The role of patients in the delivery of safe care in hospital: Study protocol

Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research

BACKGROUND

In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist.

METHODS

Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist.

RESULTS

A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% (n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall.

CONCLUSIONS

Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively.

TRIAL REGISTRATION

The review protocol is registered with PROSPERO (CRD42023450715).

The effects of educational intervention on patient participation in pressure injury prevention: a pilot study

OBJECTIVE

Patients' roles in reducing pressure injuries (PIs) are emphasised in clinical guidelines, although patients' preferences are undetermined. This study evaluated the effects of a pilot six-month educational intervention on patient participation in PI prevention.

METHOD

A convenience sampling method was used to select patients admitted to medical-surgical wards at one of the teaching hospitals in Tabriz, Iran. This is a one-group pre-test and post-test interventional study, conducted via quasi-experimental design. Using a pamphlet, patients received education in preventing PIs. Data collected before and after intervention through a questionnaire were analysed using descriptive and inferential statistics (McNemar and paired t-tests) in SPSS software (IBM Corp., US).

RESULTS

The study cohort consisted of 153 patients. Findings revealed that the knowledge of the patients about PIs, patients' ability to talk with the nurses, information received about PIs, and patients' ability to participate in decisions related to PI prevention had significantly increased following the intervention (p<0.001).

CONCLUSION

Educating patients can improve their knowledge to enable them to participate in PI prevention. The findings of this study suggests further research is necessary on factors influencing patients' participation in such self-care behaviours.

Impact of Patient Communication Preferences on the Patient Trust in Physicians: A Cross-Sectional Study in Iranian Outpatient's Clinics

There are widely emerging concerns that patient confidence in physicians is diminishing as physician-patient communication is threatened globally. This study aimed to assess patient communication preferences and their impact on patient trust in physicians. A cross-sectional study was conducted among outpatient clinics of 2 public and private hospitals in Tabriz, Iran. A total of 704 patients were selected conveniently. Of the 704 patients, 6.39% had low trust, 36.79% moderate trust, 35.37% had a high trust, and 21.45% had blind trust in physicians. Overall patient communication preference score was more in a private clinic rather than a public one (P = .008). Patients of private hospitals and those who were living in rural areas have been shown to have more trust in physicians. Patients' trust in physicians showed a significant association with patient communication preference (B = 0.58; 95% CI: 0.53-0.63, P < .001).

Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals' perspectives: A systematic review and meta-synthesis

AIMS

To explore patients' and healthcare professionals' (HCPs) perceived barriers and facilitators to patient engagement in patient safety.

METHODS

We conducted a systematic review and meta-synthesis from five computerized databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus and PsycINFO, as well as grey literature and reference lists of included studies. Data were last searched in December 2019 with no limitation on the year of publication. Qualitative and Mix-methods studies that explored HCPs' and patients' perceptions of barriers and facilitators to patient engagement in patient safety were included. Two authors independently screened the titles and the abstracts of studies. Next, the full texts of the screened studies were reviewed by two authors. Potential discrepancies were resolved by consensus with a third author. The Mixed Methods Appraisal Tool was used for quality appraisal. Thematic analysis was used to synthesize results.

RESULTS

Nineteen studies out of 2616 were included in this systematic review. Themes related to barriers included: patient unwillingness, HCPs' unwillingness, and inadequate infrastructures. Themes related to facilitators were: encouraging patients, sharing information with patients, establishing trustful relationship, establishing patient-centred care and improving organizational resources.

CONCLUSION

Patients have an active role in improving their safety. Strategies are required to address barriers that hinder or prevent patient engagement and create capacity and facilitate action.

Expert perspectives on the active role of patients in their safety: Toward a framework using Delphi methodology

AIMS

To develop a framework for Patient Engagement in Patient Safety (PEPS) in hospital.

METHODS

The Delphi technique was embraced to involve a group of knowledgeable healthcare experts in the discussion and rating of the components of the PEPS framework. On a 5-point Likert scale, every item was separately rated based on the three aspects, which include applicability, clarity and validity. The PEPS framework included items with 75% or more of participants scoring 4-5 on all three aspects. Items not attaining 75% agreement on the aspects were either changed or discarded, after the group discussion and underwent another round of rerating.

RESULTS

A total of 17 members participated in the consensus-building process. Following two rounds of rating, the consensus was reached on the final framework which consisted of 28 items in four dimensions, relating to healthcare professionals, patients, community, and helth system, and three components substituted with patient empowerment, effective communication and patient-centeredness.

CONCLUSION

The development of PEPS framework is a stimulus to strengthen human resources for health capabilities, sustain a high level of quality patient outcomes, and improve the health system. Further studies to identify strategies are needed for the successful implementation of this framework.

Scoping review of patients' attitudes about their role and behaviours to ensure safe care at the direct care level

BACKGROUND

To improve harm prevention, patient engagement in safety at the direct care level is advocated. For patient safety to most effectively include patients, it is critical to reflect on existing evidence, to better position future research with implications for education and practice.

METHODS

As part of a multi-phase study, which included a qualitative descriptive study (Duhn & Medves, 2018), a scoping review about patient engagement in safety was conducted. The objective was to review papers about patients' attitudes and behaviours concerning their involvement in ensuring their safe care. The databases searched included MEDLINE, CINAHL and EMBASE (year ending 2019).

RESULTS

This review included 35 papers about "Patient Attitudes" and 125 papers about "Patient Behaviours"-indicative of growing global interest in this field. Several patterns emerged from the review, including that most investigators have focused on a particular dimension of harm prevention, such as asking about provider handwashing, and there is less known about patients' opinions about their role in safety generally and how to actualize it in a way that is right for them. While patients may indicate favourable attitudes toward safety involvement generally, intention to act or actual behaviours may be quite different.

CONCLUSION

This review, given its multi-focus across the continuum of care, is the first of its kind based on existing literature. It provides an important international "mapping" of the initiatives that are underway to engage patients in different elements of safety and their viewpoints, and identifies the gaps that remain.

The impact of patient safety culture and the leader coaching behaviour of nurses on the intention to report errors: a cross-sectional survey

Background

There is growing interest in examining the factors affecting the reporting of errors by nurses. However, little research has been conducted into the effects of perceived patient safety culture and leader coaching of nurses on the intention to report errors.

Methods

This cross-sectional study was conducted amongst 256 nurses in the emergency departments of 18 public and private hospitals in Tabriz, northwest Iran. Participants completed the Hospital Survey on Patient Safety Culture (HSOPSC), Coaching Behavior Scale and Intention to Report Errors’ questionnaires and the data was analyzed using multiple linear regression analysis.

Results

Overall, 43% of nurses had an intention to report errors; 50% of respondents reported that their nursing managers demonstrated high levels of coaching. With regard to patient safety culture, areas of strength and weakness were “teamwork within units” (PRR = 66.8%) and “non-punitive response errors” (PRR = 19.7%). Regression analysis findings highlighted a significant association between an intention to report errors and patient safety culture (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.05), leader coaching behavior (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.01) and nurses’ educational status (B = 0.8, 95% CI: − 0.1 to 1.6, P < 0.05).

Conclusions

Further research is needed to assess how interventions addressing patient safety culture and leader coaching behaviours might increase the intention to report errors.

Exploring the barriers to patient engagement in the delivery of safe care in Iranian hospitals: A qualitative study

Aim

To investigate barriers to patient engagement in the delivery of safe hospital care.

Design

Qualitative exploratory study.

Methods

A qualitative study with 35 Iranian health professionals was conducted from February to April 2019 using semi-structured interviews to elicit their opinions. MAXQDA 11 software was used for data management, and the data were analysed using framework analysis.

Results

Barriers, which potentially have negative impact on patient engagement in the delivery of safer care, were categorized into four themes. The first category included patient-related barriers such as low levels of health literacy, ineffective education, patient unwillingness and cultural barriers. The second category included staff-related barriers such as the existence of negative attitudes towards engaging patients in matters relating to patient safety, ineffective communication, high workload and the reluctance on the part of physicians to engage with patients. Barriers created by limited resources and inadequate training provided by universities and in the workplace formed the third category and community-related barriers such as the inadequate dissemination of information via the mass media and a lack of community-based services formed the fourth category.

Conclusion

Results demonstrate the multilayered nature of the significant barriers to the engagement of patients in the delivery of safe care and reflect the need for a collaborative approach between the recipients of care, researchers, care providers and policy makers if these are to be overcome.