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Walsh SA, Walker SB, Wirihana LA. Preregistration nursing students' motivation for speaking up for patient safety: An integrated literature review. NURSE EDUCATION TODAY 2024; 140:106291. [PMID: 38917742 DOI: 10.1016/j.nedt.2024.106291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/17/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
AIM The aim of this review was to uncover what motivates preregistration nursing students to speak up for patient safety during work integrated learning (WIL) and to develop an evidence-based safety motivation framework for use by educators, clinicians, and preregistration nursing students. DESIGN This study used an integrative literature review design guided by Whittemore and Knafl's methodological framework. DATA SOURCES Five research databases, CINAHL, MEDLINE, PubMed, Scopus, and Web of Science, were searched for relevant peer reviewed research literature published in English between January 2011 and January 2024. The use of MeSH terms "undergraduate nursing student," or "preregistration nursing student" and "speaking up," "patient safety," and "motivation," resulted in 489 search returns. Following application of filters and inclusion criteria fifty-four (n = 54) studies were identified as being relevant to the research aim. REVIEW METHODS The fifty-four (n = 54) research studies were reviewed using the JBI Critical Appraisal tool relevant to the study methodology. The JBI critical appraisal tools are checklists used to determine research quality, validity, results, and meaning. Following appraisal, 27 studies were included in the integrative literature review. RESULTS Authentic learning, view of self as a nurse, and positive work integrated learning experiences were found to be the primary motivators for preregistration nursing students to speak up for patient safety during work integrated learning. These three motivators provided the foundation for an evidence-based framework, underpinned by self-determination theory, that can be used to enhance preregistration nursing students' motivation to speak up for patient safety. CONCLUSIONS The integrative review design enabled the development of the evidence-based Safety Motivation Framework to support preregistration nursing students' during work integrated learning however missing from the literature was information about the lived experience of this group of students when speaking up for patient safety.
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Affiliation(s)
- Samantha A Walsh
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Australia.
| | - Sandra B Walker
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Australia.
| | - Lisa A Wirihana
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Australia.
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2
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McKillen B. Exploring the role of communication in effective nurse leadership and patient care. Nurs Manag (Harrow) 2024; 31:16-21. [PMID: 38532620 DOI: 10.7748/nm.2024.e2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/28/2024]
Abstract
Nurses have to be aware of their personal responsibility to demonstrate effective leadership and thereby contribute to safe and effective patient care. One of the primary skills that nurses can use to become effective leaders is communication. This article explores how communication is a vital tool in enabling nurse leaders to motivate their team members and advocate for patients. The author details some of the essential communication skills that nurses require if they are to promote person-centred care and explores the often-neglected areas of non-verbal and written communication. By possessing a full range of communication skills, nurses can empower themselves to lead clinical teams and advocate for patients.
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Affiliation(s)
- Beth McKillen
- Nursing, Queen's University Belfast, Belfast, Northern Ireland
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Varaei S, Nayeri ND, Sayadi L, Shahmari M, Ghobadi A. Outcomes of professional misconduct by nurses: a qualitative study. BMC Nurs 2024; 23:200. [PMID: 38528519 DOI: 10.1186/s12912-024-01859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/10/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Professional misconduct by nurses is a critical challenge in providing safe quality care, which can lead to devastating and extensive outcomes. Explaining the experiences of clinical nurses and nursing managers in this regard using an in-depth qualitative method can be beneficial. This study was conducted with the aim of explaining the experiences of nurses regarding the outcomes of professional misconduct. METHODS The present study used a qualitative descriptive with a conventional content analysis approach. A total of 22 clinical nurses and nursing managers were selected through purposive sampling until data saturation was reached. Data were collected using semi-structured in-depth interviews and analyzed using Graneheim and Lundman's approach. RESULTS Analyzed data were categorized into four main themes and 11 subthemes: (1) Physical outcomes: critical threat and weakening patients' safety; (2) Psychological outcomes: psycho-emotional responses of patients and their families, moral distress, and cautionary tale of nurses; (3) Financial outcomes: imposing costs on the patient and financial loss of the nurse; (4) Organizational outcomes: the normalization of misconduct, chaos in the organization, waste of the organization's resources, and reputational damage to the organization. CONCLUSION Professional misconduct by nurses can have adverse outcomes for patients in physical, mental, and financial dimensions, their families, nurses, and healthcare organizations. Therefore, it is indispensable to adopt management strategies to reduce the rate of professional misconduct.
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Affiliation(s)
- Shokoh Varaei
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Sayadi
- School of nursing & midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehraban Shahmari
- Department of Medical-Surgical, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Akram Ghobadi
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Jafari MJ, Mostafazadeh P, Mojebi MR, Nemati-Vakilabad R, Mirzaei A. Identifying predictors of patient safety competency based on sleep quality in student faculty of nursing and midwifery during the internship period: a multidisciplinary study. BMC Nurs 2024; 23:67. [PMID: 38267940 PMCID: PMC10807159 DOI: 10.1186/s12912-024-01725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Ensuring patient safety is of paramount importance in healthcare services. Sleep disorders not only have detrimental effects on the health of healthcare students but also significantly impair their performance, leading to an increased risk of medication errors. These errors can pose a grave threat to the safety and well-being of patients. It is crucial to address and mitigate sleep disorders among internship healthcare students to safeguard the quality of care and minimize potential patient harm. OBJECTIVES This study aimed to investigate the predictors of Patient Safety Competency (PSC) based on the sleep quality of internship healthcare students. METHODS A study was conducted on 331 students from the Ardabil School of Nursing and Midwifery at Ardabil University of Medical Sciences in northwest Iran from August to December 2022. The participants were selected by stratified random sampling. Data were collected using a demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Health Professional Education in Patient Safety Survey (H-PEPSS). The collected data were analyzed using SPSS software version 22.0. Person correlation coefficients were used to examine the relationship between PSC level, its dimensions, and sleep quality, while multiple linear regression was conducted to identify the predictors of PSC. RESULTS The competency of nurses in patient safety was average in both classroom and clinical settings. However, their ability to work as a team with other healthcare professionals scored the lowest. In addition, the quality of sleep was found to be a predictor of patient safety competency among healthcare students during their internships. CONCLUSIONS It is important to note that healthcare students tend to have moderate patient safety competence (PSC), which is positively correlated with their sleep quality. Therefore, it is vital to identify the key factors that directly affect PSC. This would enable nursing and midwifery faculty administrators to take preventive measures to enhance patient safety competence in both classroom and clinical settings. Additionally, organizing educational workshops that engage students and improve their sleep quality could improve patient care. Practical courses are recommended for health professionals and students in clinical settings to enhance patient safety competencies. Additionally, student internships should receive hands-on training to improve teamwork and rest conditions.
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Affiliation(s)
- Mohammad Javad Jafari
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Pouya Mostafazadeh
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Reza Mojebi
- Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Reza Nemati-Vakilabad
- Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Mirzaei
- Department of Emergency Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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5
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Altmiller G. National Study of Quality, Safety, and Just Culture in Prelicensure Nursing Education. Nurs Educ Perspect 2024; 45:12-18. [PMID: 37428645 DOI: 10.1097/01.nep.0000000000001164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
AIM The study's aim was to evaluate the integration and application of quality and safety competencies and concepts of fair and just culture in prelicensure nursing education. BACKGROUND Health care organizations support a safety culture by encouraging error reporting without fear of punishment and by conducting investigations to determine causes to improve quality and learn from mistakes. In prelicensure nursing education, the response to errors is often punitive and threatens dismissal. METHOD Members of the National Student Nurses' Association were recruited to participate in an electronic assessment through the organization's mailing system. RESULTS Students representing all prelicensure program types (BSN, ADN, diploma, accelerated) and 46 states ( N = 268) completed the survey. CONCLUSION Nurse educators were found to have a positive impact on student quality and safety competency. Improvement is possible in developing and supporting just culture within nursing programs to bridge the gap between academia and practice.
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Affiliation(s)
- Gerry Altmiller
- About the Author Gerry Altmiller, EdD, APRN, ACNS-BC, ANEF, FAAN, is a professor and director of the Quality and Safety Innovation Center, The College of New Jersey Department of Nursing, Ewing, New Jersey. This research was funded by a Dorothy Otto National League for Nursing Research in Nursing Education Grant. For more information, contact Dr. Altmiller at
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Kane J, Munn L, Kane SF, Srulovici E. Defining Speaking Up in the Healthcare System: a Systematic Review. J Gen Intern Med 2023; 38:3406-3413. [PMID: 37670070 PMCID: PMC10682351 DOI: 10.1007/s11606-023-08322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Communication issues have been shown to contribute to healthcare errors. For years healthcare professionals have been told to "speak up." What "speak up" means is unclear, as it has been defined and operationalized in many ways. Thus, this study aimed to systematically review the literature regarding definitions and measurements of speaking up in the healthcare system and to develop a single, comprehensive definition and operationalization of the concept. METHODS PubMed, CINAHL, PsychoInfo, and Communication/Mass Media Complete databases were searched from 1999 to 2020. Publications were included if they mentioned speaking up for patient safety or any identified synonyms. Articles that used the term speaking up concerning non-health-related topics were excluded. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 294 articles met the inclusion criteria, yet only 58 articles focused on speaking up. While the most common synonym terms identified were "speak up" and "raise concern," only 43 articles defined speaking up. Accordingly, a modified definition was developed for speaking up-A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. DISCUSSION Speaking up is considered important for patient safety. Yet, there has been a lack of agreement on the definition and operationalization of speaking up. This review demonstrates that speaking up should be reconceptualized to provide a single definition for speaking up in healthcare.
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Affiliation(s)
- Julia Kane
- School of Nursing, Fayetteville State University, Fayetteville, NC, USA
| | - Lindsay Munn
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shawn F Kane
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
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Jeong JH, Kim SS. South Korean Nurses' Experiences of Speaking up for Patient Safety and Incident Prevention. Healthcare (Basel) 2023; 11:1764. [PMID: 37372881 DOI: 10.3390/healthcare11121764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the importance of speaking up for patient safety, hesitancy to do so remains a major contributing factor to communication failure. This study aimed to investigate the experiences of South Korean nurses in speaking up to prevent patient safety incidents. Twelve nurses responsible for patient safety tasks or with experience in patient safety education were recruited from five hospitals (three university hospitals, two general hospitals) in city "B". Data were collected through open-ended questions and in-depth interviews, transcribed, and analyzed using the inductive content analysis method. The study resulted in the identification of four main categories and nine subcategories that captured commonalities among the experience of the 12 nurses. The four main categories were as follows: the current scenario of speaking up, barriers to speaking up, strategies for speaking, and confidence training. There is a scarcity of research on speaking-up experiences for patient safety among nurses in South Korean. Overall, it is necessary to overcome cultural barriers and establish an environment that encourages speaking up. In addition, developing speaking-up training programs for nursing students and novice nurses is imperative to prevent patient safety incidents.
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Affiliation(s)
- Jeong Hee Jeong
- Department of Nursing Science, Kyungsung University, Busan 48434, Republic of Korea
| | - Sam Sook Kim
- Department of Nursing, Daedong College, Busan 46270, Republic of Korea
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Currie J, Thompson C, Grootemaat P, Andersen P, Finnegan A, Carter M, Halcomb E. A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries. J Clin Nurs 2023; 32:283-297. [PMID: 35146817 PMCID: PMC10078692 DOI: 10.1111/jocn.16239] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/14/2022]
Abstract
AIM The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice. BACKGROUND Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future. DESIGN A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines. RESULTS One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation. CONCLUSION There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.
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Affiliation(s)
- Jane Currie
- Queensland University of Technology, Kelvin Grove Campus, Brisbane, Queensland, Australia.,Susan Wakil School of Nursing & Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cristina Thompson
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, New South Wales, Australia
| | - Pam Grootemaat
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, New South Wales, Australia
| | - Patrea Andersen
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,School of Nursing, Midwifery and Social Science, CQ University, Queensland, Australia
| | - Alan Finnegan
- University of Chester, Riverside Campus, Chester, UK
| | - Michael Carter
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
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Lee SE, Kim E, Lee JY, Morse BL. Assertiveness educational interventions for nursing students and nurses: A systematic review. NURSE EDUCATION TODAY 2023; 120:105655. [PMID: 36462396 DOI: 10.1016/j.nedt.2022.105655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The purpose of this study was three-fold: to (1) synthesize evidence from experimental studies regarding educational interventions for developing nursing students' and nurses' assertiveness, (2) examine such interventions and identify their effective components, and (3) recommend future research considerations in this area. DESIGN A systematic review of the literature. DATA SOURCES Literature searches were conducted using three electronic databases (PubMed, CINAHL, and PsycINFO) in addition to hand searches to identify original research articles published between 2012 and 2022. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for the systematic review and reporting process. Included studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Checklists. RESULTS Fourteen articles were included in this review, with most of the studies conducted in Asian countries. Four intervention methods were used for assertiveness education across the studies: (1) simulation-based learning, (2) classroom-based learning, (3) classroom-based learning with peer support, and (4) hybrid learning. Classroom-based learning interventions were the most common. Among all types of interventions, key concepts included assertiveness, differentiating between assertive and non-assertive behaviors, and assertive communication skills. Most studies measured participants' speaking-up behaviors by self-report. Mixed results were observed in terms of intervention effectiveness, but providing participants with opportunities to practice assertive communication skills benefited their speaking-up. CONCLUSIONS Educational interventions can strengthen the skills, confidence, and capacity of current and future nurses to employ assertive communication. Intervention developers should create programs that involve classroom teaching and provide participants with opportunities for practice, either through simulation or role-play. Also, researchers should observe participants' post-intervention use of assertive communication in simulations or clinical practice as opposed to surveying participants' intention to speak up.
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Affiliation(s)
- Seung Eun Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea.
| | - Eunkyung Kim
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, South Korea
| | - Ji Yea Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Brenna L Morse
- Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Lowell, MA 01854, USA.
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Wawersik DM, Boutin ER, Gore T, Palaganas JC. Individual Characteristics That Promote or Prevent Psychological Safety and Error Reporting in Healthcare: A Systematic Review. J Healthc Leadersh 2023; 15:59-70. [PMID: 37091553 PMCID: PMC10120817 DOI: 10.2147/jhl.s369242] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/13/2022] [Indexed: 04/25/2023] Open
Abstract
Background Healthcare errors continue to be a safety issue and an economic burden that causes death, increased length of stays, and emotional trauma to families and the person who commits the error. Speaking up and error reporting within a safety culture can reduce the incidence of error; however, this is complex and multifaceted. Aim This systematic review investigates individual characteristics that support or prevent speaking up behaviors when adverse events occur. This study further explores how organizational interventions designed to promote error reporting correlate to individual characteristics and perceptions of psychological safety. . Methods A systematic review of peer-reviewed articles in healthcare that contain characteristics of an individual that promote or prevent error reporting was conducted. The search yielded 1233 articles published from 2015 to 2021. From this set, 81 full-text articles were assessed for eligibility and ultimately extracted data from 28 articles evaluated for quality using Joanna Briggs Institute critical appraisal tools©. Principal Findings The primary themes for individual character traits, values, and beliefs that influence a person's decision to speak up/report an error include self-confidence and positive perceptions of self, the organization, and leadership. Education, experience and knowledge are sub themes that relate to confidence. The primary individual characteristics that serve as barriers are 1) self-preservation associated with fear and 2) negative perceptions of self, the organization, and leadership. Conclusion The results show that an individual's perception of their environment, whether or not it is psychologically safe, may be impacted by personal perceptions that stem from deep-seated personal values. This exposes a crucial need to explore cultural and diversity aspects of healthcare error reporting and how to individualize interventions to reduce fear and promote error reporting.
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Affiliation(s)
- Dawn M Wawersik
- MGH Institute of Health Professions, Boston, MA, USA
- Henry Ford College, Dearborn, MI, USA
- Correspondence: Dawn M Wawersik, Email
| | | | - Teresa Gore
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Janice C Palaganas
- MGH Institute of Health Professions, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Pavithra A, Mannion R, Sunderland N, Westbrook J. Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals. J Health Organ Manag 2022; ahead-of-print:245-271. [PMID: 36380424 PMCID: PMC10424643 DOI: 10.1108/jhom-04-2022-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of employment within their hospital sites, age, gender and their ongoing exposure to unprofessional behaviours. DESIGN/METHODOLOGY/APPROACH Responses to a survey by 4,851 staff across seven sites within a hospital network in Australia were analysed to interrogate whether speaking up by hospital employees is influenced by employees' symbolic capital and situated subjecthood (SS). The authors utilised a Bourdieusian lens to interrogate the relationship between the symbolic capital afforded to employees as a function of their professional, personal and psycho-social resources and their self-reported capacity to speak up. FINDINGS The findings indicate that employee speaking up behaviours appear to be influenced profoundly by whether they feel empowered or disempowered by ongoing and pre-existing personal and interpersonal factors such as their functional roles, work-based peer and supervisory support and ongoing exposure to discriminatory behaviours. ORIGINALITY/VALUE The findings from this interdisciplinary study provide empirical insights around why culture change interventions within healthcare organisations may be successful in certain contexts for certain staff groups and fail within others.
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Affiliation(s)
- Antoinette Pavithra
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
| | - Russell Mannion
- Australian Institute of Health Innovation
, Sydney,
Australia
- Health Services Management Centre
,
University of Birmingham
, Birmingham,
UK
| | - Neroli Sunderland
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
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12
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Violato E. A state-of-the-art review of speaking up in healthcare. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1177-1194. [PMID: 35666354 DOI: 10.1007/s10459-022-10124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Throughout healthcare, including education, the need for voicing of concern by speaking up is a globally recognized issue that has come to the fore in the last ten years. There has been a rapid growth in the number of review articles on the topic. To prevent diffusion of knowledge and support future research it is necessary to gather the existing knowledge in a single place. The purpose of the present article is to bring together the existing reviews on speaking up to create a source of unified knowledge representing the current "State of the Art" to advance future research and practice. A State-of-the-Art review was conducted to synthesize the existing knowledge on speaking up. Six databases were searched. Fourteen review articles spanning 2012 to 2021 were identified. Five main research questions have been investigated in the literature and five common recommendations for improvement are made, the knowledge across all reviews related to the research questions and recommendations was synthesized. Additionally, simulation-based research was frequently identified as an important though limited method. Further issues in the literature are identified and recommendations for improvement are made. A synthesis was successfully developed: knowledge about speaking up and research related to speaking up is in an emergent state with more shortcomings, questions, and avenues for improvement than certitude. The whys and how of speaking up remain open questions.
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Affiliation(s)
- Efrem Violato
- Center for Advanced Medical Simulation, Northern Alberta Institute of Technology, CAT 126, 11762 106 St NW, Edmonton, AB, T5G 2R1, Canada.
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Liu T, Xu M, Ye M, Pan Y, Xu N, Tan X, Sun Q. Meanings and senses of organisational silence by male nurses in the emergency department: an interpretative phenomenological study protocol. BMJ Open 2022; 12:e058557. [PMID: 36008075 PMCID: PMC9422853 DOI: 10.1136/bmjopen-2021-058557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The organisational silence of nursing teams has received increasing attention from managers. Chinese nurses have a relatively high score for organisational silence, and male nurses score higher than female nurses. Lack of professional empathy, high pressure in the work environment, and traditional Chinese cultural factors suggest that Chinese male nurses' experiences of and reasons for organisational silence are complex and unique. Taking male nurses in the emergency department as an example, this study explores the experience and meaning of male nurses' organisational silence and provides ideas for nursing managers to understand the silence of male nurses. METHODS AND ANALYSIS An interpretative phenomenological approach underpins the study design. In this study, the purposive sampling method will be used to select male nurses who meet the inclusion criteria with maximum differentiation as a strategy. Face-to-face semistructured interviews and Van Manen analysis methods will be used for data collection and analysis. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (ethical approval ID: 2019-KL-036-01). Participants will provide informed consent, will be able to withdraw at any time and will have their contributions kept confidential. The findings of the study will be shared with relevant stakeholders and disseminated in conference presentations and journal publications. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2100047057).
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Affiliation(s)
- Ting Liu
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Min Xu
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Menghua Ye
- First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yue Pan
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Nafei Xu
- Department of Health and Tourism, Hangzhou Wanxiang Polytechnic, Hangzhou, Zhejiang, China
| | - Xiaoxue Tan
- First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qiuhua Sun
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Jackson D. When niceness becomes toxic, or, how niceness effectively silences nurses and maintains the status quo in nursing. J Adv Nurs 2022; 78:e113-e114. [PMID: 35929647 DOI: 10.1111/jan.15407] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022]
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15
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Madden MA, McAlister BS. A Time to Speak: When Incivility Injures Patients. J Christ Nurs 2022; 39:174-178. [PMID: 35665423 DOI: 10.1097/cnj.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Incivility continues to create challenging work environments for healthcare workers. Nurses who experience incivility related to patient concerns or treatment often must confront power differentials and the fear of consequences if they speak up on behalf of the patient. This case report of a family's labor and delivery experience demonstrates the potential of harm to patients and long-term consequences of workplace incivility for the patient and the nurse. Moral courage and biblical insights to strengthen nurses' commitment to speak up for patients are discussed.
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Yang J, Yang H, Wang B. Organizational Silence among Hospital Nurses in China: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9138644. [PMID: 35601143 PMCID: PMC9119765 DOI: 10.1155/2022/9138644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022]
Abstract
Objective To analyze the factors that contribute to organizational silence among Chinese nurses. Methods A descriptive, comparative, and cross-sectional study was performed with the participation of 866 nurses from public hospitals in China. The data were collected using an online questionnaire that included sociodemographic information and a silence scale. Results The overall level of organizational silence among nurses was moderate (51.35 ± 14.99). Nurses indicated that they remained silent about administrative (2.97 ± 1.10) and organizational topics (2.94 ± 1.11) yet were more vocal about matters related to responsibility (1.68 ± 0.86), honor (1.87 ± 0.95), and enthusiasm (2.07 ± 0.99). Moreover, data analysis demonstrated that department, educational status, professional title, years of employment, and employment status had effects on nurses' organizational silence (p < .05). Conclusion This study provides information that could facilitate an understanding of organizational silence for both nurses and nursing managers. The results helped to identify the urgent need to adopt effective strategies to address the problem of nurses' organizational silence. Changes in management practices and organizational culture should be implemented to remove communication and other barriers that impede nurses' contributions to their organizations.
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Affiliation(s)
- Jing Yang
- Nursing College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hui Yang
- Nursing College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Binquan Wang
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Ryan L, Jackson D, East L, Woods C, Usher K. Mixed Methods Study Integration: Nursing student experiences and opinions of intentional rounding. J Adv Nurs 2022; 78:1787-1797. [PMID: 35301735 DOI: 10.1111/jan.15197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/26/2021] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
AIMS To explore pre-registration nursing students' understandings and experience of intentional rounding in education and clinical sectors. Intentional rounding is a patient safety intervention used in clinical settings to regularly check and document patients' welfare and environment throughout the course of a shift. DESIGN An explanatory sequential mixed methods design using convenience sampling was used for this study, with an underlying pragmatic paradigm. Integration occurred in the design, methods, implementation and reporting phases of the study. METHODS Data were collected between August 2017 and August 2018 using a previously validated Nursing Perceptions of Patient Rounding quantitative online survey followed by individual qualitative interviews using the same cohort. RESULTS Using the Pillar Integration Process, this paper displays and discusses the final results. The integration and mixing throughout the study generated insights into the perceived benefits of intentional rounding for nursing students and patients but also indicated a theory-practice gap that affects nursing students' confidence in undertaking this intervention. CONCLUSION Students find this patient safety intervention helpful, but further clarity in the education surrounding it is required. IMPACT This study addresses pre-registration nursing students' understanding and perceptions of intentional rounding. Intentional rounding benefits nursing students as a patient safety strategy and organization tool. Educational opportunities around the topic could be enhanced, reducing the ongoing theory-practice gap. Clinicians, academics and educators who support pre-registration nursing students in clinical and tertiary education settings can benefit from this work.
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Affiliation(s)
- Liz Ryan
- University of New England, Armidale, New South Wales, Australia
| | - Debra Jackson
- University of Sydney, New South Wales, Australia.,University of Technology Sydney, New South Wales, Australia
| | - Leah East
- University of New England, Armidale, New South Wales, Australia.,Hunter New England Local Health District, New South Wales, Australia
| | - Cindy Woods
- University of Canberra, Bruce, ACT, Australia
| | - Kim Usher
- University of New England, Armidale, New South Wales, Australia.,University of Technology Sydney, New South Wales, Australia
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Choi EY, Pyo J, Ock M, Lee H. Second victim phenomenon after patient safety incidents among Korean nursing students: A cross-sectional study. NURSE EDUCATION TODAY 2021; 107:105115. [PMID: 34481312 DOI: 10.1016/j.nedt.2021.105115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 07/12/2021] [Accepted: 08/24/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Perfectionism in the medical field turns healthcare professionals into second victims of patient safety incidents. They suffer physically and psychologically, which makes them consider changing occupations. Nursing students may also have similar negative experiences during clinical practice. OBJECTIVE To describe the second victim phenomenon among nursing students after patient safety incidents during their clinical practice. DESIGN A descriptive cross-sectional study using an online questionnaire. SETTING AND PARTICIPANTS Fourth-year nursing students (n = 354) who encountered patient safety incidents directly or indirectly during clinical practice. Participants were recruited through convenience and snowball sampling methods using personal contacts, professional networks, and online platforms. METHODS The questionnaire addressed the characteristics of patient safety incidents, and physical and psychological responses after the most significant patient safety incident. Descriptive statistics and a chi-square test were performed for data analysis. RESULTS Of the participants, 22.6% were directly involved in patient safety incidents and 77.4% had indirectly encountered patient safety incidents, such as witnessing incidents with colleagues or other healthcare professionals. After patient safety incidents, of those, 67.8% experienced shock at the time of the incident, 47.2% feared experiencing a similar incident, and 28.2% were still affected although time had passed. Additionally, 26.3% reported experiencing long-term embitterment; of them, 7.3% were experiencing severe embitterment. Furthermore, 31.9% and 27.1% of the students experienced sleeping and eating difficulties, respectively, and these rates were higher when incidents were encountered directly rather than indirectly. CONCLUSIONS Nursing students may become second victims of patient safety incidents during clinical practice. Therefore, nursing education institutions need to develop comprehensive support strategies to help nursing students cope with experiencing the second victim phenomenon.
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Affiliation(s)
- Eun Young Choi
- Department of Nursing, Graduate School of Chung-Ang University, Republic of Korea; Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jeehee Pyo
- Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Haeyoung Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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Undergraduate Nursing Students and Management of Interruptions: Preparation of Students for Future Workplace Realities. Nurs Educ Perspect 2021; 42:350-357. [PMID: 34516484 DOI: 10.1097/01.nep.0000000000000886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to investigate interruption management strategies and associative cues used by nursing students when interrupted during simulated medication administration. BACKGROUND Interruptions occur with high frequency in health care settings and are associated with increased medication errors and decreased task efficiency. The Altmann and Trafton memory for goals model, a cognitive-science model, proposes use of associative cues during an interruption to mitigate these negative effects. METHOD A mixed-methods, two-site study explored associative cues and other management strategies that nursing students used when interrupted during simulated medication administration. Data were collected via direct observation and semistructured interviews. RESULTS Students primarily multitasked (66.7 percent) during the interruption. Few students (5.5 percent) used associative cues. Students voiced the need for education and practice on how to manage interruptions. CONCLUSION Evidence-based strategies are required to prepare nursing students for workplace interruptions. Use of associative cues during interruptions warrants further investigation.
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Jack K, Levett-Jones T, Ylonen A, Ion R, Pich J, Fulton R, Hamshire C. "Feel the fear and do it anyway" … nursing students' experiences of confronting poor practice. Nurse Educ Pract 2021; 56:103196. [PMID: 34534726 DOI: 10.1016/j.nepr.2021.103196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022]
Abstract
AIM The two aims of this study were, first, to explore nursing students' experiences and perspectives of reporting poor care and second, examine the process by which they raised concerns. BACKGROUND The nursing literature is replete with studies which explore nursing students' experiences of clinical placement. However only a small number explore students experiences of challenging poor care and how this is enacted in the practice setting. SETTING AND PARTICIPANTS Fourteen nursing students from undergraduate pre-registration nursing programs across three universities, two in the United Kingdom (UK) and one in Australia. DESIGN AND ANALYSIS This paper reports findings from narrative interviews about students' clinical experiences of reporting poor care. Data were audio recorded, transcribed verbatim and analyzed using a constant comparison approach. Emerging themes were identified, discussed and verified by the researchers. RESULTS Four montages from the narratives highlight the overarching themes: bullying, patient advocacy, lack of empathy and poor care. They demonstrate how, driven by an ethical imperative, students speak up when they witness poor care despite the difficulties of doing so: in some cases, the students in this study were prepared to continue speaking out even when initial concerns were dismissed. CONCLUSION Both practice and university teams have a responsibility to support students' development as ethical and courageous practitioners, able to recognize when care falls below an acceptable standard.
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Affiliation(s)
- Kirsten Jack
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, Birley Campus, 53 Bonsall Street, Manchester M15 6GX, UK.
| | | | | | - Robin Ion
- University of the West of Scotland, UK
| | | | | | - Claire Hamshire
- Faculty Head of Education, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, UK
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21
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Hu X, Casey T. How and when organization identification promotes safety voice among healthcare professionals. J Adv Nurs 2021; 77:3733-3744. [PMID: 34227140 DOI: 10.1111/jan.14868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 01/25/2021] [Accepted: 04/07/2021] [Indexed: 01/05/2023]
Abstract
AIM The aim of this study is to examine the effect of organizational identification on safety voice behaviour, focusing on the mediating role of safety motivation and the moderating role of management commitment to safety and psychological safety. DESIGN The study used a cross-sectional questionnaire and a convenience sampling method. METHOD Data were collected online during November 2019 from 165 staff members from a disability healthcare organization in Australia that employs over 800 staff. Nearly 80% of the study sample were healthcare workers without supervisory responsibilities, and the remainder were senior staff with some operational duties. Measures of organizational identification, safety motivation, perceived management commitment to safety, psychological safety and safety voice were collected. Data were analysed using a moderated mediation model available with the SPSS PROCESS macro. RESULTS Findings show that organizational identification interacted with management commitment to safety to predict safety motivation, such that only healthcare employees who identified with their organization and perceived that their management cares about safety would feel that safety was personally important to them. In turn, safety motivation predicted safety voice. However, the effect of safety motivation on safety voice was only significant when psychological safety was low. CONCLUSION These findings offer initial evidence for the important role of organizational identification in prompting safety voice, how the relationship is contingent on management commitment to safety and psychological safety. IMPACT Healthcare professionals' discretionary sharing of ideas and suggestions are crucial to organizational performance and both staff and patient safety. However, safety voice involves inherent social risks because speaking up might not always be perceived positively by co-workers and leaders. We recommend that managers implement specific strategies to cultivate employee identification with the organization and demonstrate a genuine and visible commitment to safety so that employees will be motivated to raise safety concerns.
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Affiliation(s)
- Xiaowen Hu
- QUT Business School, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tristan Casey
- Safety Science Innovation Lab, Griffith University, Nathan, QLD, Australia
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22
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Fagan A, Lea J, Parker V. Student nurses' strategies when speaking up for patient safety: A qualitative study. Nurs Health Sci 2021; 23:447-455. [PMID: 33733584 DOI: 10.1111/nhs.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two-phased approach included individual semi-structured interviews, followed by focus group discussions with students. Participants included 53 pre-registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students.
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Affiliation(s)
- Anthea Fagan
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Vicki Parker
- School of Health, University of New England, Armidale, New South Wales, Australia
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23
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Walker D, Hromadik L, Altmiller G, Barkell N, Toothaker R, Powell K. Exploratory factor analysis of the Just Culture Assessment Tool for nursing education. J Res Nurs 2020; 26:49-59. [DOI: 10.1177/1744987120951589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Just culture has been identified as a vital component of safety culture by national and international organisations. In a just culture, emphasis is not placed on blaming individuals for errors but rather on examining personal and system processes that can best support safety and prevent reoccurrence. Although those in the practice arena have worked to implement the concepts of just culture, the same is not true in nursing education, leaving nursing students lacking the pre-requisite knowledge, skills and attitudes to implement just culture in practice on graduation. Aims Assessment of this phenomena is the essential first step to align nursing education with practice in promoting just culture as a mechanism for patient safety. The purpose of this paper is to further refine the Just Culture Assessment Tool-Nursing Education through exploratory factor analysis. Methods The Just Culture Assessment Tool-Nursing Education was adapted from the Just Culture Assessment Tool, an instrument created for the practice setting. Validity and reliability were established for the Just Culture Assessment Tool-Nursing Education in a study of 800 nursing students to assess their perceptions and understanding of just culture with their nursing programmes. Using the previously conducted data, an exploratory factor analysis was conducted. Results Factor analysis supports six subscales, similar to that of the Just Culture Assessment Tool. However, individual items were loaded into different subscales. All subscales demonstrated good reliability. Factor analysis supported further refinement of two items to improve the instrument’s ability to capture data. Conclusions Perceptions of just culture differ between experienced providers and nursing students; nursing students have less experience with reporting errors. Factor analysis of Just Culture Assessment Tool-Nursing Education items demonstrated these differences, supporting modification of items by the instrument developers. An ‘if’ statement for students to consider their possible actions rather than experience was added to two items to better capture data from nursing students when completing the assessment.
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Affiliation(s)
- Danielle Walker
- Assistant Professor, Harris College of Nursing and Health Sciences, Texas Christian University, United States of America
| | - Lora Hromadik
- Associate Professor, Department of Nursing and Allied Health Professions, Indiana University of Pennsylvania, United States of America
| | - Gerry Altmiller
- Professor, School of Nursing, Health and Exercise Science, The College of New Jersey, United States of America
| | - Nina Barkell
- Faculty, Department of Nursing, Oakland Community College, United States of America
| | - Rebecca Toothaker
- Associate Professor, Department of Nursing, Bloomsburg University, United States of America
| | - Kevin Powell
- Research Associate, Applied Research Lab, Indiana University of Pennsylvania, United States of America
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Fagan A, Lea J, Parker V. Conflict, confusion and inconsistencies: Pre-registration nursing students' perceptions and experiences of speaking up for patient safety. Nurs Inq 2020; 28:e12381. [PMID: 32881137 DOI: 10.1111/nin.12381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
There is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under-explored, especially in the Australian context. This two-phased qualitative study used Interpretive Description to explore 53 pre-registration nursing students' perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students' decisions to speak up or remain silent. Understanding students' perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up.
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Affiliation(s)
- Anthea Fagan
- University of New England, Armidale, NSW, Australia
| | - Jackie Lea
- University of Southern Queensland, Toowoomba, QLD, Australia
| | - Vicki Parker
- University of New England, Armidale, NSW, Australia
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25
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Huang CH, Wu HH, Lee YC, Van Nieuwenhuyse I, Lin MC, Wu CF. Patient safety in Work Environments: Perceptions of Pediatric Healthcare Providers in Taiwan. J Pediatr Nurs 2020; 53:6-13. [PMID: 32299035 DOI: 10.1016/j.pedn.2020.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Extensive research on the link between the organizational characteristics of the work environment and patient safety in a healthcare organization has been conducted; yet, only a few studies have concentrated on care providers in a pediatric unit. OBJECTIVES To determine the correlation between different work environment factors impacting patient safety in a pediatric care unit from the perspective of registered nurses working in these units. DESIGN Cross-sectional design. DATA SOURCES AND METHODS The study was conducted with 155 registered nurses from a pediatric unit in a medical center in Taiwan with the Chinese version of the Safety Attitudes Questionnaire (SAQ) 2014-2017. RESULTS Teamwork climate, higher job satisfaction, and better working conditions are linked to positive perceptions of patient safety culture. Emotional exhaustion is negatively related to most dimensions of patient safety. CONCLUSION Teamwork climate, job satisfaction, working conditions, and emotional exhaustion were identified as critical factors impacting the patient safety climate. IMPLICATIONS FOR NURSING OR HEALTH POLICY Investments to improve teamwork climate, job satisfaction, and working conditions and reduce emotional exhaustion may have a positive effect on patient safety in pediatric care units.
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Affiliation(s)
- Chih-Hsuan Huang
- School of Business Administration, Hubei University of Economics, Wuhan City, China; Institute of Wuhan Studies, Jianghan University, Wuhan City, China; Institute for Development of Cross-Strait Small and Medium Enterprise, Wuhan City, China
| | - Hsin-Hung Wu
- Department of Business Administration, National Changhua University of Education, Changhua City, Taiwan; Department of M-Commerce and Multimedia Applications, Asia University, Taichung City, Taiwan; Faculty of Education, State University of Malang, Malang, East Java, Indonesia
| | - Yii-Ching Lee
- Department of Health Business Administration, Hung Kuang University, Taichung City, Taiwan; School of Health Policy and Management, Chung Shan Medical University, Taichung City, Taiwan
| | | | - Meng-Chen Lin
- School of Business Administration, Hubei University of Economics, Wuhan City, China
| | - Cheng-Feng Wu
- School of Business Administration, Hubei University of Economics, Wuhan City, China; Institute for Development of Cross-Strait Small and Medium Enterprise, Wuhan City, China; Research Center of Hubei Logistics Development, Hubei University of Economics, Wuhan City, China.
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26
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Brown P, Jones A, Davies J. Shall I tell my mentor? Exploring the mentor‐student relationship and its impact on students' raising concerns on clinical placement. J Clin Nurs 2020; 29:3298-3310. [DOI: 10.1111/jocn.15356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | - Aled Jones
- School of Healthcare Science Cardiff University Cardiff UK
| | - Jane Davies
- School of Healthcare Science Cardiff University Cardiff UK
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Gopee S. Enhancing patient safety: empowering students to speak up. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:712. [PMID: 32579462 DOI: 10.12968/bjon.2020.29.12.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Serena Gopee
- Fifth Year Medical Student, University College London
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28
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Mansour M, Jamama A, Al-Madani M, Mattukoyya R, Al-Anati A. Reconciling Assertive Communication Skills With Undergraduate Nursing Education: Qualitative Perspectives From British and Saudi Newly-Graduated Nurses. HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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29
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Huang FF, Shen XY, Chen XL, He LP, Huang SF, Li JX. Self-reported confidence in patient safety competencies among Chinese nursing students: a multi-site cross-sectional survey. BMC MEDICAL EDUCATION 2020; 20:32. [PMID: 32005224 PMCID: PMC6995154 DOI: 10.1186/s12909-020-1945-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/24/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Nursing interns are an important backup force for nursing professionals, so efforts to strengthen their patient safety (PS) competencies are a major priority. To do so requires assessing the strengths and weaknesses of Chinese nursing students' PS competence and identifying the influencing factors. METHODS This was a multi-site, cross-sectional, web-based study that was carried out between September 2018 and January 2019. A national online survey was completed by 732 Chinese undergraduate nursing students. Our primary outcome factor was the Health Professional Education in Patient Safety Survey score. We also collected socio-demographic and clinical practice-related characteristics as independent variables. Multiple stepwise linear regression was performed to identify predictors of PS competence. RESULTS Chinese undergraduate nursing students were fairly confident in their clinical safety skills but less confident in what they learned about sociocultural or context-dependent aspects of PS and speaking up about PS, including effective communication and understanding human and environmental factors. Less than half of the students felt that they could approach someone engaging in unsafe practice and were reluctant to voice concern about adverse events. We observed significant differences in PS competence between students from different regions, across different PS learning styles (self-study and classroom theoretical study), with different self-assessed PS competence levels, and with experiences of adverse events (p < 0.05). These factors accounted for almost 15% of the total variance in PS competence scores (adjusted R2 = 0.15, p = 0.00). CONCLUSIONS The results of this study provide a better understanding of PS competence among final-year nursing students in China. Our findings may help nursing educators or healthcare organizations to cultivate and improve PS competence by establishing documented policies or by improving the efficacy of intervention.
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Affiliation(s)
- Fei Fei Huang
- School of Nursing, Fujian Medical University, No 1 Xuefu north Road, Minhou county, Fuzhou, 350108, Fujian, China.
| | - Xiao Ying Shen
- School of Nursing, Harbin Medical University, the 2nd Affiliated Hospital of Harbin Medical University, Herbin, China
| | - Xue Lei Chen
- School of Nursing, Guilin Medical University, Gulin, China
| | - Li Ping He
- School of Nursing, Changzhi Medical College, Changzhi, China
| | - Su Fen Huang
- School of Nursing, Quanzhou Medical College, Quanzhou, China
| | - Jin Xiu Li
- School of Nursing, Ji Shou University, Jishou, China
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30
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Ryan E(LJ, Jackson D, Woods C, Usher KJ. Pre-registration nursing students’ perceptions and experience of intentional rounding: A cross-sectional study. Nurse Educ Pract 2020; 42:102691. [DOI: 10.1016/j.nepr.2019.102691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
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31
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Gagnon M, Perron A. Whistleblowing: A concept analysis. Nurs Health Sci 2019; 22:381-389. [DOI: 10.1111/nhs.12667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Marilou Gagnon
- School of NursingUniversity of Victoria Victoria British Columbia Canada
| | - Amélie Perron
- School of NursingUniversity of Ottawa Ottawa Ontario Canada
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Abstract
BACKGROUND Patient safety efforts in practice have focused on creating a just culture where errors can be identified and reported, and system remedies created to prevent reoccurrence. The same is not true of nursing education where student experiences with error and the sequelae that follow focus on individual performance. PURPOSE The purpose of this study was to adapt the Just Culture Assessment Tool (JCAT) used in practice settings into a valid and reliable instrument to evaluate just culture in academic settings. METHODS A 27-item instrument was adapted for academia. Content validity was established. Reliability was determined in a pilot study with 133 prelicensure nursing students. RESULTS The scale content validity index (CVI) was calculated at 1. The reliability of the instrument is strong (α = .75). CONCLUSIONS The CVI and pilot study findings support the use of the JCAT for Nursing Education as a valid and reliable instrument to evaluate student perception of just culture in academia.
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Novak A. Improving safety through speaking up: An ethical and financial imperative. J Healthc Risk Manag 2019; 39:19-27. [PMID: 30977243 DOI: 10.1002/jhrm.21360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Fostering a culture that empowers staff to speak up when concerned about the quality or safety of patient care is both an ethically1 and economically2 responsible endeavor. The Michigan Health & Hospital Association (MHA) Keystone Center has implemented the Speak-Up! Award program that acknowledges frontline health care staff for voicing their concerns and making care safer. The objective of this effort was to advance patient safety in Keystone Center member organizations through widespread, measurable culture improvement. After extensive data collection and analysis, there was a discernable improvement in culture survey results across a 2-year period coinciding with the launch and sustainment of the award program. Furthermore, in an effort to demonstrate the power of speaking up among staff, the Keystone Center applied a cost-savings framework to the types of harm avoided. Results from the cost-savings analysis suggest that each instance of speaking up by staff saves patients, families, and health care organizations an average of more than $13,000. METHODS Keystone Center Speak-Up! Award nominations were submitted through an electronic form that collects open, closed, and Likert-type question responses, producing a data array on type and severity of harm prevented, as well as the difficulty and magnitude of the decision to speak up. All data were then coded by harm type and subsequently applied to a tailored version of the cost-savings estimation framework used in the Great Lakes Partnership for Patients Hospital Improvement and Innovation Network. Safety culture was measured through the use of a survey instrument called the Safety, Communication, Operational Reliability, and Engagement (SCORE) instrument. RESULTS The Keystone Center Speak-Up! Award program received 416 nominations across the 2-year study period, of which 62% (n = 258) were coded as a specific harm type. Adverse drug events (n = 153), imaging errors (n = 42), and specimen errors (n = 27) were the most common harm types prevented by speaking up. After applying the cost-savings framework to these data, it is estimated that for every instance of speaking up, approximately $13,000 in total expenses were avoided, which is in line with the findings from a report on the economic impact of medical errors sponsored by the Society of Actuaries.3 Furthermore, culture survey results improved by 6% between 2015 and 2017, coinciding with the Keystone Center Speak-Up! Award program. CONCLUSIONS The Keystone Center Speak-Up! Award has proven to be a valuable tool in recognizing staff awareness and willingness to raise concerns about quality and safety in health care. Data analysis from this program presents evidence that fostering a psychologically safe culture of speaking up yields fiscal and humanistic returns, both of which are crucial to sustainable, meaningful progress in safety and quality. However, further research is required to adequately gauge the degree to which safety culture improvement is proportional to cost savings.
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Affiliation(s)
- Adam Novak
- Michigan Health and Hospital Association Keystone Center, Okemos, MI
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Cole DA, Bersick E, Skarbek A, Cummins K, Dugan K, Grantoza R. The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care. J Nurs Manag 2019; 27:1176-1181. [PMID: 31077621 DOI: 10.1111/jonm.12789] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/02/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Abstract
AIM To identify workplace factors that influence patient advocacy among registered nurses (RNs) and their willingness to report unsafe practices. BACKGROUND A prior study by Black illustrated that 34% of respondents were aware of conditions that may have caused patient harm but had not reported the issue. The most common reasons identified for failing to report issues were fear of retaliation and a belief that nothing would prevail from the reports. METHOD Using Black's study as a model, reporting data were collected from a sample of RNs actively practicing in acute care hospitals. RESULTS While reasons for reporting are consistent with Black's study, data suggest that a nurse's experiences and working environment are prime factors in their willingness to report patient care issues. CONCLUSION Although RNs may not have personally experienced workplace retaliation, fear of retaliation when reporting unsafe patient care practices still exists. Nursing leadership's ability to facilitate a culture of safety by proactively addressing unsafe practices fosters a level of comfort for patient advocacy and willingness to report issues. Education, professional associations and existing protection laws are available resources which contribute to organizational support systems. IMPLICATIONS FOR NURSING MANAGEMENT The findings of this study are consistent with the literature in that organizations need to create a supportive workplace environment whereby, through collective input and leadership, reporting protocols are in place that empower RNs to report unsafe conditions. Direct care nurses are positioned, especially well to identify and speak up regarding conditions that may result in near misses or actual adverse events. Therefore, it is the responsibility, and duty, of nursing management to create and facilitate reporting systems that will be utilized without fear of retaliation and that will contribute to a culture of safety and patient advocacy.
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Affiliation(s)
| | | | - Anita Skarbek
- School of Nursing and Health Sciences, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Kendra Dugan
- Raritan Bay Medical Center, Woodbridge, New Jersey
| | - Rosalie Grantoza
- Raritan Bay Medical Center - Old Bridge Division, Old Bridge, New Jersey
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Ion R, Olivier S, Darbyshire P. Failure to report poor care as a breach of moral and professional expectation. Nurs Inq 2019; 26:e12299. [PMID: 31162786 DOI: 10.1111/nin.12299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/01/2022]
Abstract
Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when "real-world" cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations.
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Affiliation(s)
- Robin Ion
- Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK
| | | | - Philip Darbyshire
- Philip Darbyshire Consulting Ltd., Adelaide, South Australia, Australia
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Ross C, Olson JK, Eastlick Kushner K, Murad SS, Leung WSW, Daniels S, Applin M, Eaton T. Student Preparation for Nursing Leadership: Lessons from an Undergraduate Programs Review. Int J Nurs Educ Scholarsh 2018; 15:/j/ijnes.2018.15.issue-1/ijnes-2017-0039/ijnes-2017-0039.xml. [PMID: 30210055 DOI: 10.1515/ijnes-2017-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 04/01/2018] [Indexed: 11/15/2022]
Abstract
Facilitating student achievement of nationally recognized entry-level-competencies in nursing leadership is a critical step in building capacity to promote patient safety, quality of care, and healthy work environments. Data for this substudy were drawn from a larger multi-phased, multi-method, cross-sectional, descriptive study conducted to inform comprehensive undergraduate curricular revision. The research question for this substudy was: what are the perceptions about undergraduate program preparation for nursing leadership? Frequencies and percentages summarized relevant quantitative data from the surveys and deductive content analysis was used to further explore the category of leadership which emerged from content analysis of qualitative data in the larger study. Key findings illustrate need for additional attention to learning experiences in conflict management, delegation and supervision of clinical teams, and advocacy. Greater collaboration between educational and clinical agencies is needed to find mutually beneficial strategies to support nursing leadership development for nursing students and new graduates.
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Affiliation(s)
- Carolyn Ross
- Faculty of Nursing, University of Alberta, 3 rd Floor, Edmonton Clinic Health Academy, Edmonton, Canada
| | - Joanne K Olson
- Nursing - ECHA Bldg., University of Alberta, 11405 87 Ave., Edmonton, Canada
| | - Kaysi Eastlick Kushner
- Faculty of Arts, University of Alberta, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | | | | | - Madge Applin
- Culture, Transformation & Innovation 1-60 University Terrace Bldg, Alberta Health Services, Edmonton, Canada
| | - Tristan Eaton
- Nursing and Allied Health, Keyano College, Fort McMurray, Canada
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Edrees HH, Ismail MNM, Kelly B, Goeschel CA, Berenholtz SM, Pronovost PJ, Al Obaidli AAK, Weaver SJ. Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates. Int J Qual Health Care 2018; 29:948-960. [PMID: 29186417 DOI: 10.1093/intqhc/mzx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. Design, setting, participants, intervention A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Main outcome measures Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. Results A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. Conclusions Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.
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Affiliation(s)
- Hanan H Edrees
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,National Guard Health Affairs, Quality and Patient Safety/King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Mohd Nasir Mohd Ismail
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
| | - Bernadette Kelly
- SEHA (Abu Dhabi Health Services Company), Das Tower, Sultan Bin Zayed St, Abu Dhabi, UAE
| | - Christine A Goeschel
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.,Medstar Health, 3007 Tilden St NW, Washington, DC 20008, USA
| | - Sean M Berenholtz
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Peter J Pronovost
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | | | - Sallie J Weaver
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
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Stevanin S, Causero G, Zanini A, Bulfone G, Bressan V, Palese A. Adverse events witnessed by nursing students during clinical learning experiences: Findings from a longitudinal study. Nurs Health Sci 2018; 20:438-444. [DOI: 10.1111/nhs.12430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Simone Stevanin
- Department of Medical Science; Udine University; Udine Italy
| | - Giulia Causero
- Department of Medical Science; Udine University; Udine Italy
| | | | | | | | - Alvisa Palese
- Department of Medical Science; Udine University; Udine Italy
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Ng GWY, Pun JKH, So EHK, Chiu WWH, Leung ASH, Stone YH, Lam CL, Lai SPW, Leung RPW, Luk HW, Leung AKH, Au Yeung KW, Lai KY, Slade D, Chan EA. Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses. BMJ Open 2017; 7:e015721. [PMID: 28801406 PMCID: PMC5724079 DOI: 10.1136/bmjopen-2016-015721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. DESIGN A mixed-methods design with quantitative and sequential qualitative components was used. SETTING AND PARTICIPANTS Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. RESULTS The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. CONCLUSIONS Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.
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Affiliation(s)
- George Wing Yiu Ng
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Jack Kwok Hung Pun
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- Department of Education, St Antony’s College, University of Oxford, Oxfordshire, Oxford, UK
| | - Eric Hang Kwong So
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wendy Wai Hang Chiu
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Avis Siu Ha Leung
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Yuk Han Stone
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Chung Ling Lam
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Sarah Pui Wa Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Rowlina Pui Wah Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Hing Wah Luk
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Anne Kit Hung Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kin Wah Au Yeung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kang Yiu Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Diana Slade
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- School of Literature, Languages and Linguistics, Australian National University, Canberra, Australia
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
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Usher K, Woods C, Parmenter G, Hutchinson M, Mannix J, Power T, Chaboyer W, Latimer S, Mills J, Siegloff L, Jackson D. Self-reported confidence in patient safety knowledge among Australian undergraduate nursing students: A multi-site cross-sectional survey study. Int J Nurs Stud 2017; 71:89-96. [PMID: 28364581 DOI: 10.1016/j.ijnurstu.2017.03.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient safety is critical to the provision of quality health care and thus is an essential component of nurse education. OBJECTIVE To describe first, second and third year Australian undergraduate nursing students' confidence in patient safety knowledge acquired in the classroom and clinical settings across the three years of the undergraduate nursing program. DESIGN A cross-sectional online survey conducted in 2015. SETTING Seven Australian universities with campuses across three states (Queensland, New South Wales, South Australia). PARTICIPANTS A total of 1319 Australian undergraduate nursing students. METHODS Participants were surveyed using the 31-item Health Professional Education in Patient Safety Survey (H-PEPSS). Descriptive statistics summarised the sample and survey responses. Paired t-tests, ANOVA and generalized-estimating-equations models were used to compare responses across learning settings (classroom and clinical), and year of nursing course. RESULTS Participants were most confident in their learning of clinical safety skills and least confident in learning about the sociocultural dimensions of working in teams with other health professionals, managing safety risks and understanding human and environmental factors. Only 59% of students felt confident they could approach someone engaging in unsafe practice, 75% of students agreed it was difficult to question the decisions or actions of those with more authority, and 78% were concerned they would face disciplinary action if they made a serious error. One patient safety subscale, Recognising and responding to remove immediate safety risks, was rated significantly higher by third year nursing students than by first and second year students. Two broader aspects of patient safety scales, Consistency in how patient safety issues are dealt with by different preceptors, and System aspects of patient safety are well covered in our program, were rated significantly higher by first year nursing students than by second and third year students. One scale, Understanding that reporting adverse events and close calls can lead to change and can reduce recurrence of events, was rated significantly higher by third year students than first and second year students. CONCLUSIONS In order are to achieve meaningful improvements in patient safety, and create harm free environments for patients, it is crucial that nursing students develop confidence communicating with others to improve patient safety, particularly in the areas of challenging poor practice, and recognising, responding to and disclosing adverse events, including errors and near misses.
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Affiliation(s)
- Kim Usher
- School of Health, University of New England, Armidale, NSW 2351, Australia.
| | - Cindy Woods
- School of Health, University of New England, Armidale, NSW 2351, Australia.
| | - Glenda Parmenter
- School of Health, University of New England, Armidale, NSW 2351, Australia.
| | - Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia.
| | - Judy Mannix
- School of Nursing & Midwifery, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast campus, Southport, QLD 4222, Australia.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Logan campus, Meadowbrook, QLD 4131, Australia.
| | - Jane Mills
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia.
| | - Lesley Siegloff
- School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
| | - Debra Jackson
- School of Health, University of New England, Armidale, NSW 2351, Australia.
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