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Pereira SCDA, Ribeiro OMPL, Fassarella CS, Santos EJF. The impact of nursing practice environments on patient safety culture in primary health care: a scoping review. BJGP Open 2024; 8:BJGPO.2023.0062. [PMID: 37604581 PMCID: PMC11169981 DOI: 10.3399/bjgpo.2023.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/27/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Patient safety has in recent decades become a global concern. It is a key priority area of healthcare organisations, and has a direct impact on patient health and wellbeing. Work environments can strongly impact nurses' wellbeing and may ultimately produce different outcomes for both professionals and patients. The adverse events occurrence is an example of how work environments influence outcomes, and there is evidence of this correlation in several studies conducted in recent years. AIM To map the knowledge regarding the impact that nursing practice environments have on safety culture in primary healthcare settings, as primary health care concentrates a significant portion of the population's care. DESIGN & SETTING This review was conducted following the methodology proposed by the Joanna Briggs Institute (JBI) for scoping reviews. METHOD Study selection, data extraction, and synthesis were performed by two independent reviewers. Based on Population (or participants), Concept, and Context (PCC) framework, studies were considered that addressed nurses' practice environment and patient safety culture in primary health care. All studies published or unpublished from 2002 to the present were considered. RESULTS Seven studies were included in this review; however, the existing evidence on the relation between nurses' practice environments and patient safety is still limited in primary healthcare settings. Although clear evidence was not found, several characteristics of nursing practice environments that may impact healthcare safety were found, such as leadership, communication, and organisational culture and policies. CONCLUSION More research directed at primary healthcare nursing practice settings is needed and could be valuable in defining and implementing strategies that promote the safety of care.
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Affiliation(s)
- Soraia Cristina de Abreu Pereira
- PhD student of Nursing Science at Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal, Invited Adjunct Professor at Red Cross Northern School of Health and CINTESIS@RISE, Porto University, Porto, Portugal
| | | | - Cíntia Silva Fassarella
- Adjunct Coordinator and Permanent Professor of the Graduate Program in Nursing, Adjunct Professor at the Faculty of Nursing of the State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo José Ferreira Santos
- Adjunct Professor at Polytechnic University of Viseu, School of Health; Health Sciences Research Unit: Nursing (UICISA: E) and Portugal Centre for Evidence Based Practice (PCEBP): a JBI Centre of Excellence, Coimbra, Portugal
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Hu S, Chen W, Hu H, Huang W, Chen J, Hu J. Coaching to develop leadership for healthcare managers: a mixed-method systematic review protocol. Syst Rev 2022; 11:67. [PMID: 35418168 PMCID: PMC9008960 DOI: 10.1186/s13643-022-01946-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/02/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND An increasing number of interventions have focused on leadership development for healthcare managers, among which coaching is a common strategy. The purpose of the present systematic review is to synthesize evidence on the effect of coaching in developing leadership of healthcare managers. METHODS AND ANALYSIS A literature search will be conducted in six English databases (MEDLINE (Ovid), CINAHL, Embase, Cochrane library, Nursing & Allied Health Premium, and Scopus) and four Chinese databases (Wanfang, CNKI, SinoMed, and VIP) from inception to April 1st, 2022. The titles, abstracts, and full texts of the studies will be screened by two independent researchers to determine their eligibility. The RoB 2, ROBINS-I, CASP, and MMAT will be applied to assess the quality of randomized trials, non-randomized studies, qualitative studies, and mixed-method studies, respectively. We will then extract the study characteristics, participant characteristics, and study outcomes of the reviewed papers. The Aims, Ingredients, Mechanism, and Delivery framework will be used to extract the components of coaching strategies. For quantitative data, a meta-analysis will be performed if sufficient data are available; otherwise, we will conduct a narrative synthesis. Thematic synthesis methods will be used for qualitative data analysis. DISCUSSION By conducting this systematic review, we expect to synthesize evidence regarding the components of coaching for leadership development among healthcare managers; the influence of coaching on leadership development among managers at the individual, unit-wide, or organizational level; and how managers view coaching as a leadership development strategy. TRIAL REGISTRATION PROSPERO registration number: CRD42020194290 .
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Affiliation(s)
- Shuang Hu
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Nursing, Changsha Medical University, Changsha, China
| | - Wenjun Chen
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario Canada
- Centre for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario Canada
| | | | - Wenqiu Huang
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario Canada
- Centre for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario Canada
| | - Jia Chen
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, 907 Floyd Ave, Richmond, 23284 USA
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Kim BB, Yu S. Effects of Just Culture and Empowerment on Patient Safety Activities of Hospital Nurses. Healthcare (Basel) 2021; 9:1324. [PMID: 34683004 PMCID: PMC8544452 DOI: 10.3390/healthcare9101324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
This study investigated the relationship among hospital nurses' perceptions of a just culture, empowerment, and patient safety activities. It also determined the factors affecting the patient safety activities of nurses. This cross-sectional study included 189 nurses from four hospitals in South Korea. The survey was conducted from October to December 2019 using self-report questionnaires including items on socio-demographic characteristics, just culture, empowerment, and patient safety activities. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression analysis with SPSS/WIN 25.0. Patient safety activities correlated positively with just culture (r = 0.369, p < 0.000) and empowerment (r = 0.38, p < 0.000). Additionally, empowerment (β = 0.213, p = 0.001) and just culture (β = 0.442, p < 0.000) had statistically significant effects on patient safety activities and explained about 19.5% of the variance in patient safety activities (F = 16.170, p < 0.001). The patient safety at medical institutions can be improved by cultivating a work environment that embraces a just culture and empowers nurses.
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Affiliation(s)
- Bo Bae Kim
- Bundang CHA Women’s Hospital, Seongnam 13497, Korea;
| | - Soyoung Yu
- College of Nursing, CHA University, Pocheon 11160, Korea
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Evaluation of two strategies to implement physical cancer rehabilitation guidelines for survivors of abdominopelvic cavity tumors: a controlled before-and-after study. J Cancer Surviv 2021; 16:497-513. [PMID: 34519980 PMCID: PMC9142440 DOI: 10.1007/s11764-021-01045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/16/2021] [Indexed: 11/05/2022]
Abstract
Purpose This study evaluates the effectiveness and feasibility of two strategies to implement physical cancer rehabilitation (PCR) guidelines for patients who have survived abdominopelvic cavity malignancies. Methods We tested and compared two tailored strategies to implement PCR guidelines for survivors of gastrointestinal, female organ and urogenital organ malignancies, in a clustered controlled before-and-after study. A patient-directed (PD) strategy was tested in five cancer centers, aiming to empower survivors. A multifaceted (MF) strategy was tested in four cancer centers, aiming additionally to influence healthcare professionals and the healthcare organization. Data were collected from existing registration systems, patient questionnaires and professional questionnaires. We measured both implementation- and client outcomes. For insight into the effectiveness we measured indicators related to PCR guidelines: (1) screening with the Distress Thermometer (DT) (=primary outcome measure), (2) information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), (3) advice to take part in PA and PCRPs, (4) referral to PCRPs, (5) participation in PCRPs, (6) PA uptake (PAU); and patient reported outcomes (PROs) such as (7) quality of life, (8) fatigue, and (9) empowerment. Furthermore, survivor and center determinants were assessed as possible confounders. Multilevel analyses were performed to compare the scores of the indicators of the PD and MF strategies, as well as the differences between the characteristics of these groups. The use of and experiences with both strategies were measured using questionnaires and Google Analytics to assess feasibility. Results In total, 1326 survivors participated in the study, 673 in the before- and 653 in the after-measurement. Regarding our primary outcome measure, we found a significant improvement of screening with the DT between the before- and after-measurement for both strategies, respectively from 34.2 to 43.1% (delta=8.9%; odds ratio (OR)=1.6706; p=0.0072) for the PD strategy and from 41.5 to 56.1% (delta=14.6%; OR=1.7098; p=0.0028) for the MF strategy. For both the primary and secondary outcomes, no statistically significant effect of the MF strategy compared to the PD strategy was observed. We found good use of and positive experiences with both strategies. Conclusion Implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT for survivors of abdominopelvic cavity malignancies. Further research is needed to assess the additional effectiveness of strategies that stimulate compliance among healthcare professionals and healthcare organizations. Implications for Cancer Survivors Using implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT and might improve the quality of care of patients who have survived abdominopelvic cavity malignancies. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01045-3.
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Krishnasamy K, Tan MP, Zakaria MI. Interdisciplinary differences in patient safety culture within a teaching hospital in Southeast Asia. Int J Clin Pract 2021; 75:e14333. [PMID: 33969596 DOI: 10.1111/ijcp.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/17/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. The healthcare providers perception and their role are utmost important in delivering quality care and patient safety. This study aimed to determine the interdisciplinary differences in patient safety culture in a tertiary university hospital. METHOD A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement scores of 60% was considered satisfactory. Comparisons were made between doctors, nurses, allied health professionals, nursing assistants and support staff. RESULTS Of 6562 respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range = 31.1 to 84.7%), with job satisfaction (72.3% ± 21.9%) and stress recognition (58.3 ± 25.6%) representing the highest and lowest mean domain scores, respectively. Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety climate, job satisfaction and working conditions compared to nurses. CONCLUSIONS The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.
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Affiliation(s)
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre for Innovations in Medicine Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Mohd Idzwan Zakaria
- Department of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Valle RBLRD, Balsanelli AP, Taminato M, Saconato H, Gasparino R. The relationship between the authentic leadership of nurses and structural empowerment: a systematic review. Rev Esc Enferm USP 2021; 55:e03667. [PMID: 33886899 DOI: 10.1590/s1980-220x2019029003667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To verify the relationship between authentic leadership of nurses and structural empowerment. METHOD This is a systematic review carried out at the Virtual Health Library on the Journal Portal of the Coordination for the Improvement of Higher Education Personnel, Online System for the Search and Analysis of Medical Literature, Scientific Electronic Library Online and Science Direct/Embase, and consulted until April 2019. Studies with nurses, evidencing the relationship between authentic leadership and structural empowerment, published between 2012 and 2018 in Brazilian Portuguese, English or Spanish were included. RESULTS Five studies were included, with variables other than structural empowerment: job satisfaction, burnout, bulling, mental health, performance, social capital, working environment, nurse retention, and quality of care. Authentic leadership showed a positive relationship with structural empowerment, improving engagement and job satisfaction, reducing burnout and increasing quality of care. CONCLUSION Health institutions, in addition to Canada, where researchers on this topic are located, can invest in authentic leadership to improve structural empowerment by providing greater commitment from nurses, increased job satisfaction and quality of care provided.
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Affiliation(s)
| | | | - Mônica Taminato
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
| | - Humberto Saconato
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Renata Gasparino
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Campinas, SP, Brazil
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Aouicha W, Tlili MA, Sahli J, Dhiab MB, Chelbi S, Mtiraoui A, Latiri HS, Ajmi T, Zedini C, Ben Rejeb M, Mallouli M. Exploring patient safety culture in emergency departments: A Tunisian perspective. Int Emerg Nurs 2020; 54:100941. [PMID: 33341462 DOI: 10.1016/j.ienj.2020.100941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 09/17/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Emergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors. METHODS A cross-sectional study conducted among professionals from all the EDs of public and private healthcare institutions in Tunisia. It spread from June to September 2017. We used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire. RESULTS In total, 11 EDs were included in the study, with 442 participants and a participation rate of 80.35%. All the ten dimensions of patient safety culture were in need of improvement. 'Teamwork within units' scored the highest with 46%, however, the lowest score was attributed to 'the frequency of adverse events reporting' (19.6%). Several factors have been found significantly related to safety culture. Private EDs have shown significantly higher scores regarding nine patient safety culture dimensions. CONCLUSION This study showed a concerning perception held by participants about the lack of a patient safety culture in their EDs. Also, it provided baseline results giving a clearer vision of the aspects of safety that need improvement.
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Affiliation(s)
- Wiem Aouicha
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia.
| | - Mohamed Ayoub Tlili
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia.
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Mohamed Ben Dhiab
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Houyem Said Latiri
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Sahloul University Hospital, Department of Prevention and Care Safety, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Sahloul University Hospital, Department of Prevention and Care Safety, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
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Abstract
This article draws attention to the nature and importance of public policy. It argues that if nurses are to influence the quality of healthcare effectively, they must be engaged with policymakers to get nursing care issues on the policy agenda. There is an ethical imperative to do so, driven by the advocacy role of the nurse and rooted in the values base of nursing. In addition, it is argued that if one takes the role of patient advocacy seriously, as core to the nursing role, two things are required of nurses: We must (a) broaden the conceptualisation of patient advocacy beyond the individual patient to the system of healthcare resourcing and provision and (b) see systemic change as important as change at the bedside.
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Affiliation(s)
| | - P Anne Scott
- 8799National University of Ireland Galway, Ireland
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9
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Abstract
Informal leaders in nursing, medical specialties, and administration positively impact the success of an institution. Developing all members of the team as leader then becomes important, especially in the area of nursing. The result is less need for management and control and more individual self-motivated participation in quality improvement.
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Affiliation(s)
| | - James W Fleshman
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
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Fix GM, Reisinger HS, Etchin A, McDannold S, Eagan A, Findley K, Gifford AL, Gupta K, McInnes DK. Health care workers' perceptions and reported use of respiratory protective equipment: A qualitative analysis. Am J Infect Control 2019; 47:1162-1166. [PMID: 31182235 PMCID: PMC7115305 DOI: 10.1016/j.ajic.2019.04.174] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about health care workers' (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying inappropriate use. METHODS We conducted 12 focus groups with nurses and nursing assistants at 4 medical centers. We analyzed the thematic content of 73 discrete "stories" told by focus group participants. RESULTS We identified 5 story types surrounding RPE use: 1) policies are known and seen during work routines; 2) during protocol lapses, use is reinforced through social norms; 3) clinical experiences sometimes supersede protocol adherence; 4) when risk perception is high, we found concern regarding accessing RPE; and 5) HCWs in emergency departments were viewed as not following protocol because risk was ever-present. DISCUSSION HCWs were aware of the importance of RPE and protocols for using it, and these supported use when protocol lapses occurred. However, protocol adherence was undermined by clinical experience, perceived risk, and the distinct context of the emergency department where patients continually arrive with incomplete or delayed diagnoses. CONCLUSIONS Protocols, visual cues, and social norms contribute to a culture of safety. This culture can be undermined when HCWs experience diagnostic uncertainty or they mistrust the protocol and instead rely on their clinical experiences.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Boston University School of Public Health, Boston, MA.
| | - Heather Schacht Reisinger
- Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - Anna Etchin
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA
| | - Sarah McDannold
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA
| | - Aaron Eagan
- VHA Office of Public Health, National Center for Occupational Health and Infection Control, Gainesville, FL
| | - Kimberly Findley
- VHA Office of Public Health, National Center for Occupational Health and Infection Control, Gainesville, FL
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA; Boston University School of Public Health, Boston, MA
| | - Kalpana Gupta
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA; Boston University School of Public Health, Boston, MA
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Abuosi AA, Akologo A, Anaba EA. Determinants of patient safety culture among healthcare providers in the Upper East Region of Ghana. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519876756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Aaron A Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | - Alexander Akologo
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | - Emmanuel A Anaba
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
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12
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Akologo A, Abuosi AA, Anaba EA. A cross-sectional survey on patient safety culture among healthcare providers in the Upper East region of Ghana. PLoS One 2019; 14:e0221208. [PMID: 31430303 PMCID: PMC6701748 DOI: 10.1371/journal.pone.0221208] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/01/2019] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Adverse events pose a serious threat to quality patient care. Promoting a culture of safety is essential for reducing adverse events. This study aims to assess healthcare providers' perceptions of patient safety culture in three selected hospitals in the Upper East region of Ghana. METHODS The English version of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was administered to 406 clinical staff. Statistical Package for Social Science (SPSS) software, version 23, was used to analyze the data. The results were presented using descriptive statistics, Pearson Correlation Analysis and One-way Analysis of Variance (ANOVA). RESULTS It was found that two out of twelve patient safety culture dimensions recorded high positive response rates (≥ 70%). These include teamwork within units (81.5%) and organizational learning (73.1%). Three patient safety culture dimensions (i.e. staffing, non-punitive response to error and frequency of events reported) recorded low positive response rates (≤ 50%). The overall perception of patient safety correlated significantly with all patient safety culture dimensions, except staffing. There was no statistically significant difference in the overall perception of patient safety among the three hospitals. CONCLUSION Generally, healthcare providers in this study perceived patient safety culture in their units as quite good. Some of the respondents perceived punitive response to errors. Going forward, healthcare policy-makers and managers should make patient safety culture a top priority. The managers should consider creating a 'blame-free' environment to promote adverse event reporting in the hospitals.
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Affiliation(s)
- Alexander Akologo
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
| | - Emmanuel Anongeba Anaba
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Heldal F, Kongsvik T, Håland E. Advancing the status of nursing: reconstructing professional nursing identity through patient safety work. BMC Health Serv Res 2019; 19:418. [PMID: 31234881 PMCID: PMC6591911 DOI: 10.1186/s12913-019-4222-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background Recent decades have seen increased attention to patient safety in health care. This is often in the form of programmes aiming to change professional behaviours. Health professionals in hospitals have traditionally resented such initiatives because patient safety programmes often take a managerialist form that may be interpreted as a challenge to professional identity. Research, however, has mostly paid attention to the role of physicians. This study aims to highlight how such programmes may affect professional nursing identity. Methods We qualitatively investigated the implementation of a patient safety programme in Norway, paying attention to changes in nurses’ practices and values. Based on purposive sampling, two group interviews, four individual interviews and five hours of observational studies were conducted in a hospital department, involving ten nurses and three informants from the hospital management. Interviews were conducted in offices at the hospital, and observations were performed in situ. All the interviews lasted from one to one and a half hours, and were recorded and transcribed ad verbatim. Data was analysed according to ad-hoc meaning generation. Results The following analytical categories were developed: reconstructing trust, reconstructing work, reconstructing values and reconstructing professional status. The patient safety programme involved a shift in patient safety-related decisions, from being based on professional judgement to being more system based. Some of the patient safety work that previously had been invisible and tacit became more visible. The patient safety programme involved activities that were more in accordance with the ‘cure’ discourse than traditional ‘care’ work within nursing. As a result, this implied a heightened perceived professional status among the nurses. The safety programme was – contrary to the ‘normal’ resistance against audit systems – well received because of the raised perceived professional status among the nurses. Conclusions Reconstructing trust, work, values and status, and even the profession itself, is being reconstructed through the work involved in implementing the procedures from the safety programme. Professional knowledge and identity are being challenged and changed, and what counts as good, professional nursing of high quality is being reconstructed. Electronic supplementary material The online version of this article (10.1186/s12913-019-4222-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frode Heldal
- NTNU Business School, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway.
| | - Trond Kongsvik
- Department of Industrial Economics, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway
| | - Erna Håland
- Department of Education and Lifelong Learning, NO-7491, Trondheim, Norway
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de Vasconcelos PF, de Freitas CHA, Jorge MSB, de Carvalho REF, de Sousa Freire VEC, de Araújo MFM, de Aguiar MIF, de Oliveira GYM, Bezerra Dos Anjos SJS, Oliveira ACS. Safety attributes in primary care: understanding the needs of patients, health professionals, and managers. Public Health 2019; 171:31-40. [PMID: 31082758 DOI: 10.1016/j.puhe.2019.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 03/15/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aims of this study were (1) to identify attributes for patient safety at a primary healthcare level and (2) to analyze conceptions of patients, professionals, and managers about how these attributes are being addressed. STUDY DESIGN This was a qualitative study. METHODS Participants were recruited from three primary care settings in Brazil. A total of 37 subjects (four physicians, three nurses, three dentists, three managers, five community assistants, and 19 patients) participated on interviews about their perceptions of safety attributes at the primary care settings involved in the study. Some of these participants attended a focus group meeting. A thematic categorical analysis was carried out to interpret the interviews. RESULTS The main attributes for patient safety were valued by the participants. However, barriers such as discontinuity of care, interruptions during consultations, breakdowns in the communication, and ineffective teamwork were reported as frequent sources of patient safety issues. Reports of patients left unattended for excessive time because of the lack of accurate information and disruptions that took up to 35 min show that there is still a long way to go for primary care to be safe and effective in the study settings. CONCLUSIONS It is necessary that the strategies meet the patient safety needs more effectively and efficiently. Further research is needed to understand the complex nature of the problems that affect patient safety in these settings so that appropriate decisions can be made.
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Affiliation(s)
- P F de Vasconcelos
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, Acarape, CE, Brazil.
| | - C H A de Freitas
- Nursing Department, Ceara State University, Fortaleza, CE, Brazil
| | - M S B Jorge
- Nursing Department, Ceara State University, Fortaleza, CE, Brazil
| | | | - V E C de Sousa Freire
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, Acarape, CE, Brazil
| | - M F M de Araújo
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, Acarape, CE, Brazil
| | - M I F de Aguiar
- Nursing Department, Federal University of Ceara, Fortaleza, CE, Brazil
| | | | | | - A C S Oliveira
- Nursing Department, Universidad Católica San Antonio de Murcia, Murcia, Spain
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Viken B, Solum EM, Lyberg A. Foreign educated nurses' work experiences and patient safety-A systematic review of qualitative studies. Nurs Open 2018; 5:455-468. [PMID: 30338091 PMCID: PMC6177550 DOI: 10.1002/nop2.146] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022] Open
Abstract
AIM The aim of this systematic review was to identify the evidence contributed by qualitative research studies of foreign educated nurses' work experiences in a new country and to link the results to patient safety competencies. DESIGN A systematic literature review of qualitative studies. METHODS Electronic searches in the Ovid MEDLINE, Embase, PsycINFO, Cochrane Library and Cinahl databases and additional manual searches in five scientific journals. A content analysis of 17 qualitative articles was conducted. RESULTS The analysis revealed one main theme: "Being an outsider at work" and two themes: "Cultural dissonance and Unfamiliar nursing practice. Two sub-themes emerged from the first theme; Loneliness and discrimination" and "Communication barriers". The second theme was based on the following two sub-themes: "Handling work-related stress" and "Role uncertainty and difficulties in decision-making". A better prepared and longer orientation period with continual clinical supervision including systematic reflection on practice experiences is needed to support foreign educated nurses in the transition period and strengthen their Patient Safety Competencies. Nurse Managers have an important role in ensuring the inclusion of foreign educated nurses and providing desirable working conditions.
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Affiliation(s)
- Berit Viken
- Centre for Women's, Family and Child HealthFaculty of Health and Social SciencesUniversity College of Southeast NorwayKongsbergNorway
| | - Eva Merethe Solum
- Centre for Women's, Family and Child HealthFaculty of Health and Social SciencesUniversity College of Southeast NorwayKongsbergNorway
| | - Anne Lyberg
- Centre for Women's, Family and Child HealthFaculty of Health and Social SciencesUniversity College of Southeast NorwayKongsbergNorway
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16
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Douglas Lawson T, Tecson KM, Shaver CN, Barnes SA, Kavli S. The impact of informal leader nurses on patient satisfaction. J Nurs Manag 2018; 27:103-108. [DOI: 10.1111/jonm.12653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kristen M. Tecson
- Baylor Heart and Vascular Institute; Dallas Texas
- Baylor Scott & White Research Institute; Dallas Texas
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17
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Fischer SA, Jones J, Verran JA. Consensus achievement of leadership, organisational and individual factors that influence safety climate: Implications for nursing management. J Nurs Manag 2017; 26:50-58. [PMID: 28940765 DOI: 10.1111/jonm.12519] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 11/26/2022]
Abstract
AIM To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects. BACKGROUND Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. METHODS A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys. RESULTS Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. CONCLUSIONS Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. IMPLICATIONS FOR NURSING MANAGEMENT Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety.
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Affiliation(s)
- Shelly A Fischer
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY, USA
| | | | - Joyce A Verran
- College of Nursing, University of Colorado, Aurora, CO, USA
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18
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An evaluation of a leadership development coaching and mentoring programme. Leadersh Health Serv (Bradf Engl) 2017; 30:309-329. [DOI: 10.1108/lhs-07-2016-0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper was to determine the value and impact of the Leadership Development – Coaching and Mentoring Programme at Counties Manukau Health and understand how the skills gained are applied.
Design/methodology/approach
Mixed-methods approach including surveys of programme participants and senior staff and semi-structured interviews with programme participants.
Findings
The survey response rate was 24.4 per cent for programme participants and 30 per cent for senior staff. Eight programme participants participated in semi-structured interviews. Of the 70 programme participants, 69 utilised their learning from the programme; 45 of 70 changed their approach to managing staff; and 40 of 68 programme participants reported that meeting with peers for triad group coaching was the most challenging aspect of the programme. Key themes identified through interviews included: working with others; not owning others’ problems; professional support and development; coaching and mentoring; future participants.
Practical implications
The majority of participants changed their leadership behaviours as a result of the programme, which has resulted in improved communication, a more supportive culture and distributed leadership. These changes contribute to better patient care.
Originality value
There is a paucity of evidence in the literature about the impact of coaching and mentoring programme on leadership development and how the skills gained in such programmes are applied in practice in a healthcare context. This evaluation helps to address that gap.
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19
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Affiliation(s)
- Martin Beirne
- Professor of management and organizational Behaviour, Adam Smith Business School, University of Glasgow, Scotland
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20
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Elsous A, Akbari Sari A, AlJeesh Y, Radwan M. Nursing perceptions of patient safety climate in the Gaza Strip, Palestine. Int Nurs Rev 2017; 64:446-454. [PMID: 28102544 DOI: 10.1111/inr.12351] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This study was undertaken to assess the perception of nurses about patient safety culture and to test whether it is significantly affected by the nurses' position, age, experience and working hours. BACKGROUND Patient safety has sparked the interest of healthcare mangers, yet there is limited knowledge about the current patient safety culture among nurses in the Gaza Strip. METHODS This was a descriptive cross-sectional study, administering the Arabic Safety Attitude Questionnaire (Short Form 2006) to 210 nurses in four public general hospitals. RESULTS Job Satisfaction was the most highly perceived factor affecting patient safety, followed by Perception of Management. Safety culture varied across nursing position, age, work experience and working hours. Nurse Managers had more positive attitudes towards patients than frontline clinicians did. The more experience nurses had, the better their attitudes towards patient safety. Nurses who worked the minimum weekly required hours and who were 35 years and older had better attitudes towards all patient safety dimensions except for Stress Recognition. Nurses with a positive attitude had better collaboration with healthcare professionals than those without a positive attitude. LIMITATION Generalization is limited, as nurses who worked in private and specialized hospitals were excluded. CONCLUSION Evaluation of the safety culture is the essential starting point to identify hindrances or drivers for safe patient care. Job Satisfaction, Perception of Management and Teamwork necessitate reinforcement, while Working Conditions, Stress Recognition and Safety Climate require improvement. IMPLICATIONS FOR NURSING AND HEALTH POLICY Ensuring job satisfaction through adequate staffing levels, providing incentives and maintaining a collegial environment require both strategic planning and institutional policies at the higher administrative level. Creation of a non-punitive and learning environment, promoting open communication and fostering continuous education should be fundamental aspects of hospital management. A policy of mixing experienced nurses with inexperienced nurses should be considered.
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Affiliation(s)
- A Elsous
- Department of Health Management and Economics, School of Public Health, International Campus - Tehran University of Medical Sciences, Tehran, Iran
| | - A Akbari Sari
- Department of Health Management and Economics, School of Public Health, International Campus - Tehran University of Medical Sciences, Tehran, Iran
| | - Y AlJeesh
- Faculty of Nursing, Islamic University of Gaza, Gaza Strip, Palestine
| | - M Radwan
- Department of Health Management and Economics, School of Public Health, International Campus - Tehran University of Medical Sciences, Tehran, Iran
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21
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Vaismoradi M, Griffiths P, Turunen H, Jordan S. Transformational leadership in nursing and medication safety education: a discussion paper. J Nurs Manag 2016; 24:970-980. [DOI: 10.1111/jonm.12387] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Pauline Griffiths
- College of Human and Health Sciences; Swansea University; Swansea UK
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio University Hospital; Kuopio Finland
| | - Sue Jordan
- College of Human and Health Sciences; Swansea University; Swansea UK
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22
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Kanerva A, Lammintakanen J, Kivinen T. Nursing Staff's Perceptions of Patient Safety in Psychiatric Inpatient Care. Perspect Psychiatr Care 2016; 52:25-31. [PMID: 25623953 DOI: 10.1111/ppc.12098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 10/02/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to explore nursing staff's perceptions of patient safety in psychiatric inpatient care. DESIGN AND METHODS Nurses were asked to describe their perceptions in semi-structured interviews, and their responses were analyzed by inductive content analysis. FINDINGS Nurses addressed two sets of factors: one related to the experiences of safety and the other related to the implementation of safe care. PRACTICE IMPLICATIONS The views of the nurses contribute to formalization of organizational policies and strategies. In particular, they highlight the importance of continual training for the staff and management, considering patients' views, and treating patients as collaborators in their care.
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Affiliation(s)
- Anne Kanerva
- Central Finland Health Care District, Jyväskylä, Finland
| | - Johanna Lammintakanen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Tuula Kivinen
- Central Finland Health Care District, Jyväskylä, Finland
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23
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IJsbrandy C, Ottevanger PB, Groen WG, Gerritsen WR, van Harten WH, Hermens RPMG. Study protocol: an evaluation of the effectiveness, experiences and costs of a patient-directed strategy compared with a multi-faceted strategy to implement physical cancer rehabilitation programmes for cancer survivors in a European healthcare system; a controlled before and after study. Implement Sci 2015; 10:128. [PMID: 26345182 PMCID: PMC4562188 DOI: 10.1186/s13012-015-0312-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/12/2015] [Indexed: 12/04/2022] Open
Abstract
Background The need for physical cancer rehabilitation programmes (PCRPs), addressing adverse effects from cancer, is growing. Implementing these programmes into daily practice is still a challenge. Since barriers for successful implementation often arise at different levels in healthcare, multi-faceted strategies focusing on multiple levels are likely more effective than single-faceted strategies. Nevertheless, most studies implementing PCRPs used strategies directed at patients only. The aim of this study is to develop and identify the most effective strategy to implement PCRPs into daily care. We want to assess the added value of a multi-faceted strategy compared with a single-faceted patient-directed strategy. Methods/design We will conduct a clustered controlled before and after study (CBA) in the Netherlands that compares two strategies to implement PCRPs. The patient-directed (PD) strategy (five hospitals) will focus on change at the patient level. The multi-faceted (MF) strategy (five hospitals) will focus on change at the patient, professional and organizational levels. Eligibility criteria are as follows: (A) patients: adults; preferably (history of) cancer in the gastro-intestinal, reproductive and/or urological system; successful primary treatment; and without recurrence/metastases. (B) Healthcare professionals: involved in cancer care. A stepwise approach will be followed:Step 1: Analysis of the current implementation of PCRPs and the examination of barriers and facilitators for implementation, via a qualitative study with patients (four focus groups n = 10–12) and their healthcare workers (four focus groups n = 10–12 and individual interviews n = 30–40) and collecting data on adherence to quality indicators (n = 500 patients, 50 per hospital). Step 2: Selection and development of interventions to create a PD and MF strategy during expert roundtable discussions, using the knowledge gained in step 1 and a literature search of the effect of strategies for implementing PCRPs. Step 3: Test and compare both strategies with a clustered CBA (effectiveness, process evaluation and costs), by data extraction from existing registration systems, questionnaires and interviews. For the effectiveness and cost-effectiveness, n = 500 patients, 50 per hospital. For the process evaluation, n = 50 patients, 5 per hospital, and n = 40 healthcare professionals, 4 per hospital. Main outcome measures: % screened patients, % referrals to PCRPs, incremental costs and incremental cost-effectiveness ratios (ICERs).
Trail registration NCT02205853 (ClinicalTrials.gov)
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Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Wim G Groen
- Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Wim H van Harten
- Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Health Technology and Services Research, MB-HTSR, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
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Saleh AM, Darawad MW, Al-Hussami M. The perception of hospital safety culture and selected outcomes among nurses: An exploratory study. Nurs Health Sci 2015; 17:339-46. [PMID: 26095303 DOI: 10.1111/nhs.12196] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/02/2014] [Accepted: 11/07/2014] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Ali M Saleh
- Faculty of Nursing, University of Jordan, Amman, Jordan
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25
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A Factorial Survey on Safety Behavior Providing Opportunities to Improve Safety. J Patient Saf 2015; 14:193-201. [PMID: 25906405 DOI: 10.1097/pts.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To realize safe, high-quality treatment, employees should behave according to patient safety standards. Periodic measurement of safety behavior could provide management-relevant information to adjust the implementation of interventions and maximize improvement. Therefore, we constructed a factorial survey measuring safety awareness and intentions for behavior. METHODS Cross-sectional results of the factorial survey were compared with results from the Hospital Survey on Patient Safety Culture, distributed in MAASTRO radiotherapy in 2010 to 2011. Respondents were presented 20 scenarios about incidents, randomly varying on work pressure, person causing incident, whether patient level was reached, severity of harm, notification by patient, and management support. After each scenario, questions were asked about safety awareness and behavior. χ and multilevel regression analyses were used. RESULTS Response rates were 64% (n = 54) for the culture survey and 62% (n = 52) for the factorial survey on intentions. The culture survey reflected positive opinions regarding nonpunitive response and incident reporting, in accordance with high scores (factorial survey) on safety awareness (9.0; scale, 1-10) and reporting intentions (8.7). Whether an incident reached the patient level predicted safety awareness and intentions for safety behavior (β = -1.3/-3.08) most strongly. Severity of harm showed minimal additional effects (β = -0.24/-0.42). CONCLUSIONS The factorial survey presented practical information on safety awareness and intentions for behavior. Therefore, it created additional opportunities for improving safety interventions. Because behavior is expected to change before values, one could hypothesize that factorial surveys would be more sensitive to change than culture surveys. Longitudinal research should further study the surveys' sensitivity to measure changes.
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26
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Ammouri A, Tailakh A, Muliira J, Geethakrishnan R, Al Kindi S. Patient safety culture among nurses. Int Nurs Rev 2014; 62:102-10. [DOI: 10.1111/inr.12159] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A.A. Ammouri
- College of Nursing; Hashemite University; Zarqa Jordan
| | - A.K. Tailakh
- School of Nursing; California State University; Los Angeles CA USA
| | - J.K. Muliira
- College of Nursing; Sultan Qaboos University; Al Khod Muscate Oman
| | | | - S.N. Al Kindi
- College of Nursing; Sultan Qaboos University; Al Khod Muscate Oman
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27
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Khater WA, Akhu-Zaheya LM, Al-Mahasneh SI, Khater R. Nurses' perceptions of patient safety culture in Jordanian hospitals. Int Nurs Rev 2014; 62:82-91. [PMID: 25439981 DOI: 10.1111/inr.12155] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients' safety culture is a key aspect in determining healthcare organizations' ability to address and reduce risks of patients. Nurses play a major role in patients' safety because they are accountable for direct and continuous patient care. There is little known information about patients' safety culture in Jordanian hospitals, particularly from the perspective of healthcare providers. AIM The study aimed to assess patient safety culture in Jordanian hospitals from nurses' perspective. METHODS A cross-sectional, descriptive design was utilized. A total number of 658 nurses participated in the current study. Data were collected using an Arabic version of the hospital survey of patients' safety culture. FINDINGS Teamwork within unit dimensions had a high positive response, and was perceived by nurses to be the only strong suit in Jordanian hospitals. Areas that required improvement, as perceived by nurses, are as follows: communication openness, staffing, handoff and transition, non-punitive responses to errors, and teamwork across units. Regression analysis revealed factors, from nurses' perspectives, that influenced patients' safety culture in Jordanian hospital. Factors included age, total years of experience, working in university hospitals, utilizing evidence-based practice and working in hospitals that consider patient safety to be a priority. LIMITATIONS Participants in this study were limited to nurses. Therefore, there is a need to assess patient safety culture from other healthcare providers' perspectives. Moreover, the use of a self-reported questionnaire introduced the social desirability biases. CONCLUSION The current study provides insight into how nurses perceive patient safety culture. Results of this study have revealed that there is a need to replace the traditional culture of shame/blame with a non-punitive culture. IMPLICATIONS FOR NURSING AND HEALTH POLICY Study results implied that improving patient safety culture requires a fundamental transformation of nurses' work environment. New policies to improve collaboration between units of hospitals would improve patients' safety.
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Affiliation(s)
- W A Khater
- Jordan University of Science and Technology, Irbid, Jordan
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28
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Ridelberg M, Roback K, Nilsen P. Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions. BMC Nurs 2014; 13:23. [PMID: 25132805 PMCID: PMC4134467 DOI: 10.1186/1472-6955-13-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/08/2014] [Indexed: 11/22/2022] Open
Abstract
Background Sweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, but solid evidence of effectiveness for many solutions is often lacking. Nurses play a vital role in patient safety, constituting 71% of the workforce in Swedish health care. This interview study aimed to explore perceived facilitators and barriers influencing patient safety among nurses involved in the direct provision of care. Considering the importance of nurses with regard to patient safety, this knowledge could facilitate the development and implementation of better solutions. Methods A qualitative study with semi-structured individual interviews was carried out. The study population consisted of 12 registered nurses at general hospitals in Sweden. Data were analyzed using qualitative content analysis. Results The nurses identified 22 factors that influenced patient safety within seven categories: ‘patient factors’, ‘individual staff factors’, ‘team factors’, ‘task and technology factors’, ‘work environment factors’, ‘organizational and management factors’, and ‘institutional context factors’. Twelve of the 22 factors functioned as both facilitators and barriers, six factors were perceived only as barriers, and four only as facilitators. There were no specific patterns showing that barriers or facilitators were more common in any category. Conclusion A broad range of factors are important for patient safety according to registered nurses working in general hospitals in Sweden. The nurses identified facilitators and barriers to improved patient safety at multiple system levels, indicating that complex multifaceted initiatives are required to address patient safety issues. This study encourages further research to achieve a more explicit understanding of the problems and solutions to patient safety.
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Affiliation(s)
- Mikaela Ridelberg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linkoping University, Linköping 581 83, Sweden
| | - Kerstin Roback
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linkoping University, Linköping 581 83, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linkoping University, Linköping 581 83, Sweden
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Wong CA, Giallonardo LM. Authentic leadership and nurse-assessed adverse patient outcomes. J Nurs Manag 2014; 21:740-52. [PMID: 23865927 DOI: 10.1111/jonm.12075] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/28/2022]
Abstract
AIM Our purpose was to test a model examining relationships among authentic leadership, nurses' trust in their manager, areas of work life and nurse-assessed adverse patient outcomes. BACKGROUND Although several work environment factors have been cited as critical to patient outcomes, studies linking nursing leadership styles with patient outcomes are limited suggesting the need for additional research to investigate the mechanisms by which leadership may influence patient outcomes. METHODS Secondary analysis of data collected in a cross-sectional survey of 280 (48% response rate) registered nurses working in acute care hospitals in Ontario was conducted using structural equation modelling. RESULTS The final model fit the data acceptably (χ(2) = 1.30, df = 2, P = 0.52, IFI = 0.99, CFI = 1.00, RMSEA = 0.00). Authentic leadership was significantly associated with decreased adverse patient outcomes through trust in the manager and areas of work life. CONCLUSIONS The findings suggest that nurses who see their managers as demonstrating high levels of authentic leadership report increased trust, greater congruence in the areas of work life and lower frequencies of adverse patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT Managers who emphasize transparency, balanced processing, self-awareness and high ethical standards in their interactions with nurses may contribute to safer work environments for patients and nurses.
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Affiliation(s)
- Carol A Wong
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Health Sciences Addition (HSA), The University of Western Ontario, London, ON, Canada.
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Löfgren S, Hedström M, Ekström W, Lindberg L, Flodin L, Ryd L. Power to the patient: care tracks and empowerment a recipe for improving rehabilitation for hip fracture patients. Scand J Caring Sci 2014; 29:462-9. [DOI: 10.1111/scs.12157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/19/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Susanne Löfgren
- Department of Learning, Informatics, Management and Ethics (LIME); Medical Management Center; Karolinska Institutet; Stockholm Sweden
| | - Margareta Hedström
- Division of Orthopaedics and Biotechnology; Department of Clinical Science, Intervention and Technology (CLINTEC); Karolinska Institutet; Stockholm Sweden
| | - Wilhelmina Ekström
- Division of Orthopedics and Technology; Department of Molecular Medicine and Surgery; Section of Orthopaedics and Sports Medicine; Karolinska Institutet; Stockholm Sweden
| | - Lene Lindberg
- Department of Public Health Science; Karolinska Institutet; Stockholm Sweden
| | - Lena Flodin
- Division of Orthopaedics and Biotechnology; Department of Clinical Science, Intervention and Technology (CLINTEC); Karolinska Institutet; Stockholm Sweden
| | - Leif Ryd
- Department of Learning, Informatics, Management and Ethics (LIME); Medical Management Center; Karolinska Institutet; Stockholm Sweden
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Vaismoradi M, Bondas T, Jasper M, Turunen H. Nursing students' perspectives and suggestions on patient safety--implications for developing the nursing education curriculum in Iran. NURSE EDUCATION TODAY 2014; 34:265-270. [PMID: 23116928 DOI: 10.1016/j.nedt.2012.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/15/2012] [Accepted: 10/06/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Nursing students' close involvement in knowledge development about patient safety will enhance the integrity of the current content of nursing education and pave the way towards developing a nursing curriculum that facilitates achieving a safer health-care system. OBJECTIVES This study explores nursing students' perspectives and suggestions on developing patient safety aspects of the nursing curriculum in the context of Iranian culture. DESIGN A qualitative methodology involving three focus groups with a purposive sample of 18 nursing students from a large Iranian nursing school, utilising directed semi-structured interviews generated data, which was analysed using the content analysis process. RESULTS Two main themes emerged from content analysis: (1) "involving students fully in patient care" with subthemes 'building a trusting relationship between education and practice', and 'promoting inter-dependence between health-care providers', and (2) "structuring patient safety education" with subthemes 'transforming nursing routines to evidence-based care', and 'connecting care to patient safety issues'. CONCLUSIONS The extent of students' involvement in clinical practice and clinical nurses' roles in student education in practice requires clarification. The curriculum needs to incorporate patient safety aspects throughout, and include interdisciplinary education to ensure compliance with patient safety policies. Moreover, successful implementation of such a curriculum necessitates cooperation from nursing practice and instructors to meet nursing students' expectations.
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Affiliation(s)
- Mojtaba Vaismoradi
- College of Human and Health Sciences, Swansea University, United Kingdom.
| | - Terese Bondas
- Faculty of Professional Studies, University of Nordland, Bodø, Norway; Department of Nursing Science, Kuopio Campus, University of Eastern Finland, Kuopio, Finland.
| | - Melanie Jasper
- College of Human and Health Sciences, Swansea University, Room 142 Vivian Tower, Swansea SA2 8PP, United Kingdom.
| | - Hannele Turunen
- Department of Nursing Science, Kuopio Campus, University of Eastern Finland, Kuopio, Finland.
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Kneafsey R, Clifford C, Greenfield S. What is the nursing team involvement in maintaining and promoting the mobility of older adults in hospital? A grounded theory study. Int J Nurs Stud 2013; 50:1617-29. [DOI: 10.1016/j.ijnurstu.2013.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 02/14/2013] [Accepted: 04/13/2013] [Indexed: 11/25/2022]
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Varaei S, Salsali M, Cheraghi MA. Implementation of evidence-based nursing practice for diabetic patients: an Iranian experience. Int J Nurs Pract 2013; 19 Suppl 3:73-80. [PMID: 24090300 DOI: 10.1111/ijn.12170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Evidence-based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses' experiences and perceptions about evidence-based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor-degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: 'structural backgrounds of the organization' and 'empowerment'. Accordingly, it was concluded that successful implementation of evidence-based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence-based nursing in the practice.
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Affiliation(s)
- Shokoh Varaei
- Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Hensel D. Typologies of professional identity among graduating baccalaureate-prepared nurses. J Nurs Scholarsh 2013; 46:125-33. [PMID: 24118728 DOI: 10.1111/jnu.12052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to identify patterns of professional identity arising from the Quality and Safety Education for Nurses (QSEN) attitudes among students completing their prelicensure education. DESIGN This mixed-method study used a modified Q-methodology design with a purposeful sample of 36 baccalaureate students graduating from three campuses of a large Midwestern university. Data were collected near the end of the spring semester of 2013. METHODS Participants rank-ordered their agreement or disagreement with a set of subjective statements reflecting the 46 QSEN attitudes. Data were analyzed using a standard three-step approach that included generating a correlation matrix, completing factor analysis followed by varimax rotation, and calculating the factor scores. FINDINGS Twenty statements represented consensus among the participants, and there was strong agreement that patient safety was both an individual and a team effort. Three professional identity typologies emerged: champions, collaborators, and individualists. CONCLUSIONS Evidence was found that these students internalized the QSEN attitudes to varying degrees, but more work may be needed to internalize all attitudes, especially those related to patient-centered care. Future research is needed to evaluate how students with different perspectives transition to practice and to explore other factors that comprise professional identity. CLINICAL RELEVANCE This study expands on what is known about patterns of professional identity among nurses and helps provide a beginning framework for understanding the values new graduates bring to practice.
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Affiliation(s)
- Desiree Hensel
- Alpha, Assistant Professor, Indiana University, Bloomington Indiana School of Nursing, Bloomington, IN
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Skela Savič B, Robida A. Capacity of middle management in health-care organizations for working with people-the case of Slovenian hospitals. HUMAN RESOURCES FOR HEALTH 2013; 11:18. [PMID: 23663315 PMCID: PMC3662608 DOI: 10.1186/1478-4491-11-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 04/20/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Effective human resources management plays a vital role in the success of health-care sector reform. Leaders are selected for their clinical expertise and not their management skills, which is often the case at the middle-management level. The purpose of this study was to examine the situation in some fields that involve working with people in health-care organizations at middle-management level. METHODS The study included eight state-owned hospitals in Slovenia. A cross-sectional study included 119 middle managers and 778 employees. Quota sampling was used for the subgroups. Structured survey questionnaires were administered to leaders and employees, each consisting of 24 statements in four content sets evaluated on a 5-point Likert-type scale. Respondents were also asked about the type and number of training or education programmes they had participated in over the last three years. Descriptive statistics, two-way analysis of variance, Pearson's correlation coefficient and multiple linear regression were used. The study was conducted from March to December 2008. RESULTS Statistically significant differences were established between leaders and employees in all content sets; no significant differences were found when comparing health-care providers and health-administration workers. Employment position was found to be a significant predictor for employee development (β = 0.273, P < 0.001), the leader-employee relationship (β = 0.291, P < 0.001) and organizational motivation (β = 0.258, P < 0.001). Area of work (β = 0.113, P = 0.010) and employment position (β = 0.389, P < 0.001) were significant predictors for personal involvement. Level of education correlated negatively with total scores for organizational motivation: respondents with a higher level of education were rated with a lower score (β = -0.117, P = 0.024). Health-care providers participate in management programmes less frequently than do health-administration workers. CONCLUSION Employee participation in change-implementation processes was low, as was awareness of the importance of employee development. Education of employees in Slovenian hospitals for leadership roles is still not perceived as a necessary investment for improving work processes. Hospitals are state owned and a national strategy should be developed on how to improve leadership and management in Slovenian hospitals.
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Affiliation(s)
- Brigita Skela Savič
- Visoka šola za zdravstveno nego Jesenice, College of Nursing Jesenice, Spodnji Plavž 3, 4270 Jesenice, Slovenia
| | - Andrej Robida
- Visoka šola za zdravstveno nego Jesenice, College of Nursing Jesenice, and Prosunt d.o.o., Blejska cesta 13, Zasip 4260, Bled, Slovenia
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Shanta LL, Connolly M. Using King's Interacting Systems Theory to Link Emotional Intelligence and Nursing Practice. J Prof Nurs 2013; 29:174-80. [DOI: 10.1016/j.profnurs.2012.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Indexed: 11/15/2022]
Affiliation(s)
- Linda L Shanta
- College of Nursing, University of North Dakota, Grand Forks, ND 58202, USA.
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Partners advancing clinical excellence: building professional councils for quality improvement at six community hospitals. Creat Nurs 2013; 18:177-86. [PMID: 23513430 DOI: 10.1891/1078-4535.18.4.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Engaging bedside clinicians, especially nurses, is essential for the success of sustainable process improvement programs and thus for improving the quality of health care. Studies have shown that properly implemented professional councils can be effective in engaging and empowering bedside clinicians to create lasting and meaningful improvements. This case study describes a 5-year program to implement and operate staff-led councils to lead evidence-based practice (EBP) quality improvement initiatives at 6 community hospitals. The outcomes presented in this case study demonstrate that staff-led councils have the potential to improve patient safety and quality of care as evidenced by observed reductions in ventilator-associated pneumonias, central line-associated bloodstream infections, and mortality from acute myocardial infarction and severe sepsis.
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Impact of Nurse Integrated Rounds on Self-Reported Comprehension, Attitudes, and Practices of Nurses and Resident Physicians in a Pediatric Intensive Care Unit. J Intensive Care Med 2013; 29:285-91. [DOI: 10.1177/0885066613486612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To evaluate the impact of nurse integrated rounds (NIRs) on self-reported comprehension, attitudes, and practices of nurses and resident physicians (RPs) in a pediatric intensive care unit (PICU). Materials and methods: A self-reported comprehension, attitude, and practice survey of RPs and nurses was done prior to (T0), 3 months (T3), and 15 months (T15) after initiation of NIRs in our PICU. Responses were graded on Likert-type scale from 1 to 5. The RPs, attending physicians, and nurses also ranked their overall perception of NIRs during these 3 survey time periods. Results: All 3 components of the surveys showed statistically significant improvement ( P < .05) from the T0 to T3 and T15 in RPs and nurses. A complete or almost complete reversal of attitude was noted for most questions in the attitude section in both RPs and nurses when T15 was compared to T0. The overall perception that NIRs was good for patient care also showed significant improvement in the survey of nurses and physicians. Conclusions: The NIRs are well accepted by nurses and physicians and are accompanied by self-reported improvements in comprehension, attitudes, and practices of nurses and RPs in the PICU.
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Ring L, Fairchild RM. Leadership and Patient Safety: A Review of the Literature. JOURNAL OF NURSING REGULATION 2013. [DOI: 10.1016/s2155-8256(15)30164-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Severinsson E. Patient safety management in the health services- what do patients want? J Nurs Manag 2013; 21:203-5. [DOI: 10.1111/jonm.12074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elisabeth Severinsson
- Research at the Centre for Women's; Family & Child Health; Vestfold University College; Tønsberg Norway
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Abstract
Over a decade of research on the relationship between nurse staffing and patient outcomes has demonstrated the important role of nurses in the provision of high-quality, safe care, yet currently, no evidence-based nurse staffing guidelines exist. A systematic review of reviews was conducted to explore reasons why this is the case and recommend directions for future research to improve upon this gap. Authors of the 29 included reviews reported variability in methods and measurement approaches, lack of incorporation of nurse processes and system factors that potentially affect relationships among variables, and overall inconsistencies in results across primary studies. We propose use of an Integrated Framework for a Systems Approach to Nurse Staffing Research to inform the development of applicable conceptual models. Future studies that use a systems approach and focus on establishing causal relationships among variables will potentially strengthen the evidence and advance the science in this area.
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Affiliation(s)
- Caitlin W. Brennan
- VA Boston Healthcare System, MA, USA
- Case Western Reserve University, Cleveland, OH, USA
- Veterans Affairs National Quality Scholars Program, Louis Stokes Cleveland VA Medical Center, OH, USA
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Magalhães AMMD, Dall'Agnol CM, Marck PB. Nursing workload and patient safety - a mixed method study with an ecological restorative approach. Rev Lat Am Enfermagem 2013; 21 Spec No:146-54. [DOI: 10.1590/s0104-11692013000700019] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/23/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: The aim of this study was to analyze the potential association between nursing workload and patient safety in the medical and surgical inpatient units of a teaching hospital. METHOD: a mixed method strategy (sequential explanatory design). RESULTS: the initial quantitative stage of the study suggest that increases in the number of patients assigned to each nursing team lead to increased rates of bed-related falls, central line-associated bloodstream infections, nursing staff turnover, and absenteeism. During the subsequent qualitative stage of the research, the nursing team stressed medication administration, bed baths, and patient transport as the aspects of care that have the greatest impact on workload and pose the greatest hazards to patient, provider, and environment safety. CONCLUSIONS: The findings demonstrated significant associations between nursing workload and patient safety. We observed that nursing staff with fewer patients presented best results of care-related and management-related patient safety indicators. In addition, the tenets of ecological and restorative thinking contributed to the understanding of some of the aspects in this intricate relationship from the standpoint of nursing providers. They also promoted a participatory approach in this study.
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Röing M, Rosenqvist U, K. Holmström I. Threats to patient safety in telenursing as revealed in Swedish telenurses' reflections on their dialogues. Scand J Caring Sci 2013; 27:969-76. [DOI: 10.1111/scs.12016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/09/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Marta Röing
- Department of Public Health and Caring Sciences; Health Services Research; Uppsala University; Uppsala Sweden
| | - Urban Rosenqvist
- Department of Public Health and Caring Sciences; Health Services Research; Uppsala University; Uppsala Sweden
| | - Inger K. Holmström
- Department of Public Health and Caring Sciences; Health Services Research; Uppsala University; Uppsala Sweden
- School of Health and Medicine; Örebro University; Örebro Sweden
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Abstract
The purpose of this qualitative study was to describe the process by which hospital staff nurses keep patients safe within their hospital safety culture. Findings from this study culminated in a grounded theory of Managing Risk, the process by which nurses keep their patients safe from harm. Participants perceived that their patients were always at risk ( it’s always something), thus keeping patients safe was a continual, repetitive process of managing risk to prevent harm to patients. Stages of this process included risk assessment, risk recognition, prioritization, and protective interventions. Practicing nurses can use this theory to understand and articulate their critical role in keeping patients safe in hospitals. Further examination of this process is necessary for targeted assessment of a safety culture’s impact on bedside nursing practice, thus providing a basis for specific interventions to improve patient safety.
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Killam LA, Montgomery P, Raymond JM, Mossey S, Timmermans KE, Binette J. Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology. BMC Nurs 2012. [PMID: 23181662 PMCID: PMC3526422 DOI: 10.1186/1472-6955-11-26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment. Methods Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives. Results A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site. Conclusions Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.
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Affiliation(s)
- Laura A Killam
- School of Health Sciences and Emergency Services, Cambrian College, 1400 Barrydowne Road, Sudbury, Ontario, Canada.
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A leadership challenge: staff nurse perceptions after an organizational TeamSTEPPS initiative. J Nurs Adm 2012; 42:467-72. [PMID: 22968119 DOI: 10.1097/nna.0b013e31826a1fc1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to measure RNs' perceptions of teamwork skills and behaviors in their work environment during a multiphase multisite nursing organizational teamwork development initiative. Teamwork is essential for patient safety in healthcare organizations and nursing teams. Organizational development supporting effective teamwork should include a just culture, engaged leadership, and teamwork training. A cross-sectional survey study of bedside RNs was conducted in one 5-hospital healthcare system after a TeamSTEPPS teamwork training initiative. TeamSTEPPS teamwork training related to improved RN perceptions of leadership. Initiatives to align the perspectives and teamwork efforts of leaders and bedside nurses are indicated and should involve charge nurses in the design.
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47
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Affiliation(s)
- David Pinnock
- School of Nursing, Midwifery and Physiotherapy, Queens Medical Centre Nottingham
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48
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Severinsson E, Johansson I, Lindquist I. Effects of process-oriented group supervision - a comparison of three groups of student nurses. J Nurs Manag 2012; 22:443-51. [PMID: 23409832 DOI: 10.1111/j.1365-2834.2012.01463.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Faculty of Health Sciences; Vestfold University College; Tønsberg Norway
| | - Ingrid Johansson
- The Sahlgrenska Academy, Institute of Health and Care Sciences; University of Göteborg; Göteborg Sweden
| | - Ingegerd Lindquist
- The Sahlgrenska Academy, Institute of Health and Care Sciences; University of Göteborg; Göteborg Sweden
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Zarea K, Nikbakht-Nasrabadi A, Abbaszadeh A, Mohammadpour A. Facing the challenges and building solutions in clinical psychiatric nursing in Iran: a qualitative study. Issues Ment Health Nurs 2012; 33:697-706. [PMID: 23017047 DOI: 10.3109/01612840.2012.698371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychiatric nurses play an important role in the process of caring for mentally ill patients and are continually faced with the numerous challenges and complex issues related to this field. This study aimed to understand the perspectives of psychiatric nurses regarding the issues they face while providing care and examine the possible solutions for improvement of inpatient care in clinical settings. The study adopted a qualitative approach that utilized a content analysis of audio taped, semi-structured interviews that had been conducted with 24 nurses. Two main themes emerged from the data. The first, Challenges in Providing Care within Psychiatric Wards, had the following subthemes: Politics and Rules of Organization, Safety and Security Issues, Uncertainty about the Role, Lack of Trained Staff, and Sociocultural Issues. The second theme, Solutions for Improving Psychiatric Care, had the subthemes of Empowerment across four domains: Psychiatric Nurses, Mentally Ill Patients and their Families, The Psychiatric Mental Health System, and the Cultural Context. The results indicated that if nurses are expected to provide optimal nursing care within a psychiatric ward, then there is a need for a stable and responsible organizational structure, skilled psychiatric nurses, and community-based care along with an anti-stigma program.
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Affiliation(s)
- Kourosh Zarea
- Ahvaz Jundishapur University of Medical Sciences, School of Nursing and Midwifery, Ahvaz, Islamic Republic of Iran. [corrected]
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Severinsson E, Holm AL. Knowledge gaps in nursing leadership - focusing on health care systems organisation. J Nurs Manag 2012; 20:709-12. [PMID: 22967290 DOI: 10.1111/j.1365-2834.2012.01472.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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