Patients' understandings and feelings of safety during hospitalization in Iran: A qualitative study

Patient and family engagement in patient safety in the Eastern Mediterranean Region: a scoping review

BACKGROUND

Patients can play a key role in delivering safe care by becoming actively involved in their health care. This study aimed at reviewing the literature for evidence of patients' and families' engagement in patient safety in the Eastern Mediterranean Region (EMR).

METHODS

We conducted a scoping review of the literature published in English using PubMed, Medline, CINAHL, Scopus, ISI Web of Science, and PsycINFO until June 2023.

RESULTS

A total of 9019 studies were screened, with 22 meeting the inclusion criteria. Our review found few published studies of patient and family engagement in patient safety research in the EMR. Thirteen studies explored the attitudes, perceptions, and/or experiences / preferences of patients, families, and healthcare providers (HCPs) regarding patient engagement in patient safety. Nine publications reported patient involvement in patient safety activities at varying levels. Three categories of factors were identified that may affect patient involvement: patient-related (e.g., lack of awareness on their role in preventing harms, unwillingness to challenge HCPs' authority, and cultural barriers); HCP-related (e.g., negative attitudes towards patient engagement, poor patient-provider communication, and high workload); and healthcare setting-related (e.g., lack of relevant policies and guidelines, lack of training for patients, and HCPs, and lack of patient-centered approach).

CONCLUSION

This review highlighted limitations in the current literature on patient and family engagement in patient safety in the EMR, including both the depth of evidence and clarity of concepts. Further research is needed to explore how to actively involve patients and their families, as well as to determine whether such involvement translates into improved safety in practice.

Barriers and facilitators to feeling safe for inpatients: a model based on a qualitative meta-synthesis

Objectives

To review and synthesize qualitative research exploring patients' safe experience and construct a model to present barriers and facilitators to feeling safe for inpatients.

Design

A qualitative met-synthesis.

Methods

We conducted a systematic electronic search of articles published in English with no date limitation across five databases (Ovid MEDLINE, EMBASE, Web of Science, CINAIL via EBSCO, and PsyINFO) in May 2023. Qualitative research focused on the safe experiences of inpatients was considered. Systematic searches yielded 8,132 studies, of which 16 articles were included. Two reviewers independently extracted and analyzed data. Qualitative meta-synthesis was performed through line-by-line coding of original texts, organizing codes into descriptive themes, and generating analytical themes.

Results

We identified four themes and 11 sub-themes. Across the four themes, control included a barrier (Uncertainty) and two facilitators (Patient participation and safe care); responsible included three facilitators (Confidence in the profession, care for, and responsive); dignity included two barriers (Privacy and Neglect); stability included a barrier (Potential risk), and two facilitators (Harmonious and safe culture). We constructed a model to present the logical connection between these themes and related barriers and facilitators.

Conclusion

Feeling safe for inpatients is a complex perception, including four themes: control, responsible, dignity, and stability. Surrounding four themes and related barriers and facilitators, we outline principles for creating a safe environment and present strategies for improving patients' hospitalization experience and ensuring patient safety.

Clinical relevance

This review provides valuable insight into the clinical practice and health policy and helps medical staff to identify and overcome the potential barriers to implementing interventions in safe care. In addition, the model comprehensively describes the nature and dimensions of feeling safe, informing high-quality care service and related research.

Systematic review registration

Identifier, CRD42023435489.

Increasing a patient's sense of security in the hospital: A theory of trust and nursing action

Having a decreased sense of security leads to unnecessary suffering and distress for patients. Establishing trust is critical for nurses to promote a patient's sense of security, consistent with trauma-informed care. Research regarding nursing action, trust, and sense of security is wide-ranging but fragmented. We used theory synthesis to organize the disparate existing knowledge into a testable middle-range theory encompassing these concepts in hospitals. The resulting model illustrates how individuals are admitted to the hospital with some predisposition to trust or mistrust the healthcare system and/or personnel. Patients encounter circumstances increasing their emotional and/or physical vulnerability to harm, leading to experiences of fear and anxiety. Without intervention, fear and anxiety lead to a decreased sense of security, increased distress, and suffering. Nurse action can ameliorate these effects by increasing a hospitalized person's sense of security or by promoting the development of interpersonal trust, also leading to an increased sense of security. Increased sense of security results in diminished anxiety and fear, and increased hopefulness, confidence, calm, sense of value, and sense of control. The consequences of a decreased sense of security are harmful to patients and nurses should know that they can intervene in ways that both increase interpersonal trust and sense of security.

'Development and psychometric evaluation of the safety feeling scale in adult patients at hospital: Exploratory sequential mixed method'

AIM AND OBJECTIVES

This study aimed to develop and examine psychometric properties of the safety feeling scale (SFS) in adult patients to assess their sense of safety during a hospital stay.

DESIGN

Mixed methods design. A SQUIRE checklist was used.

METHODS

This is a study with two phases of scale development and evaluation of the psychometric properties of the scale. In the first phase, the concept of 'safety feeling' was analysed using a hybrid model. Thus, a systematic review and then a qualitative study with hospitalized patients (n = 31) were conducted by conventional content analysis. In the psychometric phase, factorial validity, reliability, feasibility, and responsiveness of the scale were evaluated by different tests in various samples.

RESULTS

After integrating the results of the systematic review and qualitative study, a scale item pool with 84 items was developed. In the psychometric phase, 12 items with four factors were specified; 'effective care,' 'confidence in the healthcare team,' 'emotional enrichment' and 'hygienic facilities,' explaining 51% of the total variance of the scale. They were confirmed by confirmatory factor analysis. Internal consistency and stability of the scale were satisfactory. Feasibility and responsiveness were also acceptable.

How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory

BACKGROUND

Efforts to involve patients in patient safety continue to revolve around professionally derived notions of minimising clinical risk, yet evidence suggests that patients hold perspectives on patient safety that are distinct from clinicians and academics. This study aims to understand how hospital inpatients across three different specialties conceptualise patient safety and develop a conceptual model that reflects their perspectives.

METHODS

A qualitative semi-structured interview study was conducted with 24 inpatients across three clinical specialties (medicine for the elderly, elective surgery and maternity) at a large central London teaching hospital. An abbreviated form of constructivist grounded theory was employed to analyse interview transcripts. Constant comparative analysis and memo-writing using the clustering technique were used to develop a model of how patients conceptualise patient safety.

RESULTS

While some patients described patient safety using terms consistent with clinical/academic definitions, patients predominantly conceptualised patient safety in the context of what made them 'feel safe'. Patients' feelings of safety arose from a range of care experiences involving specific actors: hospital staff, the patient, their friends/family/carers, and the healthcare organisation. Four types of experiences contributed to how patients conceptualise safety: actions observed by patients; actions received by patients; actions performed by patients themselves; and shared actions involving patients and other actors in their care.

CONCLUSIONS

Our findings support the need for a patient safety paradigm that is meaningful to all stakeholders, incorporating what matters to patients to feel safe in hospital. Additional work should explore and test how the proposed conceptual model can be practically applied and implemented to incorporate the patient conceptualisation of patient safety into everyday clinical practice.

Person-centered climate from the perspective of hemodialysis patients and nurses working in hemodialysis units

Background

Person-centered care (PCC) is considered an important component of high-quality care in hemodialysis units. Hemodialysis patients and nurses may have different perceptions of person-centeredness in hemodialysis units. The present study aimed to assess the PCC from the perspective of hemodialysis patients and nurses working in the hemodialysis unit.

Methods

This cross-sectional study was performed on 200 patients and 71 nurses working in two hemodialysis units. Data were collected using a demographic questionnaire, person-centered climate questionnaire-patient version (PCQ-P), and person-centered climate questionnaire-staff version (PCQ-S). Data were analyzed by SPSS software (ver. 24) using ANOVA and independent t-tests.

Results

The mean score of person-centered climate from the patients' view was 81.49 ± 7.14 (Possible score: 17–102). Independent t-test showed that the mean total score of PCQ-P in patients undergoing hemodialysis in the Imam Reza Hospital (82.26 ± 7.09) was more than those undergoing hemodialysis in the Sina Hospital (78.60 ± 6.61) (P < 0.05). The mean score of the safety subscale showed a statistically significant difference between the two hemodialysis centers (P < 0.05). The mean total score of PCQ-S from the nurses' view was 66.86 ± 8.07 out of 84. The mean score of the everydayness subscale showed a statistically significant difference between nurses working in two hemodialysis units (P < 0.05).

Conclusion

Although the results showed an acceptable score in the person-centered climate questioner, it needs some improvements in the fields of safety and everydayness. The environment of the hemodialysis unit could limit or enhance the implementation of person-centered processes.

A qualitative exploration of cultural safety in nursing from the perspectives of Advanced Practice Nurses: meaning, barriers, and prospects

BACKGROUND

Cultural safety requires healthcare professionals and organisations to improve healthcare, facilitate patient access to healthcare, and achieve equity within the workforce.

METHODS

This ethnomethodological study, which consisted of two phases, explored the concept of cultural safety from the perspective of Advanced Practice Nurses. Semi-structured interviews and the nominal group technique were used to prioritise challenges related to cultural safety, identify barriers to clinical practise and assess educational needs. The data collected was subjected to thematic analysis.

RESULTS

Nurses working in Austria, Germany and Switzerland were recruited (N = 29). Accordingly, the phenomenon of cultural safety in health care is not generally known and there is little prior knowledge about it. The most frequently discussed themes were communication difficulties, lack of knowledge, the treatment of people with insufficient language skills and expectations of treatment goals and outcomes, which can lead to conflicts and accusations of unequal treatment due to diverse cultural backgrounds.

CONCLUSION

Diverse cultures are encountered in German-speaking healthcare settings. Cultural safety is also about healthcare staff, as nurses with different socialisations encounter prejudice, discrimination and racism. Although the issue of power was not discussed, academic nurses were willing to make an effort to change. Only a minority were aware that lasting change requires challenging one's own cultural structures and adapted behaviours, rather than pushing for the mere acquisition of cultural competence. Organisations were encouraged to introduce self-reflection sessions and provide better access to translation services to improve equity and support nurses.

Feeling safe or unsafe in prehospital emergency care: A qualitative study of the experiences of patients, carers and healthcare professionals

AIMS AND OBJECTIVES

To determine the feelings of safety among patients taken to hospital after requesting urgent care, based on their experiences and those of their carers and prehospital emergency care professionals.

BACKGROUND

Little research has been performed into the perception of safety in prehospital emergency care settings worldwide, from either the perspective of the patients or from that of healthcare professionals.

DESIGN

Exploratory qualitative study using focus groups in Spain.

METHODS

The participants were patients that requested care through the emergency telephone service, their carers and the professionals of the emergency care teams. The structured sampling design was based on an intentional, nonprobability selection following pragmatic criteria. Seven groups of patients/carers and two groups of professionals were formed (65 participants). The recordings were fully transcribed before their validation and codes were assigned to ensure anonymity. The ATLAS.ti software was used for the analysis. The authors took into account the COREQ checklist for qualitative studies.

FINDINGS

Neither group provided a clear definition of the meaning of feeling safe. It appeared easier to give examples that had a positive or negative influence on their perception of feeling safe. During the analysis of the discourse, six categories were detected after grouping the related codes.

CONCLUSIONS

For most of the patients' feeling of being safe or very safe arose from the perception of calmness, trust and protection. Defining the perception of safety was not easy. The factors with the greatest effect on feeling safe were related to Information and communication, Person-centred care and Professional competency, without losing sight of other factors such as Accessibility and response times of the emergency teams, Equipment and Healthcare setting.

RELEVANCE TO CLINICAL PRACTICE

The findings could be used as a knowledge base in future research and for implementing procedures for improving perceptions of safety among patients.

On the violation of hospitalized patients' rights: A qualitative study

BACKGROUND:

Nurses have always been known as an advocate for the rights of patients. The recognition of what is perceived as the violation of patients' rights can help nurses to understand patients' concerns and priorities. Thus, it helps nurses play their supportive roles more effectively.

OBJECTIVE:

The aim of this study was to explore different dimensions of the violation of patients' rights.

RESEARCH DESIGN:

Data were collected utilizing unstructured interviews and field notes. Data analysis was conducted using the qualitative content analysis approach. Prolonged engagement, maximum variation sampling, and member check were among the factors which enriched the research.

PARTICIPANTS AND RESEARCH CONTEXT:

The sample consisted of 18 patients and 11 members of their families. They were purposively selected from two hospitals in Tehran during 2009-2012.

ETHICAL CONSIDERATIONS:

The research was approved by the Ethics Committee of the university and hospitals.

FINDING:

The patients' rights were violated in a variety of ways. There were three main dimensions to this issue: (a) care recession including deprivation of the caregiver's presence and the delay/lack of needed responses; (b) receiving mechanical care including superficiality, lack of emotion, and failure to understand the situation; and (c) being disrespected including humility and aggression.

CONCLUSION:

The patients and their families consider any shortcomings in relation to the patient and the quality of care as the violation of the rights. The findings of the study imply sensitizing managers toward providing appropriate conditions as well as educating nurses to observe patients' rights. It is suggested that the processes leading to the violation of patients' rights be discovered and prevented in the future.

'I need complete trust in nurses' - home mechanical ventilated patients' perceptions of safety

BACKGROUND

Although home care has advanced over the last few decades, little research on patient safety has been carried out in this setting. Furthermore, it is unclear how patients perceive their situation and safety. The insiders' views might be especially relevant for technology-dependent individuals, such as users of home mechanical ventilation (HMV).

AIM

The aim of this study was to examine how HMV patients perceive their situation and what makes them feel safe or unsafe.

DESIGN

Explorative qualitative study.

METHODS

Data were collected in two regions in Germany between April and December 2014 by means of semi-structured interviews with 21 HMV patients. Thematic analysis was used to analyse data.

FINDINGS

Three themes emerged: the meaning of an interpersonal relationship between the nurse and HMV patient is expressed in the theme Being familiar - Having trust. The importance of the attentiveness of nurses for the patients' feeling of safety is described in the theme Being able to communicate - Being noticed. The theme Experiencing continuity - Feeling presence points to the organisational dimension of HMV care provision.

CONCLUSIONS

The interpersonal nurse-patient relationship plays a key role in promoting HMV patients' feeling of safety. Thus, HMV patients have a relational approach to safety. In order to enhance the patients' feeling of safety, nurses should strive to develop a trusting relationship with patients and demonstrate their presence and attentiveness. Regarding the provision of care, competent and continuous care should be made a priority.

Patients' perceptions of the meaning of good care in surgical care: a grounded theory study

Background

Patients in surgical care have reported a fear of being discharged prior to sufficient recovery and a lack of control of their situation. Establishing the patient-nurse relationship is essential in the context of the care. The Swedish National Board of Health and Welfare has established indicators for good care for comparison, evaluation and improvement of the quality of the health care system. These indicators are knowledge-based, appropriate, safe, effective and equal health care, as well as care within a reasonable time and patient-centred care. Current core competence in nursing education include quality improvement, patient-centred care, teamwork and collaboration, using evidence-based practice, safety and informatics. This study investigates patients’ perceptions of the meaning of good care in inpatient surgical care.

Methods

Grounded theory according to Charmaz was chosen as the study design. Interviews were conducted with 13 patients from six surgical wards in the south of Sweden in 2014–2015.

Results

The results showed that patients in surgical care perceived good care as being safe, as they were vulnerable and anxious. This could be achieved through accessible care, reliable care, caring attitudes and participating in one’s own care. Patient participation was achieved by information and education and the possibility to affect their care.

Conclusion

Patients need safety to experience good care. Caring attitudes and patient participation can be attained through patient-centred care. Bedside handover can improve patients’ perceptions of accessible care and reliable care and can increase patient participation. Continuously maintaining competence and using evidence-based practice are needed to achieve reliable care.

A grounded theory of humanistic nursing in acute care work environments

Background:

Humanistic nursing practice which is dominated by technological advancement, outcome measurement, reduced resources, and staff shortages is challenging in the present work environment.

Objective:

To examine the main concern in humanistic nursing area and how the way it is solved and resolved by Iranian nurses in acute care setting.

Research design:

Data were collected from interviews and observations in 2009–2011 and analyzed using classic grounded theory. Memos were written during the analysis, and they were sorted once theoretical saturation occurred.

Participants and research context:

In total, 22 nurses, 18 patients, and 12 families from two teaching hospitals in Tehran were selected by purposeful and theoretical sampling.

Ethical considerations:

The research was approved by the Ethics Committee of the university and hospitals.

Results:

The main concern for the nurses is the violation of their rights. They overcome this concern when there is a synergy of situation–education/learning, that is, a positive interaction between education and learning of values and sensitivity of the situation or existence of care promotion elements. They turn to professional values and seeking and meeting others’ needs, resulting in “success and accomplishment” of nurse/nursing manager and patient/family.

Conclusion:

This theory shows that professional values, elements of care promotion, and sensitivity of the situation have a key role in activation of humanistic approach in nursing. Violation of the nurses’ professional rights often leads to a decrease in care, but these factors make the nurses practice in an unsparing response approach. It is necessary to focus on development of professional values and provide essential elements of care promotion as changeable factors for realization of humanistic nursing although there is a context in which the nurses’ rights are violated.

Psychometric properties of the Persian version of the Critical Care Family Needs Inventory

BACKGROUND

Life-threatening illnesses and subsequent hospitalization in the intensive care unit (ICU) often occur unexpectedly. In many cases, this event is devastating for families and may lead to emotional stress, anxiety, and fear. To offer comprehensive and high-quality nursing care, critical care nurses not only provide critical care to patients but also attend to the psychological and social needs of patients and their families.

PURPOSE

The purpose of this study was to assess the psychometric properties of the Persian version of the Critical Care Family Needs Inventory (CCFNI-P).

METHODS

This was a cross-sectional methodological research study. Forward-backward translation was used to develop the instrument. The first version was pretested with 10 families to assess face validity. The main sample consisted of 720 family members of hospitalized patients, composed of 360 admitted to ICUs and 360 admitted to general wards of hospitals in Tehran, Iran. Participants were selected randomly to evaluate the instrument in terms of known-groups, construct, and convergent validities. The internal consistency of the translated instrument was assessed using Cronbach's alpha coefficient.

RESULTS

A significant difference was found between the scores of participants with patients in ICUs and participants with patients in the general wards (p < .001). In agreement with the original instrument, five distinct components were extracted from the CCFNI-P, which accounted for more than 52% of the total variance. The correlation between the total score for the instrument and the State-Trait Anxiety Inventory criterion was positive and significant (r = .23, p < .04). The Cronbach's alpha coefficient for the entire instrument was .89 and more than .70 for all dimensions.

CONCLUSIONS

This study confirmed the validity of the CCFNI-P in terms of face, construct, convergent, and known groups and showed acceptable internal consistency. The CCFNI-P is valid for investigating the needs of Iranians who have a family member hospitalized in an ICU.

Ethical issues in patient safety

The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in ‘the ethical imperative’ of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers’ decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.

Psychiatric nursing as 'different' care: experience of Iranian mental health nurses in inpatient psychiatric wards

Patients with mental illness require unique and specific care. The purpose of this study was to explore the experiences of nurses, who provide such care for mentally ill people, within the context of Iranian culture. This hermeneutic phenomenological study was carried out in a university-affiliated hospital in an urban area of Iran. We interviewed 10 mental health nurses to capture in detail their experiences in psychiatric units, and the approach developed by Diekelmann et al. was employed to analyse the data. Four themes and five sub-themes were identified: 'being engaged with patients' (sub-themes: 'struggle for monitor/control', 'safety/security concerns', 'supporting physiological and emotional needs'), 'being competent', 'altruistic care' and 'facing difficulties and challenges' (sub-themes: 'socio-cultural' and 'organizational challenges'). The results provide valuable insights and greater understanding of the professional experiences of psychiatric nurses in Iran, and indicate the need for a stable and responsible organizational structure for those nurses who are expected to manage patient care in psychiatric wards.

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.