The level of adherence to best-practice guidelines by interprofessional teams with and without acute care nurse practitioners in cardiac surgery: A study protocol

BACKGROUND

Acute care nurse practitioners (ACNPs) in postoperative cardiac surgery settings provide significant benefits to patients and organizations. Recent studies have suggested that ACNPs increase the level of adherence to best-practice guidelines by interprofessional teams. It is however, unknown whether interprofessional teams with ACNP are associated with higher levels of adherence to best-practice guidelines compared to interprofessional teams without ACNPs. Furthermore, no extraction tool is available to measure the level of adherence to best-practice guidelines by interprofessional teams in postoperative cardiac surgery settings. This project aims to measure and examine the level of adherence to best-practice guidelines of interprofessional teams with and without ACNPs in a postoperative cardiac surgery setting in Québec, Canada.

METHODS

A retrospective observational study will be conducted of 300 patients hospitalized between January 1, 2019 and January 31, 2020 in a postoperative cardiac surgery unit in Québec, Canada. Data will be collected from patient health records and electronic databases. An extraction tool will be developed based on systematic review of the literature, and will include best-practice guidelines and confounding variables related to patient and interprofessional teams' characteristics. Content and criterion validation, and a pilot-test will be conducted for the development of the tool. A multivariate linear regression model will be developed and adjusted for confounding variables to examine the association between interprofessional teams with and without ACNPs, and level of adherence to best-practice guidelines by those teams.

DISCUSSION

This project represents the first study to measure and examine the level of adherence to best-practice guidelines by interprofessional teams with and without ACNPs in a postoperative cardiac surgery setting. The findings of this project will generate empirical data focusing on the contribution of ACNPs within interprofessional teams, and ultimately enhance the delivery of high quality and evidence-based care for patients and families.

Patient safety improvement with the patient engagement in Iran: A best practice implementation project

Background

Patient engagement in patient safety is aimed at increasing the awareness and participation of patients in error-prevention strategies. The aim of this project was to improve the patient safety with the patient engagement within the local context of a maternity hospital by implementing best practice.

Methods

A clinical audit was conducted using the JBI Practical Application of Clinical Evidence System tool. The current project was conducted in surgical ward of Shahid-Beheshti maternity hospital, Iran. The sample size was 46 patients and 46 healthcare practitioners for both the baseline and follow-up. In phase 1, four audit criteria were used and a baseline audit was conducted for this project. In phase 2, barriers to compliance were identified, and strategies were adopted to promote best practice. In phase 3, a follow-up audit was conducted.

Results

The results showed varying levels of compliance with the four criteria used in this project. The criterion 1, which was related to training of healthcare practitioners on how they can support patients, has the highest compliance at 87% in baseline and follow up data collection. Furthermore, compared with the baseline data (criterion 2 = 52%; criterion 3 = 37%; criterion 4 = 61%), compliance with criteria 2, 3, and 4 notably improved at 85, 76, and 92%, respectively.

Conclusions

The present project successfully implements patient engagement in Iran and reveals varying results on compliance and the increasing knowledge of healthcare practitioners and patients on evidence-based patient engagement in order to improve the patient safety. The used strategies can facilitate implementation of evidence based procedures in clinical practice.

Perceptions and experiences of risk management by managers of residential aged care facilities: a qualitative study from Hunan Province, China

Background

With adverse events and injuries recurring in residential aged care facilities (RACFs), older adults’ safety in residential age care settings has attracted extensive attention from governments, researchers, and healthcare providers. Risk management is of utmost importance in reducing risks and improving the quality of care for older adults in long-term care. Although previous studies have made great efforts to explore risk management methods and technologies in RACFs, little is known about how managers identify and respond to risks in practice.

Purpose

This qualitative study aimed to elucidate the perceptions and experiences of managers involved in risk management in RACFs in China.

Participants and methods

This study used a phenomenological research design. We conducted semi-structured interviews with 13 managers across 11 RACFs in Changsha City, Hunan Province, China. Data were analysed using Colaizzi’s seven steps and NVivo 12 plus software.

Results

“Facilitation of an error-free culture” emerged as a central theme of managers’ perceptions of risk management. Four sub-themes were revealed, namely “creating an age-friendly physical environment,” “paying close attention to frail older adults,” “improving the competence of nursing staff,” and “building effective management programs.”

Conclusion

Facilitation of an error-free culture was of prime importance in risk management. Managers’ experiences can help RACFs to better manage risks, as well as provide new perspectives and approaches for RACFs to improve the quality and outcomes of care. This study developed initiatives for improving resident safety in RACFs and may foster interest in the developing these initiatives.

Outcomes of Effective Integration of Clinical Risk Management Into Health Care From Nurses' Viewpoints: A Qualitative Study

The aim of this study was to explore nurses' experiences and viewpoints about the outcomes of effective integration of clinical risk management (CRM) into health care. This qualitative study was conducted using purposive sampling and semistructured interviews with 19 nurses from three hospitals affiliated with a large medical university. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim. Data analysis reflected the following concepts: improving the quality of services and promoting health, preserving and protecting patient safety, increasing satisfaction, improving staff morale, and improving organizational awareness and vigilance. According to the results, CRM with its positive outcomes can help the development of a patient-oriented culture. The results can be a starting point for further quantitative and qualitative research to explore other strategies, potentials, and capacities of quality improvement activities such as CRM in other contexts and cultures.

Logan P, Khakurel J, Vizcaya-Moreno F. Nurses' Adherence to Patient Safety Principles: A Systematic Review

Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions. Patients’ participation, healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their effects on patient-safety outcomes.

Nurses' perceptions of systems thinking and safe nursing care: A cross-sectional study

AIM

To assess nurses' perceptions of systems thinking, safe nursing care and the correlation between them.

BACKGROUND

Systems thinking and safe nursing care are the key elements of quality improvement approaches, such as accreditation and patient safety programmes. However, these two variables have not been well studied in different health care settings.

METHODS

In this cross-sectional study, 300 nurses were selected using the stratified random sampling method. The data were collected using a demographic data form, systems thinking scale and assessment of safe nursing care questionnaire.

RESULTS

The scores of nurses' perceptions of systems thinking (63.25 ± 9.20) and safe nursing care (4.13 ± 0.60) were above average. A positive correlation was found between systems thinking and safe nursing care (r = .66, p < .001), and its dimensions: nursing skills (r = .61, p < .001), psychological needs (r = .56, p < .001), physical needs (r = .51, p < .001) and teamwork (r = .56, p < .001).

CONCLUSION

Regarding the correlation between systems thinking and safe nursing care, nurses and other medical professionals, especially novices, are recommended to strengthen their systems thinking skills to improve the safe nursing care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should deal with organisational condition and factors affecting some poor aspects of systems thinking and safe nursing care. They must lead, support and allocate resources to the foundations of systems thinking to achieve safe nursing care.

The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses

Background

The safety culture has recently attracted the attention of healthcare organizations. Considering the importance of the roles of nurses with regard to patient safety, their knowledge and experiences of the challenges that influence patient safety culture can facilitate the development and implementation of better strategies. The aim of this study was to explore the nurses’ experiences of the challenges influencing the implementation and integration of safety culture in healthcare.

Methods

A qualitative study with deep and semi-structured individual interviews was carried out using a purposive sampling method to select 23 nurses from four hospitals affiliated with a large medical university in Southeast Iran. Data were analysed using the conventional content analysis of Lundman and Graneheim.

Results

Data analysis reflected the main theme of the study, “A long way ahead of safety culture”. This theme includes four categories: 1) inadequate organizational infrastructure, 2) insufficient leadership effectiveness, 3) inadequate efforts to keep pace with national and international standards, and 4) overshadowed values of team participation.

Conclusion

While practical strategies for creating a safety culture may seem simple, their implementation is not necessarily easy. There are several challenges ahead for cultivating an effective and positive safety culture in healthcare organizations. To keep pace with international standards, healthcare managers must employ modern methods of management in order to overcome the challenges faced by the institutionalization of safety culture and to make a difference in the healthcare system.

Dignity in nursing care: What does it mean to nursing students?

BACKGROUND:

Despite growing interest in the potential of nursing education to enhance dignity in nursing care, relatively little is known about what dignity means to nursing students.

RESEARCH QUESTION:

What meaning does dignity in nursing care have for nursing students?

RESEARCH DESIGN:

Photo-elicitation was embedded within a Nominal Group Technique and responses were analysed by qualitative and quantitative content analysis.

PARTICIPANTS AND RESEARCH CONTEXT:

Participants were recruited from each year of a 3-year undergraduate preregistration adult nursing programme in Scotland. In total, 31 nursing students participated in the study.

ETHICAL CONSIDERATIONS:

The study was approved by the Ethics Committee of the School of Health, Nursing and Midwifery, University of the West of Scotland.

FINDINGS:

Participants articulated the meaning of dignity in nursing care in terms of the relationships and feelings involved. A total of 10 categories of meaning were identified.

DISCUSSION:

The significance of the nature of the nurse-patient interaction to preserving dignity in nursing care is highlighted.

CONCLUSION:

Understanding the meaning of dignity for nursing students may help prepare future nurses more able to preserve dignity in nursing care.

Rocky milieu: challenges of effective integration of clinical risk management into hospitals in Iran

Healthcare risks and clinical risks have been recognized as a major challenge in healthcare. Clinical risks can never be eliminated and can have serious adverse effects on patient safety. Thus, a clinical risk management (CRM) system has been introduced in the healthcare system to improve quality services. The aim of this study was to explore nurses' experiences related to the challenges of implementing CRM in the organizational context. This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach, and it consisted of 22 interview sessions with 20 nurses. The purposive sampling method was used to choose the participants from three hospitals affiliated with the Kerman University of Medical Sciences. We used semi-structured interviews and review of relevant documents to collect data. The analysis of the data led to the emergence of "rocky milieu" as the main theme, and it consisted of three categories that, along with their subcategories, explain the challenges of implementing CRM. The three categories and their subcategories were (1) organizational culture and leadership challenges (decision and performance of leadership and cultural resistance to change), (2) limitation of resources (financial, human, and physical and equipment resources), and (3) variations and complexities in working conditions (the emotional, psychological, and social atmosphere and the heaviness of workload). Attempts have been made to establish CRM through clinical governance and accreditation, but organizational challenges have created a rocky milieu for implementing CRM. However, from an organizational context concerning the suitability of healthcare in Iran, there are obvious needs to move toward quality improvement and safe practices through the effective implementation of CRM.

Patient participation in patient safety and nursing input - a systematic review

AIMS AND OBJECTIVES

This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives.

BACKGROUND

Ambiguities remain about how patients participate in routine measures designed to promote patient safety.

DESIGN

Systematic review using integrative methods.

METHODS

Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: "patient", "healthcare provider", "task", "work environment", "organisation & management".

RESULTS

We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives.

CONCLUSIONS

Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures.

RELEVANCE TO CLINICAL PRACTICE

Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety.