Identifying the nontechnical skills required of nurses in general surgical wards

Translation and validation of the Chinese version of the Self-awareness Scale for Nurses

Background

Levels of self-awareness may affect the decision-making ability of clinical nurses and may also be related to mental health. Therefore, it is crucial to develop tools to identify nurses' level of self-awareness. The purpose of this study was to investigate the reliability and validity of a short scale among Chinese nurses and to explore the factors associated with nurses' self-awareness.

Methods

A total of 957 participants were recruited, 549 participants were used for reliability tests and 408 subjects were used for impact factor studies. They completed the General Information Questionnaire, the Self-Awareness Scale for Nurses, and the Psychological Distress Scale. Exploratory factor analysis, confirmatory factor analysis, Cronbach's alpha, and retest reliability were used to investigate the psychometric properties of the Self-Awareness Scale for Nurses. Multiple regression analyses were used in this study to investigate the relationship between nurses' self-awareness and the independent variables.

Results

A 4-factor model of the Chinese version of the Self-Awareness Scale for Nurses was validated. The overall Cronbach's alpha value for the Chinese version of the Self-Awareness Scale for Nurses was 0.873. Cronbach's alpha values for each subscale ranged from 0.808 to 0.979. Significant predictors of each dimension of the Self-awareness and the total score of the scale were age and work experience.

Conclusion

The Chinese version of the Self-Awareness Scale for Nurses is a valid and reliable scale.

Teaching nontechnical skills in the undergraduate education of health care professionals: a nationwide cross-sectional study in Hungary

BACKGROUND

The aim of our cross-sectional study was to evaluate the current situation and curriculum of nontechnical skills (NTS) training in the undergraduate education of health care professionals in Hungary.

METHODS

All institutes with relevant NTS training in Hungarian faculties of medicine and faculties of health sciences were asked to fill out a 19-item questionnaire. Descriptive statistics were performed, and the characteristics of NTS teaching and non-NTS teaching institutes were compared. The independent predictors of teaching NTS in a particular institute were identified with multiple logistic regression.

RESULTS

Seventy-seven institutes responded (52% response rate), of which 66% trained NTS. The most frequent method of NTS training is talking about them during a practice or lecture, and less than half of NTS respondents use simulation. The most frequent cause of not teaching NTS is a lack of human or technical resources. The type of faculty (p = 0.025), academic year (p = 0.001), field of medicine (p = 0.025), and importance of teamwork (p = 0.021) differed between NTS and noNTS institutes. Teaching students in academic year two represented the only independent predictor of NTS education (p = 0.012).

CONCLUSIONS

Our findings show that the undergraduate curriculum of Hungarian universities includes some type of NTS education; however, this education requires further development.

Could Spatial Awareness Affect Situation Awareness: A Conceptual Examination

PURPOSE

The purpose of this study was to explore the relationship between situation awareness (SA) and the physical environment in patient rooms through building a conceptual model.

BACKGROUND

Nurses work in very complicated and dynamic environments where having high levels of SA could be critical for their performance. Studies have also shown that nurses' awareness of the physical environment and patient room is a part of their awareness of dynamic situations in which nurses' spatial awareness may play a role in SA. Despite literature outlining the importance of SA, there is a lack of studies exploring the relationship between the two.

METHOD

A literature review was conducted for the study from nursing and psychology databases. Thirty-three articles, books, and dissertations from a scoping review were included for in-depth review.

RESULTS

An in-depth review of the harvested literature indicated that there is in fact a relationship between these two phenomena. Founded on Endsley's model of SA, the literature review in this study offers a conceptual model that articulates a plausible causal pathway between the physical environment and SA.

CONCLUSIONS

There are a lot of studies focusing on SA and various aspects of it related to nursing, but almost none mention the physical environment and its impact on SA. The current inquiry suggests that spatial awareness plays a prominent role in SA.

Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen

Objectives

This study aimed to explore, from the perspectives of nurses, how patients, the environment, and the practice of nurses interact with each other to contribute to patient falls.

Methods

A retrospective review of incident reports on patient falls, registered by nurses between 2016 and 2020, was conducted. The incident reports were retrieved from the database set up for the project of the Japan Council for Quality Health Care. The text descriptions of the "background of falls" were extracted verbatim, and analyzed by using a text-mining approach.

Results

A total of 4,176 incident reports on patient falls were analyzed. Of these falls, 79.0% were unwitnessed by nurses, and 8.7% occurred during direct nursing care. Document clustering identified 16 clusters. Four clusters were related to patients, such as the decline in their physiological/cognitive function, a loss of balance, and their use of hypnotic and psychotropic agents. Three clusters were related to nurses, and these included a lack of situation awareness, reliance on patient families, and insufficient implementation of the nursing process. Six clusters were concerned with patients and nurses, including the unproductive use of a bed alarm and call bells, the use of inappropriate footwear, the problematic use of walking aids and bedrails, and insufficient understanding of patients' activities of daily living. One cluster, chair-related falls, involved both patient and environmental factors. Finally, two clusters involved patient, nurse, and environmental factors, and these falls occurred when patients were bathing/showering or using a bedside commode.

Conclusions

Falls were caused by a dynamic interplay between patients, nurses, and the environment. Since many of the patient factors are difficult to modify in a short time, the focus has to be placed on nursing and environmental factors to reduce falls. In particular, improving nurses' situation awareness is of foremost importance, as it influences their decisions and actions to prevent falls.

Situation awareness in intensive care unit nurses: A qualitative directed content analysis

Background

Situation awareness (SA) is an essential cognitive construct to create positive patient safety outcomes. SA of the nurses in the intensive care unit (ICU), where conditions may change rapidly, is particularly important. The present study aimed to explain the perception and experience of SA in ICU nurses based on Endsley's SA model.

Materials and methods

This qualitative directed content analysis was conducted on nurses in six hospitals in Tehran, Iran, from December 2020 to July 2021. Twenty-seven ICU nurses were selected using purposive sampling. Data were collected by semi-structured interviews and field observations. The data were analyzed based on the Elo and Kyngas method modified by Assarroudi et al. COREQ checklist was used to report the research.

Results

The concept of SA in ICU nurses, based on Endsley's model, includes perception of patients' clinical cues, perception of the human environment, perception of the physical environment, and perception of the organizational environment as generic categories of the perception of the elements in the environment. SA in ICU nurses also includes the main categories of comprehension the current situation through a sense of salience and interpretation of cues and projection the future situation through the prediction of patient status into the near future and environmental foresight.

Conclusion

Findings have further developed the concept of SA in ICU nurses based on Endsley's SA model. The insights and knowledge gained from this study can be useful for future practice, education, and research on SA among ICU nurses.

Care left undone and work organisation: A cross-sectional questionnaire-based study in surgical wards of Estonian hospitals

BACKGROUND

Care left undone is a worldwide problem for both the quality of health care and the safety of patients. In surgical nursing, care left undone is a critical issue arising from the intensive pace of work, invasive procedures and the pressure for efficiency. Previous knowledge about care left undone in surgical contexts is missing.

OBJECTIVE

To describe care left undone and its relationship to nursing and organisational characteristics in the surgical wards of regional and central hospitals in Estonia.

METHODS

A cross-sectional study with an online questionnaire took place from June to October of 2018. The target population (N = 570) consisted of nurses working in the surgical wards of two regional and three central hospitals at the time of the study. The data were analysed using descriptive statistics and Fisher's exact test. The open-ended questions were analysed with deductive content analysis.

RESULTS

Nursing care in the surgical wards was reported as having been left undone sometimes or often by 88% of the nurses. Most often, the documentation and evaluation of care plans (33%) were reported as undone and most rarely, disinfection measures were left undone (5%). Nurses with a shorter employment history left care undone more frequently, and when the number of patients per nurse increased, the amount of care left undone increased as well. More than half of the participants (59%) considered work organisation to be the cause of care left undone.

CONCLUSIONS

Work organisation and staffing in surgical wards require more attention at the management level, as nursing care left undone occurred to a significant degree in the investigated wards, and more than half of the nurses considered work organisation to be the reason for care left undone.

A human factors intervention in a hospital - evaluating the outcome of a TeamSTEPPS program in a surgical ward

BACKGROUND

Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study.

METHODS

This study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders' willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data.

RESULTS

After 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions "Mutual Support" was associated with the Patient Safety Grade, after 12 months of intervention.

CONCLUSION

These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context.

TRIAL REGISTRATION NUMBER

ISRCTN13997367 (retrospectively registered).