results

The transformational leadership model explained 35.7% of the variance in patient safety culture. Adding job demands and resources and work engagement to the model increased the explained variance to 53.5%. The job resource "skill utilization" was the strongest predictor of work engagement. The full model with all predictor variables explained 28.2% of work engagement.

Conclusion

Transformational leadership has a significant impact on patient safety culture and work engagement in home care services. Employees' perceptions of job demands, available resources and engagement also affect patient safety culture.

Text Mining Method for Studying Medication Administration Incidents and Nurse-Staffing Contributing Factors: A Pilot Study

Incident reporting systems are being implemented globally, thus increasing the profile and prevalence of incidents, but the analysis of free-text descriptions remains largely hidden. The aims of the study were to explore the extent to which incident reports recorded staffing issues as contributors to medication administration incidents. Incident reports related to medication administration (N = 1012) were collected from two hospitals in Finland between January 1, 2013, and December 31, 2014. The SAS Enterprise Miner 13.2 and its Text Miner tool were used to excavate terms and descriptors and to uncover themes and concepts in the free-text descriptions of incidents with (n = 194) and without (n = 818) nurse staffing-related contributing factors. Text mining included (1) text parsing, (2) text filtering, and (3) modeling text clusters and text topics. The term "rush/hurry" was the sixth most common term used in incidents where nurse-staffing was identified as a contributing factor. Nurse-staffing factors, however, were not pronounced in clusters or in text topics of either data set. Text mining offers the opportunity to analyze large free-text mass and holds promise for providing insight into the antecedents of medication administration incidents.

Integrating teamwork, clinician occupational well-being and patient safety - development of a conceptual framework based on a systematic review

BACKGROUND

There is growing evidence that teamwork in hospitals is related to both patient outcomes and clinician occupational well-being. Furthermore, clinician well-being is associated with patient safety. Despite considerable research activity, few studies include all three concepts, and their interrelations have not yet been investigated systematically. To advance our understanding of these potentially complex interrelations we propose an integrative framework taking into account current evidence and research gaps identified in a systematic review.

METHODS

We conducted a literature search in six major databases (Medline, PsycArticles, PsycInfo, Psyndex, ScienceDirect, and Web of Knowledge). Inclusion criteria were: peer reviewed papers published between January 2000 and June 2015 investigating a statistical relationship between at least two of the three concepts; teamwork, patient safety, and clinician occupational well-being in hospital settings, including practicing nurses and physicians. We assessed methodological quality using a standardized rating system and qualitatively appraised and extracted relevant data, such as instruments, analyses and outcomes.

RESULTS

The 98 studies included in this review were highly diverse regarding quality, methodology and outcomes. We found support for the existence of independent associations between teamwork, clinician occupational well-being and patient safety. However, we identified several conceptual and methodological limitations. The main barrier to advancing our understanding of the causal relationships between teamwork, clinician well-being and patient safety is the lack of an integrative, theory-based, and methodologically thorough approach investigating the three concepts simultaneously and longitudinally. Based on psychological theory and our findings, we developed an integrative framework that addresses these limitations and proposes mechanisms by which these concepts might be linked.

CONCLUSION

Knowledge about the mechanisms underlying the relationships between these concepts helps to identify avenues for future research, aimed at benefiting clinicians and patients by using the synergies between teamwork, clinician occupational well-being and patient safety.

Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review

OBJECTIVE

To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety.

DESIGN

Systematic research review.

DATA SOURCES

PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations.

RESULTS

Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety.

CONCLUSIONS

Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed.

IMPLICATIONS

This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42015023340.

The perception of hospital safety culture and selected outcomes among nurses: An exploratory study

The objectives of this study were to examine nurses' perceptions of the hospital safety culture in Jordan and to identify the relationships between aspects of hospital safety culture and selected safety outcomes. Data from 242 registered nurses in five Jordanian hospitals were analyzed. Aspects of hospital safety culture and outcomes were measured using the Hospital Survey on Patient Safety Culture. Among various aspects of hospital safety culture, teamwork within units had the highest average percentage of positive responses (49.8%). Additionally, participants reported deficits in other aspects of safety culture, particularly in staffing and nonpunitive response to errors, with average percentages of positive responses of 30.4% and 30.7%, respectively. Pearson correlation analysis revealed that 9 of 10 subscales of hospital safety culture were significantly correlated to one or more of the hospital safety outcomes. The findings of this study can help policymakers and healthcare administrators identify the weaknesses and strengths of hospital safety issues in order to propose effective strategies to improve patient safety and quality of care.

Emotional exhaustion and workload predict clinician-rated and objective patient safety

AIMS

To investigate the role of clinician burnout, demographic, and organizational characteristics in predicting subjective and objective indicators of patient safety.

BACKGROUND

Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables, and objective patient safety indicators is poorly understood. The present study addresses this gap.

METHOD

Participants were 1425 physicians and nurses working in intensive care. Regression analysis (multilevel) was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience) and organizational (e.g., workload, predictability) characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety.

RESULTS

Clinician-rated patient safety was associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios.

CONCLUSION

At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables and support to the development of managerial guidelines to ensure clinicians' psychological health and patients' safety.

Assessment of nurses' perceptions of patient safety culture in a Saudi Arabia hospital

The purpose of this study was to identify factors that nurses perceive as contributing to the culture of patient safety in a hospital in Saudi Arabia. A total of 498 registered nurses employed in the hospital completed the survey. The majority of nurses perceived a positive patient safety culture. There were significant differences in nurses' perceptions of patient safety culture based on gender, age, years of experience, Arabic versus non-Arabic speaking, and length of shift.

Co-worker characteristics and nurses' safety-climate perceptions

PURPOSE

Previous research indicates that nurses' safety-climate perceptions are influenced by individual nurse characteristics, leadership, staffing levels and workplace structure. No literature was identified that explored the relationship between nurses' safety climate perceptions and staffing composition in a particular hospital unit. This paper aims to fill some of the gaps in the research in this area.

DESIGN/METHODOLOGY/APPROACH

Data supplied by 430 registered nurses working in two Midwestern US hospitals were analyzed to co-worker characteristics such as education, licensure, experience and full- or part-time status.

FINDINGS

Registered nurses working in hospitals with proportionally more-experienced nurses perceived their workplaces to be significantly safer for patients. Surprisingly, co-worker licensure, education and full- or part-time status did not significantly influence nurses' safety climate perceptions.

PRACTICAL IMPLICATIONS

Findings indicate that safety-climate perceptions vary significantly between hospital units and experienced nurses may act as a resource that promotes a positive safety climate. Hospitals retaining experienced nurses may potentially reduce errors.

ORIGINALITY/VALUE

The paper illustrates that the results highlight the importance of providing nurses with an environment that encourages retention and creates a workplace where experienced nurses' skills are best utilized.

Gerontological nurses' perceptions of their rights in Finland

BACKGROUND

These are challenging times for gerontological nurses, due to the increasing need for older people care services and nursing expertise and to the burdensome nature of older people care. These changes also challenge professional ethics. Traditionally, literature has focused more on nurses' duties and responsibilities, rather than on their rights.

AIM

The aim was to explore the concept of nurses' rights from the perspective of nurses in gerontological care.

METHODS

A qualitative study conducted among gerontological nurses (n = 29) in the older people care of two publicly provided municipal older people care organisations in two mid-range towns in Finland. Participation in the study was voluntary, and the participants were recruited in collaboration with a nurse executive. The data, collected in 11 interviews (1-4 participants in each) using open-ended interview method, were analysed by inductive content analysis.

FINDINGS

Based on our findings, nurses' rights are an integral part of everyday nursing. As professionals, nurses pointed out that their rights are based on legislation and ethics, and their rights involve colleagues, managers, organisation, and patients and relatives. Their rights were connected to nurses' professional expertise and their well-being at work, but at the end, they were a factor to improving quality of older people care. This required that nurses' rights were taken as visible and elementary part of management.

CONCLUSION

On the basis of our findings, especially in very demanding areas of nursing, like older people care, nurses' rights deserve major visibility and should be taken into consideration when planning care.

A qualitative study on Iranian nurses’ experiences and perspectives on how to provide safe care in clinical practice

Nurses are the healthcare providers who are well positioned to strengthen patient safety through providing safe care in clinical practice. The purpose of this study was to explore and describe the experiences and perspectives of Iranian nurses in relation to how to provide safe care in clinical practice. A qualitative design by using a content analysis approach was applied for the data gathering and analysis. After employing a purposive sampling to choose 16 bachelor’s degree nurses working in the medical and surgical wards of a referral teaching hospital in an urban area of Iran, semi-structured interviews were conducted to collect data. During the data analysis, three main themes emerged: ‘providing safe care as the patient’s right’, with the subthemes: ‘feeling a personal commitment’ and ‘incorporating patients’ feelings of safety into providing safe care’, ‘encouraging reciprocal accountability in healthcare professionals’ and ‘leadership commitment to safe care’. The findings suggest that educators should provide more information during nurses’ education to focus on the moral duty to provide safe care. In addition, the provision of safe care needs the commitment and collaboration of all healthcare professionals, as well as the leadership of nursing for removing obstacles to nurses’ efforts to making the healthcare system safer.

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim  The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background  The health-care system's success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method  A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results  The data analysis resulted in three main themes: 'providing environmental prerequisites for safe nursing practice', 'uniting and integrating health-care providers', and 'creating an atmosphere of safe care'. Conclusion  The results indicate that to facilitate providing safe care, nurse leaders should improve nurses' working conditions, develop the nurses' practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers' professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management  Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.

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.

Patient safety: nursing students' perspectives and the role of nursing education to provide safe care

BACKGROUND AND AIM

Nurses as the largest group of healthcare providers are in the best position to improve patient safety. In preparing future nurses, nurse educators have an important role in developing the knowledge, skills and attitudes among nursing students related to patient safety. The aim of this study was to explore Iranian nursing students' perspectives regarding patient safety and the role of nursing education in developing their capabilities to provide safe care.

METHODS

A purposeful sampling strategy was used to recruit 17 junior and senior nursing students for qualitative, semi-structured interviews. Content analysis of the interview transcripts was conducted to identify several relevant themes.

FINDINGS

Three main themes emerged from the data analysis: 'safety as patient comfort', 'not being knowledgeable or experienced enough' and 'being helped to internalise the principles and values of patient safety'. The third theme consisted of two categories: 'adopting a humanistic approach towards patients' and 'practising conscientiously in the workplace'.

CONCLUSION

The present study adds insights on how nursing students understand and may be helped to internalise concepts of patient safety within their practice. Nursing education curriculum designers need to go beyond theoretical concepts of patient safety education and devise strategies to increase the application of safety knowledge and competencies in nursing practice.