Patient experience in co-production of care: perceptions about patient safety protocols

Educational video for teaching safe practices in the perioperative period: randomized controlled trial

OBJECTIVE

to assess the effectiveness of an educational video on hospitalized patients' knowledge of safe practices in the perioperative period.

METHOD

randomized, double-blind controlled trial carried out in a teaching hospital in the countryside of Minas Gerais. 100 participants undergoing elective orthopaedic surgery were randomly allocated (50 participants in the experimental group and 50 participants in the control group). Patient knowledge was assessed using a questionnaire constructed by the researchers and validated by specialists, before and after the intervention (educational video) or standard guidelines were applied. Descriptive statistics were used for quantitative variables and Student's t-test for independent samples to analyze the mean difference in knowledge between the experimental and control groups (α = 0.05).

RESULTS

100 participants took part in the study, 50 participants in the experimental group and 50 participants in the control group. The experimental group showed a significantly higher gain in knowledge (t =3.72 ±1.84; p<0.001) than the control group. Cohen's d was 1.22, indicating a large magnitude of the effect.

CONCLUSION

the educational video was effective in improving patients' knowledge and can contribute to nurses in the practice of health education, optimizing time and disseminating knowledge about safe practices in the perioperative period. Brazilian Registry of Clinical Trials (REBEC): RBR-8x5mfq. (1) Development of a valid patient knowledge assessment questionnaire. (2) Production of a valid educational video on perioperative safety. (3) The final version of the educational video is 7 minutes and 50 seconds long. (4) The educational video was effective in improving patient knowledge. (5) It contributes to patient involvement in safe care.

Experience of the patient regarding their safety in the hospital environment

OBJECTIVES

to analyze the factors that can impact patients' experience concerning safety-related measures in the hospital setting.

METHODS

this qualitative, descriptive, and exploratory study was conducted with patients and their family members at a hospital in southern Brazil. Semi-structured interviews were carried out using the Critical Incident Technique between January and February 2022. The collected data underwent content analysis with the assistance of IRaMuTeQ software.

RESULTS

five patients, four family members, and three patient-family units participated in the study. The following categories emerged: "Patientprofessional interaction as a component of safe care," "Recognition of safety protocols in the patient's experience," and "Safe care and the challenges in hospital care."

CONCLUSIONS

patient-professional interaction, communication, awareness of safety protocols, and the availability of the nursing team are factors that influence patients' experience regarding the safety of their care during hospitalization.

Qualidade do cuidado e segurança do paciente: o papel dos pacientes e familiares

RESUMO Este ensaio procurou discutir o papel dos pacientes e das famílias na qualidade dos cuidados e na segurança do paciente. Tradicionalmente, o papel dos profissionais de saúde – especialmente, dos médicos – tem sido predominante na discussão e na definição do que constitui um cuidado de saúde de alta qualidade. Entretanto, outros atores foram reconhecidos no debate contemporâneo sobre a qualidade do atendimento e, em particular, sobre a segurança do paciente e a centralidade do atendimento. O papel dos pacientes na qualidade do atendimento e até mesmo o seu protagonismo na identificação dos principais problemas presentes na prestação de cuidados e em como contribuir para um atendimento mais seguro são destacados. Inicialmente, discute-se o papel dos pacientes e seus familiares na qualidade do atendimento e na segurança do paciente. Em seguida, são discutidos os fatores que influenciam e dificultam a sua participação. Finalmente, são propostas estratégias para aumentar a participação dos pacientes. Pacientes e familiares podem desempenhar um papel essencial na melhoria da qualidade dos cuidados de saúde e da segurança do paciente. Entretanto, eles devem estar ativamente envolvidos para que isso ocorra, com suas contribuições consideradas em um ambiente favorável a uma cultura de segurança justa.

Modeling of adult patient falls and the repercussions to Nursing as a second victim

OBJECTIVE

analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim.

METHOD

an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers.

RESULTS

a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories "The complexity of care to prevent falls" and "Feelings of the second victim" emerged.

CONCLUSION

falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

Professionals’ beliefs in patient involvement for hospital safety

ABSTRACT Objectives: to analyze the beliefs of health care professionals about the benefits of patient involvement in care during hospitalization. Methods: a descriptive, exploratory, qualitative study was conducted with 87 health professionals from a teaching hospital. Semi-structured interviews were conducted between December 2019 and January 2020 - data was submitted to content analysis and interpreted in light of Rosenstock’s Model of Beliefs in Health. Results: participants included nursing technicians, nurses, doctors, and other professionals. The categories “Professionals’ beliefs about patient involvement in care”, “Practices of patient involvement in care” and “Factors favoring patient involvement in hospital care” emerged. The perception of professionals revealed the influence of patient involvement in care outcomes and benefits for the safety of care. Final Considerations: involving the patient in care is associated with the healthcare professional’s belief in the benefits of this practice for reducing incidents.

FACILITATORS AND BARRIERS OF PATIENT INVOLVEMENT IN HOSPITAL SERVICES: INTEGRATIVE REVIEW

ABSTRACT Objective to identify the facilitating factors and barriers that influence patient involvement in hospital services. Method integrative review; search of articles published between January 2011 and December 2020, in the electronic databases PubMed, Web of Science, Cinahl, Lilacs and Scopus, using descriptors related to "patient involvement", Barriers, Facilitators, in English, Spanish and Portuguese. Data collection was performed from May to June 2021, identifying 32 publications that met the inclusion criteria. Results the analysis resulted in three categories of facilitating factors and barriers: communication, actors of involvement and organizational culture, allowing the elaboration of a theoretical model of patient involvement. This model shows that in the centrality of the process are the actors involved, that is, patients and professionals, inserted in an organizational context, being influenced by leadership, culture, environment, available resources and processes, where communication permeates as a basis for involvement. Conclusion the facilitating factors and barriers identified in this review, synthesized in a theoretical model, allow transcending theoretical knowledge for practice. The complexity to operationalize this model requires patients, professionals, health services and society join forces to make this theoretical proposition a practice incorporated by the services.

Modelaje de caídas de pacientes adultos y las repercusiones en la Enfermería como segunda víctima

Resumen Objetivo: analizar las caídas de pacientes adultos hospitalizados y sus repercusiones en el trabajador de Enfermería como segunda víctima. Método: estudio exploratorio, descriptivo y cualitativo realizado en dos etapas - Identificación de las caídas con daño moderado a grave y el modelaje de las caídas utilizando el software Functional Resonance Analysis Method y Análisis de las repercusiones en el trabajador como segunda víctima por medio de entrevistas semiestructuradas posteriormente sometidas al Análisis de Contenido, en 21 trabajadores de Enfermería. Resultados: fueron identificadas 447 caídas de pacientes adultos, siendo 12 con daño moderado a grave, ocurridas en la ausencia del acompañante, al usar medicamentos inductores de sueño, hipotensores y/o los que alteran la fuerza muscular. El modelaje identificó 22 funciones relacionadas al Procedimiento Operacional Estándar, es decir el protocolo de prevención de caídas y las acciones seguidas después del evento. Entre estas, ocho presentaron variabilidad en su ejecución. En la segunda etapa, surgieron las categorías “La complejidad de los cuidados para prevenir las caídas” y “Sentimientos de la segunda víctima”. Conclusión: las caídas son fenómenos complejos y la prevención exige la participación del paciente, familia y equipo multiprofesional. Los profesionales involucrados son segundas víctimas y experimentan sentimientos de culpa, miedo, angustia e impotencia. Este estudio puede contribuir con la multiprofesionalidad y el abordaje precoz a las segundas víctimas.

Modeling of adult patient falls and the repercussions to Nursing as a second victim

Objective:

analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim.

Method:

an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers.

Results:

a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories “The complexity of care to prevent falls” and “Feelings of the second victim” emerged.

Conclusion:

falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

FACILITADORES E BARREIRAS DO ENVOLVIMENTO DO PACIENTE NOS SERVIÇOS HOSPITALARES: REVISÃO INTEGRATIVA

RESUMO Objetivo identificar os fatores facilitadores e as barreiras que influenciam no envolvimento do paciente nos serviços hospitalares. Método revisão integrativa; realizada busca de artigos publicados entre janeiro de 2011 e dezembro de 2020, nas bases eletrônicas PubMed, Web of Science, Cinahl, Lilacs e Scopus, utilizando descritores relacionados a “patient involvement”, Barriers, Facilitators, nos idiomas inglês, espanhol e português. Coleta de dados realizada de maio a junho de 2021, identificando-se 32 publicações que atenderam aos critérios de inclusão. Resultados a análise resultou em três categorias de fatores facilitadores e barreiras: comunicação, atores do envolvimento e cultura organizacional, permitindo a elaboração de um modelo teórico de envolvimento do paciente. Esse modelo mostra que na centralidade do processo estão os atores envolvidos, ou seja, pacientes e profissionais, inseridos em um contexto organizacional, sendo influenciados pela liderança, cultura, ambiente, recursos disponíveis e processos, onde a comunicação perpassa como base para o envolvimento. Conclusão os fatores facilitadores e as barreiras identificadas nesta revisão, sintetizados num modelo teórico, permitem transcender o conhecimento teórico para a prática. A complexidade para operacionalizar esse modelo requer que pacientes, profissionais, serviços de saúde e sociedade unam os esforços para tornar esta proposição teórica em uma prática incorporada pelos serviços.