Concept analysis of safety climate in healthcare providers

AIM AND OBJECTIVE

To report an analysis of the concept of safety climate in healthcare providers.

BACKGROUND

Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care.

DESIGN

Concept analysis.

DATA SOURCES

The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'.

METHOD

The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers.

RESULTS

Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate.

CONCLUSION

More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures.

RELEVANCE TO CLINICAL PRACTICE

The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients.

Psychogeriatric inpatient unit design: a literature review

BACKGROUND

In many parts of the world the provision of psychogeriatric inpatient units (PGUs) remains limited. More units will be required over coming decades given rapid population aging.

METHODS

Medline (1950-2010), psycINFO (1806-2009), EMBASE (1980-2009) and CINAHL (1982-2009) were searched for papers about PGU design. Selected non-peer reviewed literature such as government reports and unpublished academic dissertations were also reviewed. Data were also obtained from the literature related to general adult psychiatry inpatient units where there was limited information from studies of units designed for older people. Over 200 papers were reviewed and 130 were included.

RESULTS

There are few good quality studies to guide the design of acute PGUs and much of the existing literature is based on opinion and anecdote or, at best, based on observational studies. Randomized controlled studies comparing different designs and assessing outcomes are virtually non-existent. Several studies have identified violence and trauma resulting from hospitalization as significant problems with current acute PGU care. Despite its limitations the available literature provides useful guidance on how PGU design can optimize patient and staff safety and improve clinical outcomes.

CONCLUSIONS

There are significant problems with current acute PGUs, and patient mix on existing units is an important issue. Future research should examine patient and staff perceptions of different PGU ward environments, the relationship between ward design and clinical outcomes, the effects of segregating patients with challenging behaviors in dementia and the benefits or otherwise of gender segregation.

Reflection on the use of seclusion: in an acute mental health facility

This pilot study provides a snapshot of the use of seclusion within an acute care mental health unit in Queensland, Australia. The study collected baseline data against which practice reform aimed at reducing its use could be gauged. A mixed methodology was adopted, undertaking retrospective chart reviews, collecting qualitative survey data from individual nursing staff (n = 71) and patients (n = 4), and conducting focus groups to identify factors contributing to seclusion use. The study revealed a local facility seclusion rate of 12% compared with a national average of 10%. The re-seclusion rate of 76% was significantly higher than the national average of 31%. Eighty-seven percent of seclusion episodes were longer than 4 hours, compared with a national average of 41%. In approximately one third of cases, the required documentation was incomplete. Consumers mostly perceived seclusion as punishing and nontherapeutic, in contrast to staff, who generally viewed it as appropriate and potentially therapeutic.

Work-related factors and violence among nursing staff in the European NEXT study: A longitudinal cohort study

BACKGROUND

The occurrence of workplace violence is rather frequent within the nursing profession, with well-known consequences on the psychological health of victims.

OBJECTIVES

This study is aimed at assessing the relationships between relevant individual, organizational, and psychosocial factors, and the frequency of several types of workplace violence; the direct as well as the interactive impact of violence and psychosocial factors on organizational commitment and perceived health.

DESIGN

Questionnaire-based cross-sectional and longitudinal survey designs were employed for the two study objectives, respectively.

SETTING

Five hundred and sixty-five healthcare institutions from eight European countries participated in the Nurses' Early Exit Study.

PARTICIPANTS

The 34,107 participants were nursing staff holding different qualifications. The response rate was 55.1% in the cross-sectional part and 40.5% in the follow-up phase. At baseline, the respondents were mostly female (89.3%), in the age group 30-44 years (52.9%), registered or specialized nurses (67.0%), working mainly in medico-surgical wards (36.3%), and employed full-time (72.8%).

METHODS

In the cross-sectional analysis, the relationship between the predictor variables and frequency of violence was assessed by means of a hierarchical multiple linear regression. In the longitudinal analysis, main direct and interactive effects of violence and psychosocial factors on perceived health and organizational commitment were assessed by means of hierarchical multiple linear regression analyses with interaction terms.

RESULTS

Higher levels of adverse work-related factors were significantly associated with higher frequency of the distinguished types of violence. Significant interactions were found between psychosocial factors and violence only in predicting organizational commitment, even if effect sizes were very low. No interactions were observed for perceived health. The prevalence of the distinguished types of violence varied across the participating countries according to the presence of adverse work- and non-work-related factors.

CONCLUSIONS

These findings suggest the necessity of interventions both over working conditions conducive to violence and violent behaviours themselves.

Facteurs liés aux épisodes violents dans les soins

INTRODUCTION

The respective roles of medical specialties and work organization on violent events against healthcare workers (HCW) in different countries was examined.

METHODS

Using the results of the Presst-Next study, we analyzed data from 27134 HCW in 7 European countries. Multivariate logistic analyses were conducted with SPSS 12 software.

RESULTS

After adjustment for age, gender and other occupational risk factors, the factors indicating insufficient team work were highly associated with an increased risk of violent events. Dissatisfaction with shift change (OR=1.35; 95%CI 1.23-1.47), uncertainty about treatment (OR=1.57; 95%CI 1 .44-1.71), and frequent interruptions (OR=2.04; 95%CI 1.81-2.31) were linked to violent events, up to twice the number among HCW reporting better team work. Contradictory orders, dissatisfaction with psychological support, and harassment by superiors were all significantly associated with increased reporting of frequent violent events. We observed a positive gradient between violent events and job demand (time pressure) (OR=1.25 for an intermediate score and OR=1.55 for a high score, compared with a low score). Loneliness at work, certain work schedules, and physical load increased the risk. Nurses' aides were exposed to violent events more often (OR=1.57; 95%CI 1.38-1.79) than head nurses. Older HCW and those with more experience were less exposed. The highest risks were associated with working in psychiatric (OR=4.89; 95%CI 3.82-6.25) and emergency (OR=2.68; 95%CI 2.10-3.44) departments, compared with home care and day care. The excess risk was an additional 30% in geriatrics and long-stay departments. Significantly less risk was observed in pediatrics, obstetrics and gynecology departments (OR=0.70; 95%CI 0.56-0.88).

CONCLUSION

Team building requires time, and shift change is a key period. This time is far from nonproductive. Rather, its effective use reduces treatment errors, enhances quality of care, and reduces the frequency of violent events. It is crucial in every department.