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Norouzinia R, Aghabarary M, Rahmatpour P. Psychometric evaluation of the Persian version of Emergency Medical Services- Safety Attitudes Questionnaire (EMS-SAQ). BMC Emerg Med 2024; 24:24. [PMID: 38355405 PMCID: PMC10865542 DOI: 10.1186/s12873-024-00941-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
AIM This study aimed to conduct a psychometric evaluation of the Persian adaptation of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ). METHODS In this cross-sectional study, the validity and reliability of the EMS-SAQ were assessed among 484 Iranian pre-hospital emergency department employees between February and June 2023. RESULTS Five factors were extracted namely safety climate, teamwork, job satisfaction, stress management, and working conditions with explained 38.75% of the total variance. The goodness of fit indexes confirmed the model (χ2 = 409.031, DF = 196, χ2 /df = 2.087, CFI = 0.900, IFI = 0.901, PCFI = 0.763 and PNFI = 0.701, and RMSEA = 0.069 [CI90% 0.059-0.078]). CONCLUSION The Persian version of the SAQ-EMS, comprising 22 items across five factors, demonstrated good validity and reliability. It is recommended to undertake qualitative studies focusing on the concept of patient safety in pre-hospital settings, considering diverse contexts and cultural nuances to develop more robust assessment tools.
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Affiliation(s)
- Roohangiz Norouzinia
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Maryam Aghabarary
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Pardis Rahmatpour
- School of Nursing, Alborz University of Medical Sciences, Karaj, Iran.
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Vifladt A, Ballangrud R, Myhr K, Grusd E, Porthun J, Mæhlum PA, Aase K, Sollid SJM, Odberg KR. Team training program's impact on medication administration, teamwork and patient safety culture in an ambulance service (TEAM-AMB): a longitudinal multimethod study protocol. BMJ Open 2023; 13:e067006. [PMID: 36669839 PMCID: PMC9872483 DOI: 10.1136/bmjopen-2022-067006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Medication administration errors (MAEs) have the potential for significant patient harm, and the frequency of MAEs in the ambulance services is not well known. Effective teamwork is paramount for providing safe and effective patient care, especially in a time-sensitive, high-risk environment such as the ambulance services. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme that, to our knowledge, has not been studied in the ambulance services previously. TeamSTEPPS is based on the five principles: team structure, communication, leadership, situation monitoring and mutual support. This study aims to advance the knowledge of the medication administration process in the ambulance services and study the impact of a team training programme on the frequency of MAEs, and the perception of teamwork, and patient safety culture. METHODS AND ANALYSIS This study uses a longitudinal multimethod design to evaluate medication administration and the implementation of the team training programme TeamSTEPPS in an ambulance service. A review of electronic patient journals 6 months prior to the intervention, and 12 months after the intervention will provide data on the frequency of MAEs. Focus group interviews and questionnaires will be carried out before and after the intervention to describe the perception of teamwork and patient safety culture among ambulance professionals. Observations, individual interviews and a review of guidelines will be conducted in the first and second quarters of 2022 to study the medication administration process in ambulance services. ETHICS AND DISSEMINATION The study protocol was reviewed by the Regional Committees for Medical and Health Research Ethics Central Norway and approved by the Hospital Trust data protection officer, and the head of the Prehospital Division at the Hospital Trust. The data material will be managed confidentially and stored according to regulations. The results will be disseminated through scientific papers, reports, conference presentations, popular press, and social media. TRIAL REGISTRATION NUMBER NCT05244928.
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Affiliation(s)
- Anne Vifladt
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Randi Ballangrud
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Kjetil Myhr
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Acute Care Medicine, Innlandet Hospital Trust, Brumunddal, Norway
| | - Eystein Grusd
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Prehospital Care, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jan Porthun
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Pål Anders Mæhlum
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Prehospital Care, Innlandet Hospital Trust, Brumunddal, Norway
| | - Karina Aase
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Stephen J M Sollid
- Department of Prehospital Care, Innlandet Hospital Trust, Brumunddal, Norway
- Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kristian Ringsby Odberg
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
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Camacho-Rodríguez DE, Carrasquilla-Baza DA, Dominguez-Cancino KA, Palmieri PA. Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14380. [PMID: 36361273 PMCID: PMC9658502 DOI: 10.3390/ijerph192114380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America. PURPOSE Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated. RESULTS In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66). CONCLUSIONS Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.
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Affiliation(s)
- Doriam E. Camacho-Rodríguez
- Facultad de Enfermería, Universidad Cooperativa de Colombia, Santa Marta 470002, Colombia
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
| | - Deibys A. Carrasquilla-Baza
- Facultad de Enfermería, Universidad Cooperativa de Colombia, Santa Marta 470002, Colombia
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
| | - Karen A. Dominguez-Cancino
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
- Addiction Study Program, Université de Sherbrooke, 150, Place Charles-Le Moyne, Bureau 200, Longueuil, QC J4K 0A8, Canada
- Escuela de Salud Pública, Universidad de Chile, Av. Independencia 939, Independencia, Santiago de Chile 8380453, Chile
| | - Patrick A. Palmieri
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
- South American Center for Qualitative Research, Universidad Norbert Wiener, Av. Arequipa 444, Lima 15046, Peru
- College of Graduate Health Studies, A.T. Still University, 800 West Jefferson Street, Kirksville, MO 63501, USA
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030, USA
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Hoff JJ, Zimmerman A, Tupetz A, Van Vleet L, Staton C, Joiner A. Shame and Guilt in EMS: A Qualitative Analysis of Culture and Attitudes in Prehospital Emergency Care. PREHOSP EMERG CARE 2022; 27:418-426. [PMID: 35522078 DOI: 10.1080/10903127.2022.2074178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Study ObjectivesThe shame reaction is a highly negative emotional reaction shown to have long-term deleterious effects on the mental health of clinicians. Prior studies have focused on in-hospital personnel, but very little is known about what drives shame reactions in emergency medical services (EMS), a field with very high rates of post-traumatic stress disorder, burnout, anxiety, and depression. The objective of this study was to describe emotions, processes, and resilience associated with self-identified adverse events in the work of prehospital clinicians.MethodsWe conducted a qualitative study using a modified critical incident technique. Participants were recruited from two EMS agencies in North Carolina: one urban and one rural. They provided an open-ended, written reflection in which they were asked to self-identify particular events in their EMS careers that felt emotionally difficult. In-person or video in-depth interviews about these events were then conducted in a semi-structured fashion using an iterative interview guide. The codebook was developed through a mix of inductive and deductive analysis strategies and discussed within the research team and a content expert for validation. Interviews were transcribed and data were analyzed following a thematic content analysis approach for types of cases identified as emotionally difficult, common emotional responses and coping mechanisms, and the lingering effects of these experiences on study subjects.ResultsEight interviews were conducted with EMS personnel: five from an urban agency and three from a rural agency. Participants commonly identified complex medical cases as being emotionally difficult, which led to the most robust shame reactions. Shame reactions were more common when EMS clinicians committed self-perceived errors in patient care, whereas guilt reactions were more common when patient outcomes seemed "inevitable" despite any intervention. Common themes related to coping mechanisms included both personal mechanisms, which tended to be less successful compared to interpersonal mechanisms, particularly when emotions were shared with colleagues. This reflected a perceived culture change within EMS in which sharing emotions with colleagues was seen as a departure from the "old school" where emotions tended to be kept to oneself. Feelings of inadequacy, low self-worth, and being "not good enough" were frequently identified as lingering emotions after difficult cases that were hard to move on from, corresponding to longstanding shame in these clinicians. Recovery and resilience varied but tended to be positively associated with a culture in which sharing with colleagues was encouraged, along with personal introspection on root causes for the sentinel event.ConclusionEMS clinicians often identify complex patient cases as those leading to emotions such as shame and guilt, with shame reactions being more common when a perceived error was committed. Coping mechanisms were varied, but individuals often relied on their co-workers in a sharing environment to adequately process their negative feelings, which was seen as a departure from past practices in EMS personnel. Our hope is that future studies will be able to use these findings to identify targets for intervention on negative mental health outcomes in EMS personnel.
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Affiliation(s)
- J J Hoff
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Department of Emergency Medicine, East Carolina University, Greenville, NC
| | - Armand Zimmerman
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Lee Van Vleet
- Duke Global Health Institute, Durham, NC.,Durham County Emergency Medical Services, Durham, NC
| | - Catherine Staton
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Global Health Institute, Durham, NC
| | - Anjni Joiner
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Global Health Institute, Durham, NC
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Draganović Š, Offermanns G. Development of the German version of the patient safety climate inventory to the Austrian context. BMJ Open 2022; 12:e049270. [PMID: 35172993 PMCID: PMC8852657 DOI: 10.1136/bmjopen-2021-049270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In recent years, patient safety culture (PSC) in hospitals, including its development and measurement, has increasingly received attention in Europe. Even though several instruments have been developed for PSC measurement in European countries, there is, to date, no validated measure to assess PSC in Austria. The study at hand addresses this gap in the evidence base by psychometrically assessing the German 'Patient Safety Climate Inventory' (PaSKI) in terms of its potential suitability for the Austrian healthcare system. The goal is to theoretically develop and empirically verify a separate instrument for PSC measurement in Austria. SETTING Ten hospitals. PARTICIPANTS Healthcare professionals (n=1202); doctors (n=142), nurse (n=645), other health workers (n=51), medical technology professions (n=170), management/administration (n=76), other (n=20), no response (n=98). PRIMARY AND SECONDARY OUTCOME MEASURES The pretest was conducted with 101 health professionals. Psychometric evaluations, including exploratory factor analysis and confirmatory factor analysis, were performed with both an original version of the PaSKI and an adapted one. The original PaSKI and the newly adapted 'Austrian Patient Safety Climate Inventory' (A-PaSKI) were then compared. RESULTS The A-PaSKI's factor structure developed in our study differs from the original 14-factor structure (49 items) of the PaSKI. The new instrument consists of 10 factors (30 items), comprising seven departmental factors, two hospital factors, and one outcome factor. The new instrument A-PaSKI revealed satisfactory results on the model-level and internal consistency. The confirmatory factor analysis for the A-PaSKI (χ2 (360)=1408.245, p=0.0001) showed a good model fit, and the absolute and relative fit indices showed an excellent model adjustment. The construct validity was acceptable for nine and unacceptable for one factor. CONCLUSIONS This is the first validation study of a standardised safety culture measure in Austrian hospitals. The Austrian version of PaSKI demonstrated good psychometric properties, with acceptable to good internal consistency and construct validity for use in Austrian hospitals.
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Affiliation(s)
- Šehad Draganović
- Department of Organization, Human Resources, and Service Management, University of Klagenfurt, Klagenfurt, Austria
| | - Guido Offermanns
- Department of Organization, Human Resources, and Service Management, University of Klagenfurt, Klagenfurt, Austria
- Institute for Hospital Organization, Karl Landsteiner Society, Vienna, Austria
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Li Y, Cheng Y, Hu X, Zhang L. Transcultural adaptation and psychometric evaluation of the mainland China version of Nursing Home Survey on Patient Safety Culture Questionnaire: a cross-sectional survey based on 50 nursing homes in China. BMJ Open 2021; 11:e043994. [PMID: 34158294 PMCID: PMC8220463 DOI: 10.1136/bmjopen-2020-043994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To provide a validated Chinese-language measurement of the Nursing Home Survey on Patient Safety Culture (NHSOPS) in mainland China. The primary goal is to carry out a transcultural adaptation of the NHSOPS Questionnaire into Chinese and evaluate its psychometric properties. DESIGN A psychometric evaluation study is constructed. First, the 'translation-back-translation-cultural adaptation' and the pretesting procedure were followed to introduce the NHSOPS. Second, a cross-sectional survey was used to assess the psychometric properties for the mainland China version of the NHSOPS (M-NHSOPS), and a test-retest survey was then applied. SETTING AND PARTICIPANTS The survey was carried out among 1397 nursing home staff from 50 nursing homes in Southwest China. OUTCOME MEASURES Exploratory factor analysis (EFA) was used to assess the potential structure, and confirmatory factor analysis (CFA) was then applied. Reliability was assessed by the content validity index, Cronbach's α and the test-retest value. RESULTS Among the 1397 respondents, 1211 were included (86.7%). EFA was used, and a nine-factor structure was explored. Five factors (Cronbach's α >0.6) were selected into the new structure for the M-NHSOPS. Moreover, data showed that it was suitable for CFA, and convergent validity and discriminant validity were satisfactory. On the other hand, M-NHSOPS contains five dimensions and 22 items. The overall Cronbach's α value was 0.883; the values of each dimension ranged from 0.648 to 0.913. Additionally, content validity showed significant performance. Eventually, test-retest reliability was 0.892, and each dimension was 0.713, 0.809, 0.924, 0.795 and 0.859, respectively (p<0.001). CONCLUSIONS M-NHSOPS has acceptable reliability and satisfactory validity among staff of nursing homes in Southwest China, and further verification among samples in other regions of mainland China is required.
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Affiliation(s)
- Yaqin Li
- School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yufei Cheng
- Core Facilities, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longhao Zhang
- 'Double First-Class' Construction Office, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Use of the Hospital Survey of Patient Safety Culture in Norwegian Hospitals: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126518. [PMID: 34204374 PMCID: PMC8296424 DOI: 10.3390/ijerph18126518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 12/20/2022]
Abstract
This review aims to provide an overview of empirical studies using the HSOPSC in Norway and to develop recommendations for further research on patient safety culture. Oria, an online catalogue of scientific databases, was searched for patient safety culture in February 2021. In addition, three articles were identified via Google Scholar searches. Out of 113 retrieved articles, a total of 20 articles were included in our review. These were divided into three categories: seven perception studies, six intervention studies, and seven reliability and validation studies. The first study conducted in Norway indicated a need to improve patient safety culture. Only one intervention study was able to substantially improve patient safety culture. The validity of HSOPSC is supported in most studies. However, one study indicated poor quality in relation to the testing of criteria related to validity. This review is limited to Norwegian healthcare but has several relevant implications across the research field, namely that intervention studies should (1) validate dimensions more carefully, (2) avoid pitfalls related to both factor analysis methods and criteria validity testing, (3) consider integrating structural models into multilevel improvement programs, and (4) benefit from applying different, new versions of HSOPSC developed in Norway.
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Lozano-Lozano JA, Chacón-Moscoso S, Sanduvete-Chaves S, Holgado-Tello FP. Work Climate Scale in Emergency Services: Abridged Version. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126495. [PMID: 34208668 PMCID: PMC8296405 DOI: 10.3390/ijerph18126495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
This study is based on a 40-item work climate scale in hospital emergency services (WCSHES). Teams working in these emergency services experience a heavy workload and have a limited amount of time with each patient. COVID-19 has further complicated these existing issues. Therefore, we believed it would be helpful to draft an abridged version of the 40-item WCSHES, considering both validity and reliability criteria, but giving greater weight to validity. One hundred and twenty-six workers between the ages of 20 to 64 (M = 32.45; standard deviation (SD = 9.73)) years old participated voluntarily in the study. The validity, reliability, and fit model were evaluated in an iterative process. The confirmatory factor analysis yielded appropriate global fit indices in the abridged 24-item version (Χ2(248) = 367.84; p < 0.01, RMSEA = 0.06 with an interval of 90% from 0.05 to 0.07, SRMR = 0.08, GFI = 0.9, AGFI = 0.96, CFI = 0.98, NFI = 0.95, and NNFI = 0.98), along with test criteria validity (ρXY = 0.68, p < 0.001) and excellent reliability (α = 0.94 and ω = 0.94), maintaining the same conceptualization and usefulness of the original scale. The abridged 24-item version was used to measure four work climate factors (work satisfaction, productivity/achievement of aims, interpersonal relations, and performance at work). Evidence of the usefulness of the new abridged scale is provided along with a description of our study limitations and future areas for development.
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Affiliation(s)
- José Antonio Lozano-Lozano
- Instituto de Ciencias Biomédicas, Instituto Iberoamericano de Desarrollo Sostenible, Universidad Autónoma de Chile, Santiago 7500912, Chile
- Correspondence: (J.A.L.-L.); ; (S.C.-M.); Tel.: +34-954-557-672 (S.C.-M.)
| | - Salvador Chacón-Moscoso
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, 41018 Sevilla, Spain;
- Departamento de Psicología, Universidad Autónoma de Chile, Santiago 7500138, Chile
- Correspondence: (J.A.L.-L.); ; (S.C.-M.); Tel.: +34-954-557-672 (S.C.-M.)
| | - Susana Sanduvete-Chaves
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, 41018 Sevilla, Spain;
| | - Francisco Pablo Holgado-Tello
- Departamento de Metodología de las Ciencias del Comportamiento y de la Salud, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain;
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O’connor P, O’malley R, Oglesby AM, Lambe K, Lydon S. Measurement and monitoring patient safety in prehospital care: a systematic review. Int J Qual Health Care 2021; 33:mzab013. [PMID: 33459774 PMCID: PMC10517741 DOI: 10.1093/intqhc/mzab013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prehospital care is potentially hazardous with the possibility for patients to experience an adverse event. However, as compared to secondary care, little is known about how patient safety is managed in prehospital care settings. OBJECTIVES The objectives of this systematic review were to identify and classify the methods of measuring and monitoring patient safety that have been used in prehospital care using the five dimensions of the Measuring and Monitoring Safety (MMS) framework and use this classification to identify where there are safety 'blind spots' and make recommendations for how these deficits could be addressed. METHODS Searches were conducted in January 2020, with no limit on publication year, using Medline, PsycInfo, CINAHL, Web of Science and Academic Search. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies concerned with measuring and monitoring safety in prehospital care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool (the Quality Assessment Tool for Studies with Diverse Designs). RESULTS A total of 5301 studies were screened, with 52 included in the review. A total of 73% (38/52) of the studies assessed past harm, 25% (13/52) the reliability of safety critical processes, 1.9% (1/52) sensitivity to operations, 38.5% (20/52) anticipation and preparedness and 5.8% (3/52) integration and learning. A total of 67 methods for measuring and monitoring safety were used across the included studies. Of these methods, 38.8% (26/67) were surveys, 29.9% (20/67) were patient records reviews, 14.9% (10/67) were incident reporting systems, 11.9% (8/67) were interviews or focus groups and 4.5% (3/67) were checklists. CONCLUSIONS There is no single method of measuring and monitoring safety in prehospital care. Arguably, most safety monitoring systems have evolved, rather than been designed. This leads to safety blind spots in which information is lacking, as well as to redundancy and duplication of effort. It is suggested that the findings from this systematic review, informed by the MMS framework, can provide a structure for critically thinking about how safety is being measured and monitored in prehospital care. This will support the design of a safety surveillance system that provides a comprehensive understanding of what is being done well, where improvements should be made and whether safety interventions have had the desired effect.
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Affiliation(s)
- Paul O’connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Roisin O’malley
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Anne-Marie Oglesby
- Health Protection and Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1, Ireland
| | - Kathryn Lambe
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
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Habibzadeh H, Baghaei R, Ajoudani F. Relationship between patient safety culture and job burnout in Iranian nurses: Assessing the mediating role of second victim experience using structural equation modelling. J Nurs Manag 2020; 28:1410-1417. [PMID: 32668493 DOI: 10.1111/jonm.13102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 12/25/2022]
Abstract
AIM The study examined the mediating effect of the second victim experience between safety culture and burnout in Iranian nurses. METHODS A convenience sample of 298 nurses from five teaching hospitals of Urmia participated in the study. Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and The Second Victim Experience and Support Tool were used to measure the major variables. We adopted structural equation modelling to examine the hypotheses. RESULTS Safety culture was significantly associated with second victim experience and burnout (p < .01). Second victim experience had a partial mediating role on the relationship between safety culture and burnout (p < .01). The mediating model including major variables showed satisfactory fitness (χ2 /df = 2.11, p < .01, Comparative Fit Index = 0.94, root-mean-square error of approximation = 0.062). CONCLUSIONS Establishing a safety culture is crucial for decreasing job burnout, and second victim experience has an intervening role clarifying how high level of safety culture reduces burnout. IMPLICATIONS FOR NURSING MANAGEMENT Managers should plan to promote safety culture and provide sufficient support to staff involved in the patient safety incident, which could reduce staff burnout.
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Affiliation(s)
- Hossein Habibzadeh
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Baghaei
- Patient Safety Research Centre, Urmia University of Medical Sciences, Urmia, Iran
| | - Fardin Ajoudani
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Sørskår LIK, Olsen E, Abrahamsen EB, Bondevik GT, Abrahamsen HB. Assessing safety climate in prehospital settings: testing psychometric properties of a common structural model in a cross-sectional and prospective study. BMC Health Serv Res 2019; 19:674. [PMID: 31533786 PMCID: PMC6751584 DOI: 10.1186/s12913-019-4459-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research exists on patient safety climate in the prehospital context. The purpose of this article is to test and validate a safety climate measurement model for the prehospital environment, and to explore and develop a theoretical model measuring associations between safety climate factors and the outcome variable transitions and handoffs. METHODS A web-based survey design was utilized. An adjusted short version of the instrument Hospital Survey on Patient Safety Culture (HSOPSC) was developed into a hypothetical structural model. Three samples were obtained. Two from air ambulance workers in 2012 and 2016, with respectively 83 and 55% response rate, and the third from the ground ambulance workers in 2016, with 26% response rate. Confirmatory factor analysis (CFA) was applied to test validity and psychometric properties. Internal consistency was estimated and descriptive data analysis was performed. Structural equation modelling (SEM) was applied to assess the theoretical model developed for the prehospital setting. RESULTS A post-hoc modified instrument consisting of six dimensions and 17 items provided overall acceptable psychometric properties for all samples, i.e. acceptable Chronbach's alphas (.68-.86) and construct validity (model fit values: SRMR; .026-.056, TLI; .95-.98, RMSEA; .031-.052, CFI; .96-.98). A common structural model could also be established. CONCLUSIONS The results provided a validated instrument, the Prehospital Survey on Patient Safety Culture short version (PreHSOPSC-S), for measuring patient safety climate in a prehospital context. We also demonstrated a positive relation between safety climate dimensions from leadership to unit level, from unit to individual level, and from individual level on the outcome dimension related to transitions and handoffs. Safe patient transitions and handoffs are considered an important outcome of prehospital deliveries; hence, new theory and a validated model will constitute an important contribution to the prehospital safety climate research.
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Affiliation(s)
- Leif Inge K. Sørskår
- Institute for Safety, Economics and Planning, University of Stavanger, Kjølv Egelands hus, Kristine Bonnevies vei 22, 4021 Stavanger, Norway
| | - Espen Olsen
- Department of Innovation, Management & Marketing, UiS Business School, University of Stavanger, Elise Ottesen-Jensens hus, Kjell Arholms gate 37, 4021 Stavanger, Norway
| | - Eirik B. Abrahamsen
- Institute for Safety, Economics and Planning, University of Stavanger, Kjølv Egelands hus, Kristine Bonnevies vei 22, 4021 Stavanger, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, 5018 Bergen, Norway
| | - Håkon B. Abrahamsen
- Institute for Safety, Economics and Planning, University of Stavanger, Kjølv Egelands hus, Kristine Bonnevies vei 22, 4021 Stavanger, Norway
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Gerd Ragna Bloch Thorsens gate, Stavanger, 4011 Norway
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de Lima Garcia C, Bezerra IMP, Ramos JLS, do Valle JETMR, Bezerra de Oliveira ML, de Abreu LC. Association between culture of patient safety and burnout in pediatric hospitals. PLoS One 2019; 14:e0218756. [PMID: 31233543 PMCID: PMC6590886 DOI: 10.1371/journal.pone.0218756] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/08/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Providing safety culture is the first and undoubtedly most important feature that patient care should have, as it is the basis for other measures. There are associations between Burnout Syndrome and lower perceptions of safety culture and greater risks in patient safety. OBJECTIVE To analyze the relationship between patient safety culture and burnout in pediatric hospitals. METHOD This is a cross-sectional study with a quantitative approach performed with health professionals who work in pediatric hospitals located in the Metropolitan Region of Cariri, Northeastern Brazil. The study enrolled 148 professionals who performed direct health care for the child in three different hospitals. For the evaluation of the Patient Safety Culture, the version, translated and validated for Brazil, of the Survey on Patient Safety Culture (HSOPSC) questionnaire was applied and to evaluate the occurrence of Burnout, we chose the Maslach Burnout Inventory (MBI). RESULTS Among the dimensions of burnout that presented the most moderate to high, depersonalization and low professional achievement stand out. When considering the syndrome with the professional who presented a "high" score in only one of the three dimensions, it was identified that 44.6% presented the disease. All patient safety dimensions studied correlated with some dimension of burnout. CONCLUSION The study evidenced the influence of all patient safety domains for the development of burnout syndrome in pediatric professionals. Also, it was identified that the organizational climate is the main determinant of burnout, especially in what refers to "teamwork between units".
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Affiliation(s)
- Cintia de Lima Garcia
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC, FMABC, Santo André, SP, Brazil
- Faculdade de Medicina Estácio de Juazeiro do Norte, FMJ, Juazeiro do Norte, Ceará, Brazil
| | - Italla Maria Pinheiro Bezerra
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC, FMABC, Santo André, SP, Brazil
- Programa de Pós-graduação em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES, Brazil
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES, Brazil
| | - José Lucas Souza Ramos
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES, Brazil
| | | | - Maryldes Lucena Bezerra de Oliveira
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC, FMABC, Santo André, SP, Brazil
- Centro Universitário Doutor Leão Sampaio, Juazeiro do Norte, Ceará, Brazil
| | - Luiz Carlos de Abreu
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC, FMABC, Santo André, SP, Brazil
- Programa de Pós-graduação em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES, Brazil
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