The effect of nurse empowerment educational program on patient safety culture: a randomized controlled trial

Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature

BACKGROUND

In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified?

METHODS AND ANALYSIS

We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects.

RESULTS

We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units.

DISCUSSION

This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.

Perceived authority gradients among anaesthetic teams in Malta

Over the decades, cases like those of Elaine Bromiley, who passed away after a 'cannot intubate, cannot ventilate' scenario, have prompted deeper analyses of team dynamics and authority gradients. It is thought that a steep authority gradient may have impeded lifesaving communication between members of the anaesthetic team, leading to her death. Using an online questionnaire, we carried out a cross-sectional observational study exploring the perceived authority gradients within anaesthetic teams in the main operating theatres at Mater Dei Hospital, Malta. Nurses were found to experience a steeper authority gradient than anaesthetists. They were less comfortable making suggestions too and also felt like the suggestions they made were less listened to by lead anaesthetists. To a lesser extent, females also experienced a steeper authority gradient. Increasing age and grade were associated with a flatter authority gradient. Further research needs to be carried out to identify the underlying reasons behind the steeper perceived authority gradient affecting nurses. Interventions are being planned to attempt to decrease the perceived authority gradient.

The nurses' perception of the factors influencing professional misconduct: A qualitative study

BACKGROUND

Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors.

AIM

This study aimed to explain the factors influencing professional misconduct in nurses.

RESEARCH DESIGN

This qualitative study was conducted using the conventional content analysis method.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach.

ETHICAL CONSIDERATIONS

The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality.

FINDINGS

Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics).

CONCLUSION

This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.

A survey on the effects of patient safety training programs based on SBAR and FMEA techniques on the level of self-efficacy and observance of patient safety culture in Iran hospital, Shiraz in 2022-2023

BACKGROUND AND OBJECTIVE

Patient safety and medical personnel self-efficacy are among the main factors involved in providing quality health services. Moreover, safety culture in an organization is considered one of the most critical factors regarding patients' safety. Therefore, the present study aimed to determine the effects of patient safety programs based on Situation, Background, Assessment, Recommendation (SBAR) and Failure Model Effects Analysis (FMEA) techniques on self-efficacy and patient safety culture in Iran Hospital of Shiraz in 2022-2023.

MATERIALS AND METHODS

This two-stage quasi-experimental study was conducted in 2022-2033. Considering inclusion criteria, the present study included 80 nurses working in Iran Hospital. The participants were divided into groups of SBAR (40 participants) and FMEA (40 participants). All the data were collected using a Hospital Survey on Patient Safety Culture questionnaire and Sherer General Self-Efficacy Scale. Then, the collected data were analyzed using SPSS 13, Fisher's exact test, paired t-test, and independent t-test with a significant level of P < 0.05.

RESULTS

The mean score of total patient safety culture between the two groups was insignificant before the intervention (P = 0.58). However, it was more significant in the FMEA group than the SBAR group after the intervention (P < 0/05). In addition, the mean self-efficacy score between the two groups was insignificant before the intervention (P = 0.80). However, after the intervention, the mean score of the FMEA group was significantly higher than the SBAR group (P < 0.05).

CONCLUSION

According to the findings of this study, there is a meaningful relationship between patient safety training programs based on SBAR and FMEA techniques on patient safety and self-efficacy of nurses; however, FMEA training has more positive effects on self-efficacy and patient safety compared to other techniques. As a result, these techniques, along with other plans, are recommended to authorities in order to help improve patient safety.

Baby-Friendly Hospital Initiative: Past, Present, and Future

Quality improvement is paramount in the nursing profession today, and there is increased awareness and focus on implementing evidence-based practices into nursing care. The Baby-Friendly Hospital Initiative (BFHI) is an evidence-based program that promotes and protects exclusive breastfeeding by encouraging breast milk feeds to infants from the time of birth. This article will discuss the history and current state of breastfeeding in the United States as well as an evidence-based change model that can be used to implement the BFHI to change the status quo and future of breastfeeding in the United States. Physical benefits to the infant and mother as well as financial benefits to the mother, hospital, and global economy will also be addressed.

Patient safety in hemodialysis clinics: perception of the nursing team

OBJECTIVE

To analyze the perception of the nursing team regarding patient safety in hemodialysis clinics.

METHOD

Descriptive-exploratory study with a qualitative approach, conducted with 37 professionals from the nursing team of five hemodialysis clinics, located in the cities of Sobral and Fortaleza, in Ceará, Brazil. Data were collected from October to December 2021, through semi-structured interviews recorded and analyzed by Descending Hierarchical Classification.

RESULTS

Four classes emerged: operation of hemodialysis clinics; role of companions and patients in their safety in hemodialysis clinics; role of the nursing team in the safe care of patients undergoing hemodialysis; international patient safety goals in hemodialysis clinics.

CONCLUSION

The participants recognize the existence of shortcomings in international patient safety goals, mainly errors in patient identification and medication administration.

Effectiveness and feasibility of an interprofessional training program to improve patient safety-A cluster-randomized controlled pilot study

Introduction

Interprofessional healthcare teams are important actors in improving patient safety. To train these teams, an interprofessional training program (IPTP) with two interventions (eLearning and blended learning) was developed to cover key areas of patient safety using innovative adult learning methods. The aims of this study were to pilot test IPTP regarding its effectiveness and feasibility. The trial was registered with DRKS-ID: DRKS00012818.

Methods

The design of our study included both a pilot investigation of the effectiveness of the two interventions (eLearning and blended learning) and testing their feasibility (effectiveness-implementation hybrid design). For testing the effectiveness, a multi-center cluster-randomized controlled study with a three-arm design [intervention group 1 (IG1): eLearning vs. intervention group 2 (IG2)]: blended learning (eLearning plus interprofessional in-person training) vs. waiting control group (WCG) and three data collection periods (pre-intervention, 12 weeks post-intervention, and 24 weeks follow-up) was conducted in 39 hospital wards. Linear mixed models were used for the data analysis. The feasibility of IPTP was examined in 10 hospital wards (IG1) and in nine hospital wards (IG2) using questionnaires (formative evaluation) and problem-focused interviews with 10% of the participants in the two intervention groups. The collected data were analyzed in a descriptive exploratory manner.

Results

Pilot testing of the effectiveness of the two interventions (eLearning and blended learning) showed no consistent differences between groups or a clear pattern in the different outcomes (safety-related behaviors in the fields of teamwork, error management, patient involvement, and subjectively perceived patient safety). Feasibility checks of the interventions showed that participants used eLearning for knowledge activation and self-reflection. However, there were many barriers to participating in eLearning, for example, lack of time or access to computers at the ward. With regard to in-person training, participants stated that the training content sensitized them to patient-safety-related issues in their everyday work, and that awareness of patient safety increased.

Discussion

Although the interventions were judged to be feasible, no consistent effects were observed. A possible explanation is that the duration of training and the recurrence rate may have been insufficient. Another conceivable explanation would be that participants became more sensitive to patient safety-critical situations due to their knowledge acquired through the IPTP; therefore, their assessment post-intervention was more critical than before. In addition, the participants reported high pre-measurement outcomes. Future studies should examine the evidence of the intervention within a confirmatory study after adapting it based on the results obtained.

The effect of electronic error-reporting forms on nurse's stress and the rate of error-reporting

OBJECTIVES

The patient safety culture includes a systematic approach that promotes safe care for patients and the leadership that supports it. Medical errors threaten patient safety. A significant portion of medical errors is committed by nurses. Although error-reporting provides valuable information to prevent errors, most nurses do not report their errors due to their high level of stress. This study was to investigate the effect of electronic error-reporting forms on nurses' stress and the rate of error-reporting.

METHODS

The nurses' level of stress was compared when using paper error-reporting and 6 months after using electronic forms. A revised version of the Coudron questionnaire was completed by 186 nurses. Data were analyzed by SPSS 23 using Wilcoxon test. The number of reported errors in paper and electronic media was compared over the same period.

RESULTS

Implementation of the electronic error-reporting form reduced the job stress of nurses by 22.22 points (p=.00) and increased the error-reporting rate by 12.86% (p<.05).

CONCLUSIONS

Although nurse's stress significantly decreases after implementing electronic error-reporting forms, their level of stress is still high and they are still at risk for physical and mental problems. Using methods like modifying the error-reporting form will increase the error-reporting rate.

Psychometric evaluation of the Persian version of the Hospital Survey on Patient Safety Culture Questionnaire (HSOPSC) in neonatal intensive care units: a methodological study

BACKGROUND

A valid and reliable tool compatible with the culture is needed to evaluate the safety culture as one of the vital and promotional components in improving the quality of safety and health care. This study aimed to investigate the psychometric properties of the Persian version of the "Hospital Survey on Patient Safety Culture (HSOPSC)" in physicians and nurses working in Neonatal Intensive Care Units.

METHODS

In this methodological research, the qualitative face, content validity, and construct validity were performed by Confirmatory Factor Analysis to the psychometric evaluation of the HSOPSC questionnaire. Based on convenience sampling and the inclusion criteria, 360 individuals completed the questionnaire. Internal consistency and stability were measured. Data analysis was performed using SPSS 21 and LISREL.

RESULTS

In examining the construct validity, fit indices were not appropriate for the 12-dimension model of the Persian version. According to T-value, six heterogeneous items and a dimension were omitted. The 11-dimension model with 36 items showed an appropriate fit with the data. Cronbach's alpha was evaluated at 0.79, and the stability was 0.82 (p˂0.001).

CONCLUSION

The Persian version of HSOPSC with 11 dimensions and 36 items has favorable validity and reliability and can be used in NICUs.

Evaluation of a charge nurse leadership development program

A pilot study evaluated the change in charge nurses' perception of their leadership skills after engaging in a 4-month structured leadership program. Based on a self-assessment, multimodal education using authentic leadership tenets and an appreciative inquiry framework increased participants' confidence in their skills.

The association of patient safety culture with intent to leave among Jordanian nurses: a cross-sectional study

BACKGROUND

The existence of patient safety culture is crucial for healthcare providers' retention, particularly for nurses. Patient safety culture is getting more attention from healthcare organizations worldwide, and Jordan is no exception. Nurses' satisfaction and retention are paramount to providing safe, high-quality patient care.

PURPOSE

To investigate the relationship between patient safety culture and intent to leave among Jordanian nurses.

METHODS

A descriptive cross-sectional design was used. A sample of 220 nurses was selected through convenience sampling from one governmental and one private hospital in Amman. The patient safety culture survey and anticipated turnover scale were used to collect data. Descriptive statistics and Pearson r correlation were used to answer the research questions.

RESULTS

The findings showed that nurses had 49.2% positive scores for patient safety. Teamwork (65.3%) and handoff and exchange of information (62% each) had the highest scores, while staffing and workplace (38.1%) and response to error (26.6%) had the lowest. Moreover, nurses had strong intentions to leave their jobs (M = 3.98). A moderately significant but not highly negative relationship existed between patient safety culture and intent to leave (r = -0.32, p = 0.015).

CONCLUSIONS

There are opportunities to improve patient safety culture, satisfaction, and nurse retention in Jordanian hospitals by implementing several recommendations, such as ensuring better staffing patterns and increasing staff motivation by utilizing various available methods.

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

Simulation-based training program on patient safety management: A quasi-experimental study among new intensive care unit nurses

BACKGROUND

Patient safety is an essential responsibility of nurses. However, newly graduated nurses experience patient safety incidents due to a lack of patient safety competency. In particular, intensive care unit nurses provide care to critical patients, making it difficult for new nurses to maintain patient safety. Therefore, it is necessary to improve the patient safety competency of newly graduated nurses working in the intensive care unit.

OBJECTIVES

To analyze the effects of a simulation-based training program on patient safety management on the patient safety competency, patient safety management activity, communication self-efficacy, and teamwork of newly graduated nurses working in an intensive care unit.

DESIGN

A quasi-experimental study.

SETTINGS

The study was conducted at a university in Korea.

PARTICIPANTS

A total of 44 newly graduated nurses working in the intensive care unit of a university hospital.

METHODS

A simulation-based training program on patient safety management was applied to the experimental group (n = 22), while only the usual hospital training program was used for the control group (n = 22). A structured questionnaire survey comprising Patient Safety Competency Self-Evaluation, Patient Safety Management Activities, the Korean version of the self-efficacy questionnaire, and K-self assessment of teamwork was conducted at baseline test (T1), post test (T2), and follow-up test (T3). Data were analyzed using a repeated measures ANOVA.

RESULTS

The experimental group showed significantly higher patient safety competency, patient safety knowledge, and patient safety skills, along with higher communication self-efficacy scores than the control group (p < .05) after the intervention and at four weeks after the intervention.

CONCLUSIONS

The simulation-based training program on patient safety management effectively improved the patient safety competency, patient safety knowledge, and patient safety skills as well as communication self-efficacy of newly graduated nurses working in an intensive care unit.

Strategies to improving patient safety in hospitals

Introduction: Patient safety is the initial foundation of quality healthcare that shared responsibility between policymakers as well as healthcare delivery, especially nurses, who aim for improvement. Interventions in patient safety culture reduce safety incidents, thereby, lowering the disability rates and deaths due to side effects of healthcare delivery. Therefore, this research aims to provide an overview of strategies to improve patient safety culture, which involves nurses in hospital settings. Design and Methods: In this research, a Scoping review was carried out using online database searches at ProQuest, Ebsco, and Sciencedirect. The selected article was experimental research, using English, published between 2011-2021, and fulfilled the criteria for inclusion and exclusion set. Result: In the initial disbursement, 480 articles were obtained with 13 studies that meet the inclusion criteria. The articles obtained used quasi-experimental research methods (2 articles), pre-post intervention design (4 articles), intervention time series (2 articles), randomized controlled trial (1 article), prospective cohort intervention (1 article), repeated cross-sectional experimental research (1 article), Mix quasi-experimental method non-randomized design and qualitative (1 article), and control groups (4 articles). Based on the articles obtained, the strategies to increase the patient safety culture in hospitals can be categorized into 4, which include educational, simulation, team, and comprehensive programs. Conclusions: All interventions implemented possess a positive impact on patient safety culture.  

Effect of patient safety education interventions on patient safety culture of health care professionals: Systematic review and meta-analysis

AIM

To synthesize and evaluate the cumulative effect of patient safety education intervention for health care professional staff in the hospital setting on their patient safety culture.

BACKGROUND

Patient security Culture is an important factor in ensuring patient safety and it is recommended as one of the pillars of preventive strategies in the healthcare system.

DESIGN

Systematic review and meta-analysis were prospectively registered with PROSPERO.

METHODS

This review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, Ovid, CINAHL, Cochran Library, Web of Science and randomized control trial registration databases from January 1999 to February 2021. Studies on patient safety culture intervention were included. We assessed research quality using the jadad scale for RCTs and the Methodological Index for Non-Randomized Studies RESULTS: Sixteen studies with a total of 3438 participants in the intervention group and 3121 in the control group were included in the final analysis. The random-effect meta-analysis shows significant heterogeneity among studies that assessed patient safety culture as a mean percentage of positive responses or as a mean score of 1-5 scale. (I² = 91% and 77%, respectively). Also, there was a significant difference between experimental and control group in the overall pooled effect of patient safety culture in the studies that used the mean percentage of positive response [Mean Difference = 5.24, 95% confidence interval (1.32, 9.16, Z = 2.62; P = 0.009] or the mean score [Mean Difference = 0.08, 95% confidence interval (0.01, 0.15), Z = 2.26; P = 0.02]. The difference was no longer significant in the mean score studies after excluding the studies with low-quality scores. Subgroup analysis showed no change in the pooled effect of the studies with quasi-experimental [Mean Difference = 7.84, 95% confidence interval (2.35, 13.33); Z = 2.80; p = 0.005) or before-after design [MD= 0.11, 95% confidence interval (0.07, 0.14); Z = 5.74; p = 0.000]. However, the patient safety education intervention remained effective after one year of follow-up.

CONCLUSIONS

Our review Provides empirical evidence on current efforts in patient safety education to improve a healthcare professional-patient safety culture. The Patient safety education program could improve the patient safety culture of health care professionals.

Nurses' perceptions about patient safety culture in public hospital in Vietnam

AIM

This paper is aimed to assess nurses' perceptions of patient safety culture in four public general hospitals in Hanoi, Vietnam.

BACKGROUND

Patient safety culture is a vital component in ensuring high quality and safe patient care. Assessment of nurses' perceptions on existing hospital patient safety culture (PSC) is the first step to promote PSC.

METHODS

The cross-sectional study surveyed 705 nurses utilizing the validated Hospital Survey on Patient Safety Culture (HSOPSC) in an online format.

RESULTS

The average positive response rate was high at 72.8 % and varied from 52.9 % to 93.4 %. The strongest areas are teamwork within units (93.7 %) and supervisor/manager expectations and actions promoting patient safety (85.0 %). The areas for improvement are staffing (52.9 %) and non-punitive response to error (57.6 %). The communication openness, staffing, frequency of events reported, lengths of services in hospital and unit are significant factors that predict the overall patient safety grade.

CONCLUSIONS

Initiatives are necessary to improve response to errors, staffing, and error reporting. Nurse managers could develop and implement interventions and program to improve patient safety, including providing education related to patient safety culture, encouraging staff to notify incidents and avoiding punitive responses.

Complications Associated with Peripherally Inserted Central Catheters (PICC) in People Undergoing Autologous Hematopoietic Stem Cell Transplantation (HSCT) in Home Hospitalization

INTRODUCTION

The SARS-CoV-2 pandemic generated the need to keep immunosuppressed patients away from hospital institutions for as long as possible. This in turn stimulated the implementation of a home hospitalization model for autologous hematopoietic stem-cell transplantation (HSCT).

PURPOSE

To analyze whether there are significant differences in post-transplantation complications related to catheters observed in patients treated in the home-transplant care modality compared to patients treated in the hospital.

METHODOLOGY

Observational, analytical, longitudinal, and retrospective study of cases and controls. A convenience sample was chosen, in which the cases comprised 20 patients included in the home HSCT care model. For each patient, it was considered suitable to propose two controls among those who received autologous transplantation in the last five years with a baseline demographic and pathological profile similar to the case for whom they were control.

RESULTS

The home patients achieved an average of 22.4 ± 2.6 days of evolution with an average of 16.4 ± 2.08 days post-transplant, compared to the hospital process with an average of 21.21 ± 4.18 days of evolution and 15.51 ± 3.96 days post-transplant (evolution days p = 0.022; post-transplant days p = 0.002). A higher percentage of use of parenteral nutrition (p = 0.036) and transfusions (p = 0.003) was observed during the post-transplant phase in the hospital. The rest of the therapeutic measures did not show significant differences. When analyzing the frequency of adverse effects in the post-transplant phase, a significant increase in neutropenic fever (OR = 8.55) and positive blood cultures (OR = 6.65) was observed in hospital patients. Any other significant differences in other variables related to PICC were found (presence and days of neutropenic fever, catheter infection, complications, pathogens, admission to the ICU, or death). Concerning local complications (pain, DVT, Medical adhesive-related Skin Injury, and erythema), there was more erythema in the hospital (p = 0.056).

CONCLUSIONS

The results obtained indicate that regarding the appearance of complications associated with PICCs in home hospitalization HSCT patients, there are no significant differences compared to hospitalization, so that home care can be a safe context for people with these lines.

Evaluation of Clinical Competence and Job Satisfaction and Their Related Factors Among Emergency Nurses in Palestinian Hospitals

Introduction

Nurses are responsible for providing primary care to millions of patients, and emergency nurses serve on the frontline in providing care for mildly to severely critically ill patients.

Objectives

This study aims to assess and evaluate the clinical competence and its related factors among emergency nurses in Palestinian hospitals.

Methods

A cross-sectional study was conducted among 170 nurses working in the emergency units of hospitals in the West Bank, Palestine. Data collection utilized the Nurse Competence Scale, and the Job Satisfaction Scale.

Results

The results showed that only 33(19.4%) of the participants exhibited a good level of clinical competence, with none reaching the very good level. Among them, the highest proportion of good level 60 (35.3%) was in the helping role, while the lowest 38 (22.4%) was in ensuring quality. About 35% of nurses reported very low or low job satisfaction, while 58% had high or very high job satisfaction. Additionally, the results revealed a statistically significant relationship between clinical competence and job satisfaction (P < 0.05). Both clinical competence and job satisfaction were positively correlated with age and experience.

Conclusion

The study found a significant relationship between demographic characteristics (e.g., education, experience, and marital status) and clinical competency among emergency nurses. Notably, less than half of the participants demonstrated good clinical competency, with none reaching a very good level. The highest scores were observed in the helping role domain, while the lowest were in the ensuring quality domain. Furthermore, clinical competence was found to be significantly associated with job satisfaction. Consequently, enhancing nurses' clinical competency will lead to an improvement in the quality of patient care.

The relationship between surgical intensive care unit nurses' patient safety culture and adverse events

BACKGROUND

Adverse events are often encountered in surgical intensive care units (ICUs), and most of them occur due to preventable errors. Establishment of a patient safety culture is recommended for preventing and reducing these errors.

AIMS

This study was performed to investigate the relationship between surgical ICU nurses' patient safety culture and adverse events.

DESIGN

This was a cross-sectional descriptive study.

METHODS

The study was performed in the surgical ICUs of four university hospitals in Izmir province, Turkey and was conducted in accordance with the Declaration of Helsinki and approved by an Ethics Committee. The sample comprised 113 nurses working in the surgical ICUs of the hospitals between November 2018 and February 2019. Data were collected using a questionnaire that comprised a demographic form, adverse events form, and patient safety culture hospital questionnaire. Student's t test, one-way analysis of variance, and logistic regression analyses were used to evaluate the data. P values <.05 were considered significant.

RESULTS

At the end of the study, nurses' level of patient safety culture was found to be intermediate (65.5%), with the highest average positive response rate (PRR) obtained for teamwork within the units (65.5%) and the lowest average PRR obtained for the frequency of adverse event reporting (25.3%). There was a significant correlation between patient safety culture and adverse events (r = 0.027, P < .05).

CONCLUSIONS

Surgical ICUs nurses' level of patient safety culture was average, and there was a significant correlation between patient safety culture and adverse events.

RELEVANCE TO CLINICAL PRACTICE

Managers should establish a reliable system for reporting adverse events and encourage ICU nurses to report them. It is very important to adopt a non-punitive approach at instances when an adverse event is reported.

Patient Safety Training Programs for Health Care Professionals: A Scoping Review

OBJECTIVE

This study aimed to map the evidence available on patient safety training programs for health professionals.

METHODS

A scoping review was carried out. Several studies published between January 2010 and March 2020 in the following databases were investigated: CINAHL; MEDLINE; Nursing & Allied Health Collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane; MedicLatina , via EBSCOhost; World Health Organization; Google Scholar; BVS- Biblioteca Virtual da Saúde ; PubMed; B-On; and RCAAP- Repositórios Científicos de Acesso Aberto de Portugal .

RESULTS

A total of 2841 articles were found, 7 were included. Most studies report that the development of patient safety programs for health care professionals provides them with tools and techniques to recognize adverse incidents induced by the professional system/practice; recognize human factors related to patient safety, such as nontechnical skills or tiredness; understand high-risk clinical processes; develop strategies that influence and enhance patient safety culture; promote communication, teamwork, and organizational culture concerning patient safety; analyze other characteristic and emerging topics in patient safety; and develop project proposals to improve patient safety, allowing health care professionals to consolidate their knowledge, leading initiatives to improve patient safety.

CONCLUSIONS

There are still few studies that test patient safety training programs, which is a concern given the importance of implementing safe practices. The existing evidence proves the efficacy of the training programs in improving patient safety, although there are some gaps.

Effectiveness of speak-up training programs for clinical nurses: A scoping review

BACKGROUND

Speaking up about patient safety concerns is critical when bedside nurses encounter unsafe situations. Training programs that encourage nurses' speaking up behavior have been introduced, but there is limited evidence regarding whether such training leads to behavior change or improves patient safety.

OBJECTIVE

The aim of this review was to identify the effectiveness of speak-up training programs for clinical nurses, focusing on program content and outcomes.

DESIGN

A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to the Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines.

METHODS

This study used bibliographic databases of PubMed, Embase, PsycINFO, Scopus, ProQuest Dissertations and Theses Global for the English language, and NDSL, KCI, RISS, KISS, and DBpia for the Korean language. The literature search used a combination of keywords and subject headings related to speak-up training programs for nurses or any type of nurse training program with an assertiveness component. Training outcomes were evaluated according to the 4-level Kirkpatrick model.

RESULTS

A total of 4808 references were retrieved, of which 21 articles were selected. These 21 studies were conducted in different parts of the world and published from 1981 to 2020. Speak-up training primarily increased some degree of nurses' levels of assertiveness and speak-up behavior, and also led to secondary outcomes such as job stress, work motivation, and communication conflicts. Most studies (n = 19) applied traditional training formats which consisted of multi-session lectures and practice, whereas three studies applied new methodologies such as high-fidelity simulations and online learning. According to the Kirkpatrick model, five studies assessed reactions to speak-up training (level 1), all studies evaluated learning as a result of training (level 2), two studies measured the effect of speak-up training on nurses' behavior (level 3), and one study evaluated nurses' results (level 4) while no studies evaluated patient-level outcomes.

CONCLUSIONS

Speak-up training for nurses can improve their levels of assertiveness or speak-up behaviors. Despite inconsistent or mixed findings, speak-up training has the potential to improve nurses' psychological well-being, leading to positive organizational performance. New training methods are directed at specialized education for clinical situations. Future speak-up training should consist of training programs based on real clinical situations in which team members participate together to comprehensively evaluate the effect of training on behavioral changes of health professionals as well as patient safety.

Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small-Medium-Sized Hospitals: A Cross-Sectional Study

Perceived safety culture and nursing work environment are considered important prerequisites for a patient safety activity. Patient safety is also associated with person-centered care; however, few studies apply the person-centered care framework which includes staff attributes and care environment. This study aimed to examine the canonical correlations of person-centered care factors, including professional self-concept, patient safety culture, nursing work environment, and patient safety activities of nurses working in small-medium-sized hospitals. A cross-sectional survey was used. Participants included 171 nurses from seven small-medium-sized hospitals in Busan metropolitan city, in Korea. Data were analyzed using descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation coefficients, and canonical correlations. Two significant canonical variates were found. First, better professional self-concept, a positive patient safety culture, and better nursing work environment were associated with better patient safety care activities. Second, a negative patient safety culture and healthy nursing work environment were associated with a lack of communication between medical staff. Person-centered framework factors such as staff attributes and care environment were positively associated with patient safety activities. Based on the results, nurses in small-medium-sized hospitals should be highly aware of their professional self-concept. Moreover, nurses should be equipped with psychological safety and a healthy work environment to enhance patient safety activities.

Usefulness of Midline Catheters versus Peripheral Venous Catheters in an Inpatient Unit: A Pilot Randomized Clinical Trial

Canalization of vascular accesses is one of the most used techniques in hospitalization units. When talking about peripherally inserted catheters, we can differentiate between peripheral intravenous catheters (PIVC), midline catheters, and long peripheral catheters (LPC). Midline catheters are rarely used despite being recommended for intravenous therapies lasting more than six days. This research is a pilot study of a longitudinal clinical trial. It aims to compare the complications associated with intravenous therapy between the control group (CG) with a PIVC and the experimental group (EG) with a midline in an Internal Medicine Unit of a Spanish hospital for three months. In this study, 44 subjects participated, 25 in the CG and 19 in the EG. The duration of cannulation was longer in the experimental group (8.13 days vs. 3.22, p < 0.001), and the appearance of phlebitis was more significant in the control group (19 patients in CG and 25 patients in EG). Midlines have presented a longer duration of cannulation and fewer complications than the PIVC. This protocol was registered with ClinicalTrials.gov (NCT05512117).

Factors Affecting Patient Safety Culture from Nurses’ Perspectives for Sustainable Nursing Practice

Individual and group beliefs, attitudes, perceptions, competences, and behavioral patterns all contribute to the safety culture of a healthcare company. The study’s goal is to assess nurses’ perceptions of elements that influence patient safety culture in order to promote long-term nursing practice. A descriptive cross-sectional study design was done among a sample of 146 nurses who were recruited from one hospital in Egypt. They completed a self-administered, printed questionnaire. The questionnaire assessed participants’ socio-demographic data and their perception regarding patient safety culture for sustainable nursing practices. The findings revealed that nursing staff had a high perception regarding patient safety culture a with mean score (159.94 ± 7.864). Also, the highest percentage (74.66%) of had no safety events reported yearly. Creating a unit-specific patient safety culture suited to the competences of the unit’s RNs in patient safety practice would be crucial to increasing and sustaining high levels of patient safety attitudes, skills, and knowledge among the unit’s RNs, influencing patient safety. When implementing interventions to promote patient safety and reporting culture in hospitals, policymakers, hospital administrators, and nurse executives should take the current findings into account. A multidimensional network intervention addressing many elements of patient safety culture and integrating different organizational levels should be implemented to enhance patient safety and a no-blame culture.

Perceptions of Patient Safety Culture Dimensions among Hospital Nurses: A Systematic Review

Background

Patient safety culture, an important aspect in the field of patient safety, plays an important role in the promotion of healthcare quality. Improved patient safety culture decreases patient readmission rates, lengths of hospital stay, and patient safety issues. Patient safety culture includes a set of dimensions. This review focuses on the differing perceptions of these dimensions among healthcare providers in hospitals.

Aims

This study aimed to identify studies examining healthcare providers’ perceptions of patient safety culture in hospitals and to summarize the data from these studies.

Method

Electronic database searching was based on the research question. Two electronic databases were used: CINHAL and Scopus. The search was limited to the period 2005–2012, and studies examining healthcare providers’ perceptions of patient safety culture were identified. Key terms were used to search the articles that were selected on the basis of inclusion and exclusion criteria. Articles examining healthcare providers’ perceptions of patient safety culture in hospitals without comparison between nurses and other healthcare professionals were selected.

Results

Eight articles were reviewed. Several questionnaires were used to assess healthcare providers’ perceptions of patient safety culture in these articles. Our review indicated differences in healthcare providers’ perceptions. In two articles, participants reported a high positive response to teamwork. In addition, participants in the other two articles reported a high positive response to job satisfaction.

Conclusion

The results of the current review reveal healthcare providers’ perceptions of patient safety culture. The results highlight that careful recognition and committed work on various scales/dimensions of patient safety culture can improve healthcare quality and consequently decrease patient safety issues associated with nursing care. Our findings also encourage hospital management and decision-makers to focus on and establish improvements in areas that will positively affect the quality of healthcare.

Effect of Patient Safety Training Program of Nurses in Operating Room

PURPOSE

This study developed an in-service training program for patient safety and aimed to evaluate the impact of the program on nurses in the operating room (OR).

METHODS

A pretest-posttest self-controlled survey was conducted on OR nurses from May 6 to June 14, 2020. An in-service training program for patient safety was developed on the basis of the knowledge-attitude-practice (KAP) theory through various teaching methods. The levels of safety attitude, cognition, and attitudes toward the adverse event reporting of nurses were compared to evaluate the effect of the program. Nurses who attended the training were surveyed one week before the training (pretest) and two weeks after the training (posttest).

RESULTS

A total of 84 nurses participated in the study. After the training, the scores of safety attitude, cognition, and attitudes toward adverse event reporting of nurses showed a significant increase relative to the scores before the training (p < .001). The effects of safety training on the total score and the dimensions of safety attitude, cognition, and attitudes toward nurses' adverse event reporting were above the moderate level.

CONCLUSION

The proposed patient safety training program based on KAP theory improves the safety attitude of OR nurses. Further studies are required to develop an interprofessional patient safety training program. In addition to strength training, hospital managers need to focus on the aspects of workflow, management system, department culture, and other means to promote safety culture.

Redefining the concept of professionalism in nursing: an integrative review

Objective

In today's world with sweeping changes, nurses are responsible for providing high-quality and cost-benefit care, which would almost be impossible unless they achieve their high professional status. To date, no precise and comprehensive definition of professionalism in nursing has been evidently proposed. In fact, many of the previously proposed definitions are either complicated or ambiguous. Moreover, there is no consensus in the literature on an exhaustive definition for “a professional nurse.” The present study aimed to illustrate the concept of professionalism in nursing and identify its defining characteristics.

Methods

In this study, concept analysis was conducted using Whittemore et al.'s method for the integrated review. A comprehensive search of electronic, scientific databases including Eric, PubMed, Scopus, Web of Science, EBSCO, PsychoINFO, Embass, MagIran, IranDoc, SID, and IRANMEDEX was carried out using the keywords such as professionalism, professional behavior, nursing professionalism (NP), professional attribute, and nursing.

Results

In the present study, a comprehensive search of 11 electronic databases retrieved 5738 articles. Then, 2837 duplicate articles were removed by endnote (version 8). Based on a preliminary examination of the titles and abstracts as well as the inclusion and exclusion criteria, 1517 articles were excluded. In addition, 137 articles were removed for scientific reasons. Finally, 52 articles in English and Persian were selected. Content analysis of the articles revealed four major themes, namely, individual prerequisite, professional prerequisite, appropriate structure, and socio-individual factors.

Conclusions

Professionalism in nursing is a major, multidimensional concept according to the literature that included individual prerequisites, professional prerequisites, appropriate structures, and socio-individual factors. In fact, professionalism in nursing comprises a wide range of personal characteristics, self-regulation, professional values, striving to acquire and enhance professional expertise, professional interactions, social, professional, and legal responsibility, and creation of a sense of belonging, and professional development.

Safety Performance in Acute Medical Care: A Qualitative, Explorative Study on the Perspectives of Healthcare Professionals

Healthcare professionals need specific safety performance skills in order to maintain and improve patient safety. The purpose of this study is to get a deeper understanding of healthcare professionals’ perspective in acute care on the topic of safety performance. This study was conducted using a qualitative approach. Healthcare professionals working in nursing were interviewed using semi-structured interviews. Using content analyzing, categories were identified which present aspects of safety performance; subcategories were developed deductively. A total of 23 healthcare professionals were interviewed, of which 15 were registered nurses, five were nursing students and three were pedagogical personnel. Nine (39.1%) were <30 years old, 17 (73.9%) were female, and 9 (39.1%) had a leadership function. Results highlight the importance of safety performance as a construct of occupational health rather than of patient safety, and the role of the organization, as well as the self-responsibility of healthcare professionals. Healthcare professionals should be more conscious of their role, have a deeper understanding of the interaction of individual, team, patient, organization and work environment factors.

Effects of Just Culture and Empowerment on Patient Safety Activities of Hospital Nurses

This study investigated the relationship among hospital nurses' perceptions of a just culture, empowerment, and patient safety activities. It also determined the factors affecting the patient safety activities of nurses. This cross-sectional study included 189 nurses from four hospitals in South Korea. The survey was conducted from October to December 2019 using self-report questionnaires including items on socio-demographic characteristics, just culture, empowerment, and patient safety activities. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression analysis with SPSS/WIN 25.0. Patient safety activities correlated positively with just culture (r = 0.369, p < 0.000) and empowerment (r = 0.38, p < 0.000). Additionally, empowerment (β = 0.213, p = 0.001) and just culture (β = 0.442, p < 0.000) had statistically significant effects on patient safety activities and explained about 19.5% of the variance in patient safety activities (F = 16.170, p < 0.001). The patient safety at medical institutions can be improved by cultivating a work environment that embraces a just culture and empowers nurses.

An Examination of Nurses' Empowerment and Speaking Up During Postanesthesia Clinical Hand Overs

Hierarchical relationships can negatively affect nurses' psychological empowerment and interprofessional hand overs. We explored nurses' perceptions of their psychological empowerment, teamwork, and work engagement; relationships between these concepts during interprofessional clinical hand overs; and observed interactive communication behaviors during hand overs. We used surveys and observations of interprofessional clinical hand overs to collect data from 39 nurses in a postanesthesia care unit in Australia. Nurses reported high scores for psychological empowerment and work engagement. Relationships between empowerment and teamwork (r = 0.41, P = .01) and empowerment and work engagement (r = 0.65, P < .001) were positive and significant. Relationships between nurses' observed communication behaviors and perceptions of empowerment, teamwork, and work engagement were nonsignificant. Additional research is needed to better understand how empowerment, teamwork, and work engagement affect nurses' interactive communication behaviors during interprofessional clinical hand overs in the postanesthesia care unit.

Educational intervention to improve the safety medication process: a review using the GRADE approach

Objectives

Medication errors are frequent and affect patient safety in all the world. This review using the GRADE approach aims to identify the educational intervention which improves nursing medication competences and knowledge.

Methods

According to PRISMA statement, a review was conducted.

Key findings

In this review of nine studies, we determined that there is a lot of educational intervention aimed to improve nursing knowledge, such as traditional classroom training, simulation, e-learning, slide show presentations and the use of posters and pamphlets or mobile application. All of these can improve the medication process and nursing skills. Only three studies reached moderate, and two studies reached low-quality ratings.

Conclusions

Our findings show that all educational interventions can lead to medication without harm. This work will inform regulators, public health initiatives and policy makers considering the nursing educational intervention for increasing patient safety and improve medication competence and knowledge.

Development and Effectiveness of a Patient Safety Education Program for Inpatients

Background: Patient safety is considered an important issue in the field of healthcare, and most advanced countries. Purpose: This study was designed to evaluate a patient safety education program among hospitalized patients. Of the 69 participants, 33 completed the patient safety education program while the 36 remaining participants were given educational booklets. The program was used to measure knowledge about patient safety, patient safety perception, and willingness to participate in patient safety. Methods: Patient safety education was developed by the analysis–design–development–implementation–evaluation model considering expert advice, patient needs, and an extensive literature review. Data were collected from 20 July to 13 November 2020. Data were analyzed using SPSS statistical program. The effectiveness of the experimental and control groups before and after education was analyzed using paired t-tests, and the difference in the amount of increase in the measured variables for each group was analyzed using independent t-tests. Results: The experimental group had significantly higher patient safety scores (t = 2.52, p = 0.014) and patient safety perception (t = 2.09, p = 0.040) than those of the control group. However, there was no significant difference between the two groups regarding the willingness to participate in patient safety. Conclusion: The patient safety education program developed using mobile tablet PCs could be an effective tool to enhance patient involvement in preventing events that may threaten the safety of patients. Further studies are recommended to develop a variety of educational interventions to increase patient safety knowledge and perceptions of patients and caregivers.

Interventions promoting employee "speaking-up" within healthcare workplaces: A systematic narrative review of the international literature

BACKGROUND

Healthcare systems worldwide increasingly value the contribution of employee voice in ensuring the quality of patient care. Although employees' concerns are often dealt with satisfactorily, considerable evidence suggests that some employees may feel unable to speak-up, and even when they do their concerns may be ignored. As a result, in addition to trans-national and national policies, workplace interventions that support employees to speak-up about their concerns have recently increased.

METHODS

A systematic narrative review, informed by complex systems perspectives addresses the question: "What workplace strategies and/or interventions have been implemented to promote speaking-up by employees"?

RESULTS

Thirty-four studies were included in the review. Most studies reported inconclusive results. Researchers explanations for the successful implementation, or otherwise, of speak-up interventions were synthesised into two narrative themes (Braithwaite et al., 2018 (a)) hierarchical, interdisciplinary and cultural relationships and (Francis, 2015 (b)) psychological safety.

CONCLUSIONS

We strengthen the existing evidence base by providing an in-depth critique of the complex system factors influencing the implementation of speak-up interventions within the healthcare workforce. Although many of the studies were locally unique, there were international similarities in workplace cultures and norms that created contexts inimical to speaking-up interventions. Changing communication behaviours and creating a climate that supports speaking-up is immensely challenging. Interventions can be usurped in practice by complex, emergent and contextual issues, such as pre-existing socio-cultural relationships and workplace hierarchies.

Front-line staff's perspective on patient safety culture in Iranian medical centers: A systematic review and meta-analysis

BACKGROUND

The prerequisite for promoting safety culture is to assess the existing safety culture level of institutes, because safety precautions without appropriate evaluation increase costs and unforeseen risks.

OBJECTIVE

This study aimed to systematically review the status of patient safety culture from the perspective of clinical personnel at Iranian hospitals through a meta-analysis of studies using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire.

METHODS

The present systematic review and meta-analysis was conducted in 2018. Data were gathered by searching Google Scholar, Scopus, PubMed, and Web of Science databases up to November 2018. Search keywords were "patient", "safety", "culture", "healthcare", "hospital", "medical center", "HSOPSC tool", and "Iran". The search protocol was limited to 10 years. To estimate the PSC score, computer software CMA:2 (Comprehensive Meta-Analysis) was used. The presence of heterogeneity across the studies was assessed with the I2 statistic. A forest plot was used to report the results. Publication bias was assessed through a funnel plot.

RESULTS

The meta-analysis of studies showed that the PSC score based on the random effect model was 52.7% (95% CI: 50.2%-55.2%), (Q = 522.3, df = 54, P < 0.05, I2 = 89.6). A mean of 12 dimensions of HSOPSC showed that the "Teamwork within units" dimension had the highest PSC score (67.2%) and "Non-punitive response to error" had the lowest score (40.4%).

CONCLUSIONS

Managers and policymakers should be directed towards non-punitive responses to errors and persuade staff to report errors and execute the approach to learn from mistakes. Also, a periodic government evaluation of the patient safety culture will help further its sustainable development.

Effects of training on knowledge and attitudes of coronary care unit nurses in relation to teamwork: A quasi-experimental study

Teamwork has special significance in patient safety and quality of care in the coronary care units (CCUs). This study aimed to determine the impact of training on attitudes and knowledge of CCU nurses about teamwork. This quasi-experimental study was conducted in the CCUs of Al-Zahra Cardiovascular Hospital, Shiraz, Iran. Participants included 70 nurses with a mean age of 31.33 ± 4.56 years. They were divided into experimental and control groups. Data were collected at the baseline and one month after an intervention using a teamwork knowledge test and Teamwork Attitude Questionnaire. The intervention involved a 4-hour workshop on teamwork. Data were analyzed via SPSS 16.0, using descriptive statistics, chi-square, paired t-test, and independent samples t-test. The mean overall teamwork attitude score of the experimental group following intervention (125.5 ± 12.56) had statistically significant differences from the baseline (110.4 ± 12.6) and the mean score of the control group (112.11 ± 15.17) (P < .001). Furthermore, the mean scores of attitude dimensions improved significantly, except for mutual support and situation monitoring. In addition, in relation to teamwork knowledge, the experimental group had a significantly higher mean score after the intervention (18.6 ± 4.35) compared with the baseline (13.14 ± 4.25) and the control group (14.8 ± 4.07) (P < .001). Training improved knowledge and attitudes of CCU nurses in relation to teamwork. Considering the critical role of mutual support and situation monitoring in nursing performance, we should place more emphasis on them in nursing education and practice. TRIAL REGISTRATION: IRCT2016080123199N2. Date registered 2016-09-22.

A study on improving nursing clinical competencies in a surgical department: A participatory action research

Aims

The purpose of the present study was to improve clinical competencies in nursing staff in a selected surgical department in Kashan/Iran during 2016-2018.

Design

This was a participatory action research.

Methods

This action research was implemented in four steps of problem identification, planning, action and reflection. Interviews, focus groups and observation were used for the qualitative part. Conditions of Work Effectiveness Questionnaire-II, job satisfaction and patients' satisfaction questionnaires were completed before and after the study. Qualitative content analysis, paired and independent t test were used for data analysis.

Results

Three main problems could affect the clinical competencies including professional insufficiency, basic shortages and external influences. Three changes were implemented in the surgical department including improving education, involving nursing students in patients' education and increasing the motivations by peer evaluation and selecting the nurse of the week. The changes significantly increased patients' satisfaction, nurses' job satisfaction and work effectiveness.

A Qualitative Evaluation of Adverse Drug Reaction Reporting System in Pakistan: Findings from the Nurses' Perspective

The contribution of all key healthcare professionals is vital to promote an efficient adverse drug reaction (ADR) reporting system. In this context, nurses are important as they are in a better position to observe a patient's response regarding the drug therapy and to report an ADR. The aim of the study was to explore the perspectives of nurses about ADR reporting system in Lahore, Pakistan. A total of 21 nurses were interviewed. The thematic content analysis of the qualitative interviews yielded six major themes and eight subthemes. Major themes included: (1) Knowledge about the concept of the medication safety & the ADR; (2) Knowledge regarding pharmacovigilance activities; (3) Willingness to report; (4) Practices related to the ADR reporting; (5) Barriers to the ADR reporting; (6) Facilitators to the ADR reporting. The majority of the nurses were aware of medicine safety and ADRs, but in many cases, they were unable to report these ADRs. The study pointed out considerable concerns regarding the knowledge and practices of nurses about pharmacovigilance activities in their workplace, mainly due to increased workload, due to the absence of a reporting system and legal liability. The main challenges turned out to be the lack of knowledge and training, as well as the implementation of guidelines. Based on the findings, it is suggested that outcome of this study can serve as a guide to design policies that support ADR reporting by nurses in Pakistan.

Innovative Methodologies to Teach Patient Safety in Undergraduate Nursing: Scoping Review

Objective: This work sought to identify the innovative methodologies used to teach patient safety in undergraduate Nursing. Materials and method: this is a scoping review conducted according to the recommendations by the Joanna Briggs Institute Reviewers’ Manual, through the databases: Medline/PubMed, Cumulative Index of Nursing and Allied Health, Scopus, Web of Science, Education Resources Information Center, Latin American and Caribbean Literature on Health Sciences, Catálogo de Tesis de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, The National Library of Australia’s Academic Archive Online, Digital Access to Research Theses Europe E-Theses Portal, Electronic Theses Online Service, Repositório Científico de Acesso Aberto de Portugal, National ETD Portal, and Theses Canada. Results: the study included 19 studies, most of descriptive type (n = 8; 42.1 %) and quasi-experimental (n = 7; 36.8 %) with quantative approach (n = 11; 57.9 %), conducted in the United States (n = 4; 21.1 %), in 2013 (n = 4; 21.1 %) and 2017 (n = 4; 21.1 %). The innovative methodologies used to teach patient safety in undergraduate Nursing that were highlighted included the scenario of the care practice simulated in the laboratory (n = 14; 73.7 %) and educational videos (n = 7; 36.8 %). Conclusions: it was identified that innovative methodologies used to teach patient safety in undergraduate Nursing were simulation, videos, staging/role playing, and films, all applied in the classroom teaching modality.

The effect of training and awareness of subtle control on the frequency of hand hygiene among intensive care unit nurses

Objective

This study aimed to determine the effect of awareness of subtle control after training on the hand hygiene compliance among nurses in intensive care units (ICUs). The study was conducted in two ICUs of a trauma center in Shiraz, Iran on 48 nurses. The nurses of one ICU were randomly allocated to the intervention and the nurses of the other ICU were allocated to the control group. All nurses were trained on hand hygiene. Then a fake closed camera television (CCTV) was visibly installed in the intervention group’s ICU, while the nurses were aware of it. The degree of compliance with hand hygiene was observed in both groups before and after the intervention. Data were gathered using a checklist based on the World Health Organization hand hygiene protocol and analyzed using SPSS 16 and the Chi square, Wilcoxon, Mann–Whitney U, and Independent T-tests, were performed.

Results

The mean percentage of hand hygiene compliance in the intervention group after the intervention was significantly higher than before the intervention (p < 0.001). Additionally, the changes in the mean percentage of the intervention group was significantly higher than that for the control group (p = 0.001). The findings showed that a fake CCTV after training, installed in ICUs, can improve hand hygiene compliance.

Antimicrobial stewardship: Staff nurse knowledge and attitudes

BACKGROUND

Registered nurses are uniquely qualified to augment antimicrobial stewardship (AS) processes. However, the role of nursing in AS needs further development. More information is needed regarding gaps in registered nurse knowledge, attitudes toward AS, and how infection preventionists can help.

METHODS

An online descriptive survey was deployed to a convenience sample of approximately 2,000 nurses at the bedside. The survey included 15 questions addressing: (1) overall knowledge of AS; (2) antimicrobial delivery; (3) knowledge and attitudes regarding antimicrobial use; (4) antimicrobial resistance; and (5) antimicrobial resources and education.

RESULTS

Three hundred sixteen staff nurses from 3 hospitals (15.8%) responded to the survey. Fifty-two percent of nurses were not familiar with the term "antimicrobial stewardship," although 39.6% of nurses indicated that an AS program was moderately or extremely important in their health care setting. Almost all nurses (95%) believed that they should be involved in AS interventions.

DISCUSSION

These findings suggest gaps in nursing knowledge rearding AS. However, nurses believed AS programs were important and were eager to be involved.

CONCLUSIONS

This study showed that many nurses are not aware of AS, or do not understand their role in contributing to AS endeavors. Infection preventionist education should focus on increasing staff nurse awareness and demonstrating how nurses can make specific AS interventions.

Improving safety through speaking up: An ethical and financial imperative

BACKGROUND

Fostering a culture that empowers staff to speak up when concerned about the quality or safety of patient care is both an ethically¹ and economically² responsible endeavor. The Michigan Health & Hospital Association (MHA) Keystone Center has implemented the Speak-Up! Award program that acknowledges frontline health care staff for voicing their concerns and making care safer. The objective of this effort was to advance patient safety in Keystone Center member organizations through widespread, measurable culture improvement. After extensive data collection and analysis, there was a discernable improvement in culture survey results across a 2-year period coinciding with the launch and sustainment of the award program. Furthermore, in an effort to demonstrate the power of speaking up among staff, the Keystone Center applied a cost-savings framework to the types of harm avoided. Results from the cost-savings analysis suggest that each instance of speaking up by staff saves patients, families, and health care organizations an average of more than $13,000.

METHODS

Keystone Center Speak-Up! Award nominations were submitted through an electronic form that collects open, closed, and Likert-type question responses, producing a data array on type and severity of harm prevented, as well as the difficulty and magnitude of the decision to speak up. All data were then coded by harm type and subsequently applied to a tailored version of the cost-savings estimation framework used in the Great Lakes Partnership for Patients Hospital Improvement and Innovation Network. Safety culture was measured through the use of a survey instrument called the Safety, Communication, Operational Reliability, and Engagement (SCORE) instrument.

RESULTS

The Keystone Center Speak-Up! Award program received 416 nominations across the 2-year study period, of which 62% (n = 258) were coded as a specific harm type. Adverse drug events (n = 153), imaging errors (n = 42), and specimen errors (n = 27) were the most common harm types prevented by speaking up. After applying the cost-savings framework to these data, it is estimated that for every instance of speaking up, approximately $13,000 in total expenses were avoided, which is in line with the findings from a report on the economic impact of medical errors sponsored by the Society of Actuaries.³ Furthermore, culture survey results improved by 6% between 2015 and 2017, coinciding with the Keystone Center Speak-Up! Award program.

CONCLUSIONS

The Keystone Center Speak-Up! Award has proven to be a valuable tool in recognizing staff awareness and willingness to raise concerns about quality and safety in health care. Data analysis from this program presents evidence that fostering a psychologically safe culture of speaking up yields fiscal and humanistic returns, both of which are crucial to sustainable, meaningful progress in safety and quality. However, further research is required to adequately gauge the degree to which safety culture improvement is proportional to cost savings.

Multilevel Analysis of Individual, Organizational, and Regional Factors Associated With Patient Safety Culture: A Cross-Sectional Study of Maternal and Child Health Institutions in China

Supplemental digital content is available in the text.

The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations.

The effects of empathy skills training on nursing students' empathy and attitudes toward elderly people

BACKGROUND

Nursing students' empathy and positive attitudes toward elderly people could help provide improved elderly care in their future practice. This study aimed to investigate the effects of empathy skills training on nursing students' empathy and attitudes toward elderly people.

METHODS

This quasi-experimental study was conducted in Yasuj, Iran in 2014. The sample consisted of 63 students at Hazrat Zeinab Nursing and Midwifery School who were randomly divided into a control (n = 31) and an intervention group (n = 32). The intervention group attended an eight-hour workshop on empathy skills that was presented through lectures, demonstration, group discussions, scenarios, and questioning. The data were collected using the Persian versions of Kogan's Attitudes towards Old People Scale and Jefferson Scale of Physician Empathy-Health Professionals Version. Then, the data were entered into the SPSS software, version 19 and were analyzed using descriptive statistics, chi-square test, t-test, and repeated measures analysis of variance.

RESULTS

The results showed that the empathy skills training program had a significant impact on the students' mean scores of empathy and attitudes toward elderly people (p < 0.001). The intervention group's mean score of empathy increased from 77.8 (SD = 10.7) before the intervention to 86 (SD = 7.3) immediately after that and 85.2 (SD = 8.9) 2 months later. Their mean score of attitude also increased from 110.8 (SD = 10.9) before the intervention to 155.2 (SD = 23.4) immediately after the intervention and 158.6 (SD = 23.2) 2 months later. Additionally, the empathy and attitude scores of the intervention group were significantly higher than those for control group immediately and 2 months after the intervention.

CONCLUSIONS

Empathy skills training improved the nursing students' empathy and attitudes towards elderly people. Therefore, empathy training is recommended to be incorporated into the undergraduate nursing curriculum.