Manager's influence on the registered nurse and nursing assistant relational quality and patient safety culture

Rural and regional maternity managers' and educators' views of the Maternity and Newborn Emergencies (MANE) education program in Victoria, Australia: a qualitative descriptive study

BACKGROUND

Australia has one of the lowest perinatal morbidity and mortality rates in the world, however a cluster of perinatal deaths at a regional health service in the state of Victoria in 2015 led to state-wide reforms, including the introduction of the Maternity and Newborn Emergencies (MANE) program. MANE was a 2-day interprofessional maternity education program delivered by external expert facilitators to rural and regional Victorian maternity service providers. An independent evaluation found that the MANE program improved the confidence and knowledge of clinicians in managing obstetric emergencies and resulted in changes to clinical practice. While there is a large volume of evidence that supports the use of interprofessional education in improving clinicians' clinical practice, the impact of these programs on the overall safety culture of a health service has been less studied. Managers and educators have an important role in promoting the safety culture and clinical governance of the heath service. The aim of this study, therefore, was to explore Victorian rural and regional maternity managers' and educators' views and experiences of the MANE program.

METHODS

Maternity managers and educators from the 17 regional and rural health services across Victoria that received the MANE program during 2018 and 2019 were invited to participate. Semi-structured interviews using mostly open-ended questions (and with a small number of fixed response questions) were undertaken. Qualitative data were transcribed verbatim and analysed thematically. Descriptive statistics were used for quantitative data.

RESULTS

Twenty-one maternity managers and educators from the 17 health services participated in the interviews. Overall, participants viewed the MANE program positively. Four themes were identified: the value of external facilitation in providing obstetric emergency training; improved awareness and understanding of clinical governance; improved clinical practice; and the importance of maintaining the program. Participants agreed that MANE had improved the confidence (94%) and skills (94%) of clinicians in managing obstetric emergencies, as well as confidence to escalate concerns (94%), and most agreed that it had improved clinical practice (70%) and teamwork among attendees (82%).

CONCLUSION

Maternity managers and educators were positive about MANE; they considered that it contributed to improving factors that impact the safety culture of health services, with delivery by external experts considered to be particularly important. Given the crucial role of maternity managers and educators on safety culture in health services, as well in program facilitation, these findings are important for future planning of maternity education programs across the state.

TRIAL REGISTRATION

Trial registration was not required for this study.

Perceived patient safety culture and its associated factors among clinical managers of tertiary hospitals: a cross-sectional survey

BACKGROUND

Patient safety is a global challenge influenced by perceived patient safety culture. However, limited knowledge exists regarding the patient safety culture perceived by hospital clinical managers and its associated factors. This study aims to investigate the perceptions of patient safety culture and associated factors among clinical managers of tertiary hospitals in China.

METHODS

A cross-sectional survey was conducted from June 19 to July 16, 2021, involving 539 clinical managers from four tertiary hospitals in Changsha City of Hunan Province. The Hospital Survey on Patient Safety Culture (HSOPSC) was utilized to assess perceived patient safety culture. Bivariate, multivariable linear regression, and logistic regression analyses were performed.

RESULTS

The mean score for the total HSOPSC was 72.5 ± 7.6, with dimensional scores ranging from 62.1 (14.9) to 86.6 (11.7). Three dimensions exhibited positive response rates (PRRs) < 50%, indicating areas that need to be improved: "nonpunitive response to errors" (40.5%), "staffing" (41.9%), and "frequency of events reported" (47.4%). Specialized hospitals (β = 1.744, P = 0.037), female gender (β = 2.496, P = 0.003), higher professional title (β = 1.413, P = 0.049), a higher education level (β = 1.316, P = 0.001), and shorter time delays per shift (β=-1.13, P < 0.001) were correlated with higher perceived patient safety culture. Education level, work department, "teamwork within a unit", "management support for patient safety", "communication openness", and "staffing" dimensions were associated with patient safety grades (all P < 0.05). Years worked in hospitals, occupation, education level, work department, hospital nature, professional title, "communication openness", and "handoffs & transitions" were associated with the number of adverse events reported (all P < 0.05).

CONCLUSIONS

Our study revealed a generally low level of patient safety culture perceived by clinical managers and identified priority areas requiring urgent improvement. The associated factors of patient safety culture provide important guidance for the development of targeted interventions in the future. Promoting patient safety by optimizing the patient safety culture perceived by clinical managers should be prioritized.

Administration approaches of nursing assistants in hospitals: a scoping review

OBJECTIVES

The administration of nursing assistants (NAs) is closely associated with patient outcomes, but studies evaluating intrahospital administration of NAs are limited. This study aimed to identify existing literature on intrahospital NAs' administration approaches.

DESIGN

Scoping review.

DATA SOURCES

PubMed, Embase, CINAHL, Scopus, ProQuest, CNKI, APA PsycInfo, Wanfang Med, SinoMed, Ovid Emcare, NICE, AHRQ, CADTH, JBI EBP and Cochrane DSR were searched for articles published between January 2011 and March 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Qualitative, quantitative or mixed-method studies and evidence syntheses that evaluate administration approaches, models and appraisal tools of intrahospital NAs were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers conducted search, data selection and data extraction according to Joanna Briggs Institute guidance and methodology for scoping review. The quality of included studies was assessed using Mixed Methods Appraisal Tool or AMSTAR V.2. Data were synthesised using narrative methods and frequency effect size analysis.

RESULTS

Thirty-six studies were eligible, with acceptable quality. We identified 1 administration model, 9 administration methods, 15 educational programmes and 7 appraisal tools from the included studies. The frequency effect size analysis yielded 15 topics of the main focus at four levels, suggesting that included articles were mainly (33%) focused on the competency of NAs, and the lectures were the most (80%) used strategy in quality improvement projects. Evidence from the studies was of low-to-moderate quality, indicating huge gaps between evidence-based research and management practice.

CONCLUSIONS

Practical intrahospital administration approaches were revealed, and fifteen primarily focused topics were identified. We should explore this area more thoroughly using structured frameworks and standardised methodology. This scoping review will help managers find more effective ways to improve the quality of care. Researchers may focus more on evidence-based practice in NA administration using the 15 topics as a breakthrough.

Medical-surgical nurse leaders' experiences with safety culture: An inductive qualitative descriptive study

AIM

To describe safety culture as experienced by medical-surgical nurse leaders.

BACKGROUND

Safety culture remains a barrier in safer patient care. Nurse leaders play an important role in creating and supporting a safety culture.

METHODS

An inductive qualitative descriptive study using semi-structured interviews, document review, and observations in a Midwestern community hospital in the United States.

RESULTS

Making sure nurses are keeping patients safe, making sure nurses have nursing interventions in place, expecting nurses to stop unsafe acts or escalate when they feel uncomfortable, making sure nurses have what they need to provide safe care, organization prioritizes patient safety, and making sure nurses are learning and growing emerged as themes describing safety culture.

CONCLUSIONS

Nurse leaders made sure patients were safe by making sure everyone was doing their best to provide safe care. Insufficient time, too many priorities, insufficient resources, poor physician behaviors, and lack of respect for their role emerged as barriers to leading a safety culture.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizations must remove barriers for nurse leaders to develop and lead a safety culture. Nurse leaders must learn to advocate successfully for safe nursing care and professional work environments.