1
|
Clarke-Romain B. Supporting nurses in acute and emergency care settings to speak up. Emerg Nurse 2024; 32:16-21. [PMID: 37723863 DOI: 10.7748/en.2023.e2162] [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] [Accepted: 06/28/2023] [Indexed: 09/20/2023]
Abstract
Nurses' competence and confidence in raising concerns with senior clinicians is integral to patient safety and the quality of patient care. If nurses do not speak up when needed it can contribute to incidences of failure to rescue. There are many barriers to nurses speaking up in busy emergency departments and complex major trauma patient cases. Assessment and communication tools such as the SBAR (situation, background, assessment, recommendation) approach and communication techniques such as graded assertiveness can help to overcome some of these barriers. This article uses a case study to discuss how nurses can respectfully but efficiently escalate their concerns to the trauma team leader. It describes barriers to nurses speaking up and tools that can support nurses to speak up, with a focus on graded assertiveness.
Collapse
Affiliation(s)
- Binx Clarke-Romain
- emergency department, Royal London Hospital, Barts Health NHS Trust, London, England
| |
Collapse
|
2
|
Dror IE. Linear Sequential Unmasking- Expanded (LSU- E): A general approach for improving decision making as well as minimizing noise and bias. Forensic Sci Int Synerg 2021; 3:100161. [PMID: 34466797 PMCID: PMC8385162 DOI: 10.1016/j.fsisyn.2021.100161] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
|
3
|
Hinding B, Deis N, Gornostayeva M, Götz C, Jünger J. Patient handover - the poor relation of medical training? GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc19. [PMID: 30993177 PMCID: PMC6446468 DOI: 10.3205/zma001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Objective: The handover of patients to medical colleagues and to members of other professional groups is a central task in the medical care process for patient safety. Nevertheless, little is known about teaching and testing on the subject of handing over. The present article therefore examines the extent to which handover is the subject of teaching and examinations at medical faculties in Germany. Methodology: In 31 medical faculties the teachers were asked about the implementation of the NKLM learning objectives in the area of communication. The survey was conducted within the framework of group interviews with lecturers, in which it was determined whether each learning objective of the NKLM (National Competency-based Catalogue of Learning Objectives in Medicine) on the subject of communication, is explicitly taught in lectures and examinations at the respective faculty. Results: The learning objective "transfer to medical colleagues" is covered by 19 faculties, while the learning objective of interprofessional transfer is covered by 14 faculties. There are examinations for transfer to medical colleagues and interprofessional transfer at two faculties. There is a highly significant relationship between the total number of communicative learning objectives that are put into practice in a faculty and the coverage of the learning objectives for handover. Conclusions: In the field of communications, the subject of handover is less frequently taught at the faculties and, more importantly, it is less frequently examined than other NKLM contents. This is particularly evident in the interprofessional area. The subject is more likely to be taught as a handover between physicians, while the interprofessional interfaces attract less attention. In terms of patient safety, it would be desirable to give a higher priority to the subject of handover. An inter-faculty exchange and the inclusion of the subject of intra- and interprofessional transfer in state examinations could give the implementation process at the faculties a decisive impetus.
Collapse
Affiliation(s)
- Barbara Hinding
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Nicole Deis
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Maryna Gornostayeva
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Christian Götz
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Jana Jünger
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| |
Collapse
|
4
|
Uhm JY, Lim EY, Hyeong J. The impact of a standardized inter-department handover on nurses' perceptions and performance in Republic of Korea. J Nurs Manag 2018; 26:933-944. [PMID: 30209878 DOI: 10.1111/jonm.12608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the impact of a standardized inter-department nursing handover protocol from intensive care units to general wards on the nurses' perceptions and performance. METHODS We developed an inter-department nursing handover protocol based on the situation, background, assessment and recommendation technique. All participating paediatric nurses were trained in this new protocol, which was then implemented for nine months in eight units of a children's hospital in the Republic of Korea. Data were extracted from a questionnaire and handover auditing using audio recording. RESULTS Following the protocol's introduction, nurses' perceptions of handover effectiveness significantly improved (F = 5.17, p = .007), while their experience of handover errors significantly decreased (F = 12.85, p < .001). Furthermore, the prevalence of additive calls per handover decreased from 70.7% to 45.9% (χ2 = 9.88, p = .002), and the prevalence of handover-related errors decreased from 51.2% to 32.4% (χ2 = 5.63, p = .023). Handover accuracy significantly increased (t = -5.12, p < .001) without prolonging the handover duration. CONCLUSIONS The handover protocol positively influenced the nurses' perception of handover and clinical performance. IMPLICATIONS FOR NURSING MANAGEMENT A standardized inter-department handover helped intensive care unit nurses to improve their organisation and to provide ward nurses with sufficient information during handover, which could ensure safer transitions from intensive care units to wards.
Collapse
Affiliation(s)
- Ju-Yeon Uhm
- Department of Nursing Science, Daegu Haany University, Gyeongsan-si, Gyeongsangbuk-Do, Korea
| | - Eun Young Lim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jinju Hyeong
- Department of Nursing, Asan Medical Center, Seoul, Korea
| |
Collapse
|
5
|
Nasarwanji MF, Badir A, Gurses AP. Standardizing Handoff Communication: Content Analysis of 27 Handoff Mnemonics. J Nurs Care Qual 2017; 31:238-44. [PMID: 26845420 DOI: 10.1097/ncq.0000000000000174] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study synthesizes information contained in 27 mnemonics to identify what information should be communicated during a handoff. Clustering and content analysis resulted in 12 primary information clusters that should be communicated. Given the large amount of information identified, it would be beneficial to use a structured handoff communication tool developed using a participatory approach. In addition, we recommend local standardization of information communicated during handoffs with variation across settings.
Collapse
Affiliation(s)
- Mahiyar F Nasarwanji
- Department of Anesthesiology and Critical Care, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland (Drs Nasarwanji and Gurses); and Koc University, School of Nursing, Nisantasi, Istanbul, Turkey (Dr Badir)
| | | | | |
Collapse
|
6
|
Dror IE. Human expert performance in forensic decision making: Seven different sources of bias. AUST J FORENSIC SCI 2017. [DOI: 10.1080/00450618.2017.1281348] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Itiel E. Dror
- University College London (UCL), London, UK
- Cognitive Consultants International (CCI-HQ)
| |
Collapse
|
7
|
Cash T, Brand E, Wong E, Richardson J, Athorn S, Chowdhury F. Near-peer medical student simulation training. CLINICAL TEACHER 2016; 14:175-179. [PMID: 27488259 DOI: 10.1111/tct.12558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is growing concern that medical students are inadequately prepared for life as a junior doctor. A lack of confidence managing acutely unwell patients is often cited as a barrier to good clinical care. With medical schools investing heavily in simulation equipment, we set out to explore if near-peer simulation training is an effective teaching format. METHODS Medical students in their third year of study and above were invited to attend a 90-minute simulation teaching session. The sessions were designed and delivered by final-year medical students using clinical scenarios mapped to the Sheffield MBChB curriculum. Candidates were required to assess, investigate and manage an acutely unwell simulated patient. Pre- and post-simulation training Likert scale questionnaires were completed relating to self-reported confidence levels. There is growing concern that medical students are inadequately prepared for life as a junior doctor RESULTS: Questionnaires were completed by 25 students (100% response rate); 52 per cent of students had no prior simulation experience. There were statistically significant improvements in self-reported confidence levels in each of the six areas assessed (p < 0.005). Thematic analysis of free-text comments indicated that candidates enjoyed the practical format of the sessions and found the experience useful. DISCUSSION Our results suggest that near-peer medical student simulation training benefits both teacher and learner and that this simplistic model could easily be replicated at other medical schools. As the most junior members of the team, medical students are often confined to observer status. Simulation empowers students to practise independently in a safe and protected environment. Furthermore, it may help to alleviate anxiety about starting work as a junior doctor and improve future patient care.
Collapse
Affiliation(s)
- Thomas Cash
- Academic Unit of Medical Education, The University of Sheffield Medical School, Sheffield, UK
| | - Eleanor Brand
- Academic Unit of Medical Education, The University of Sheffield Medical School, Sheffield, UK
| | - Emma Wong
- Academic Unit of Medical Education, The University of Sheffield Medical School, Sheffield, UK
| | - Jay Richardson
- Academic Unit of Medical Education, The University of Sheffield Medical School, Sheffield, UK
| | - Sam Athorn
- Clinical Skills Department, Royal Hallamshire Hospital, Sheffield, UK
| | | |
Collapse
|
8
|
|
9
|
Ead H. Perianesthesia nursing-beyond the critical care skills. J Perianesth Nurs 2015; 29:36-49. [PMID: 24461281 DOI: 10.1016/j.jopan.2013.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 04/28/2013] [Accepted: 05/15/2013] [Indexed: 10/25/2022]
Abstract
Provision of patient care within the perianesthesia specialty is demanding in nature. Although a nurse may be well equipped with the assessment, planning, and critical thinking skills required for these fast-paced areas, there are other competencies to be developed. These include skills in mentorship, communication, crisis management, and competency as an ambassador of patient safety. Barriers to developing these skills may include a high patient acuity and turnover, a sense of isolation from other departments, and strong hierarchical structures. However, there are resources and strategies that nurses can leverage to facilitate development of these less-technical, "softer" skills. In this article, the author reviews some of the unique demands commonly seen within the perianesthesia specialty. Methods to address these challenges are shared to facilitate an enjoyable career in this dynamic environment.
Collapse
|
10
|
Hanson JT, Leykum LK, Pugh JA, McDaniel RR. Nighttime clinical encounters: how residents perceive and respond to calls at night. J Hosp Med 2015; 10:142-6. [PMID: 25736614 DOI: 10.1002/jhm.2315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/19/2014] [Accepted: 12/07/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Care fragmentation is common and contributes to communication errors and adverse events. Handoff tools were developed to reduce the potential for these errors. Despite their widespread adoption, there is little information describing their impact on clinical work. Understanding their impact could be helpful in improving handoffs and transitions. OBJECTIVE To better understand what clinical work is done overnight, the housestaff perceptions of overnight clinical work, and how handoff instruments support this work. DESIGN Real-time data collection and survey. PARTICIPANTS Internal medicine resident physicians. MAIN MEASURES Data collection measured information related to nighttime clinical encounters, including the information sources and actions taken. Surveys assessed resident perceptions toward care transitions. KEY RESULTS Of 299 encounters, 289 contained complete data. The tool was used as an information source in 27.7% of encounters, whereas the information source was either the nurse or the chart in 94.4% of encounters. Many encounters resulted in a new order for a medication, whereas 3.8% resulted in documentation. In the survey data, 73.6% residents reported the sign-out procedure was safe. CONCLUSION These data suggest that a handoff tool is not sufficient to address nighttime clinical issues and suggest that effective care requires more than just the information transfer. It may also reflect that electronic medical records have become a readily available information source at the point of care. Sign-out should support residents' ability to make sense of what is happening and integrate care of day and night teams, rather than solely transfer information.
Collapse
Affiliation(s)
- Joshua T Hanson
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, Texas; Department of Medicine, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | | |
Collapse
|
11
|
Pollard CL, Wild C. Nursing leadership competencies: low-fidelity simulation as a teaching strategy. Nurse Educ Pract 2014; 14:620-6. [PMID: 25017299 DOI: 10.1016/j.nepr.2014.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 04/17/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022]
Abstract
Nurses must demonstrate leadership and followership competencies within complex adaptive team environments to ensure patient and staff safety, effective use of resources, and an adaptive health care system. These competencies are demonstrated through the use of communication strategies that are embedded within a relational practice. Health care professionals, regardless of formal position, need to assert their opinions and perspectives using a communication style that demonstrates value of all team members in open discussions about quality patient care, appropriate access, and stewardship. Challenges to effective communication and relational practice are the individual and organizational patterns of behavior, and the subsequent impact that these behaviors have on others. Students articulate situational awareness when they conduct a critical analysis of individual, team, and organizational functioning, and then use this information and evidence gained from a critical literature review to develop recommendations to improve individual, team, and/or organizational performance. Leadership and followership simulation exercises, inclusive of public feedback and debriefing, are used as a pedagogical/andragogical strategy in a nursing baccalaureate senior leadership course to facilitate learning of team communication skills and improve situational awareness. We view this strategy as an alternative to traditional classroom learning activities which provide little opportunity for recursive learning.
Collapse
Affiliation(s)
- Cheryl L Pollard
- Bachelor of Science in Nursing Program, Faculty of Health and Community Studies, MacEwan University, 10910-104 Avenue, Edmonton AB T5J 2P2, Canada.
| | - Carol Wild
- Bachelor of Science in Nursing Program, Faculty of Health and Community Studies, MacEwan University, 10910-104 Avenue, Edmonton AB T5J 2P2, Canada.
| |
Collapse
|
12
|
Abstract
The Culture of Caring model is an education-practice partnership built on a crosswalk of contemporary nursing concepts. It provides a framework and a bundle of strategies to create a transformed teaching-learning environment. Preliminary evaluation suggests that such a culture can strengthen student learning and support transition to practice for new graduate nurses.
Collapse
|
13
|
Hanson JT, Pierce RG, Dhaliwal G. The new education frontier: clinical teaching at night. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:215-218. [PMID: 24362386 DOI: 10.1097/acm.0000000000000096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Regulations that restrict resident work hours and call for increased resident supervision have increased attending physician presence in the hospital during the nighttime. The resulting increased interactions between attendings and trainees provide an important opportunity and obligation to enhance the quality of learning that takes place in the hospital between 6 PM and 8 AM. Nighttime education should be transformed in a way that maintains clinical productivity for both attending and resident physicians, integrates high-quality teaching and curricula, and achieves a balance between patient safety and resident autonomy. Direct observation of trainees, instruction in communication, and modeling of cost-efficient medical practice may be more feasible during the night than during daytime hours. To realize the potential of this educational opportunity, training programs should develop skilled nighttime educators and establish metrics to define success.
Collapse
Affiliation(s)
- Joshua T Hanson
- Dr. Hanson is assistant professor, Department of Medicine, University of Texas Health Sciences Center, and South Texas Veterans Health Care System, San Antonio, Texas. Dr. Pierce is assistant professor, Department of Medicine, University of Colorado, Denver, Colorado. Dr. Dhaliwal is associate professor, Department of Medicine, University of California, San Francisco, and San Francisco VA Medical Center, San Francisco, California
| | | | | |
Collapse
|
14
|
Loseby J, Hudson A, Lyon R. Clinical handover of the trauma and medical patient: a structured approach. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/jpar.2013.5.10.563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Anthony Hudson
- Kent, Surrey and Sussex Air Ambulance, and St George's Hospital, London; and
| | - Richard Lyon
- Kent, Surrey and Sussex Air Ambulance, and Emergency Medicine Research Group, Edinburgh
| |
Collapse
|