Communication for patient safety in pediatric hospitalizations

A critical perspective on institutional violence against hospitalized children: Testimonies by health professionals and family members

The purpose of this study is to understand institutional violence (IV) in the relationships between health professionals, hospitalized children, and family members. This is a qualitative study developed at the pediatric inpatient unit of a university hospital in the city of Salvador, Bahia, Brazil. The research participants consisted of 39 health professionals who specialized in pediatrics and 10 family members of hospitalized children. Semi-structured interviews were the method used for data collection. Using discourse analysis as a basis and taking a Foucauldian perspective, the researchers observed that the expressions of IV could be traced to abusive power relations within the system. We found four discursive forms within the data set: communication problems as IV, violence through inattention and neglect, violence as an action and consequent materialization on the body, and psychological violence as a submission mechanism. Based on these findings, we argue that professionals, managers, the scientific community, and users might be able to better guarantee the safety of children by recognizing IV and effectively intervening in it.

Nursing competencies in aeromedical transport in the Brazilian Air Force: a descriptive study

OBJECTIVE

To analyze nursing skills in military aeromedical transport of the Brazilian Air Force.

METHOD

Descriptive, qualitative research, carried out in three Brazilian Air Force hospitals in Rio de Janeiro, involving 64 military nurses. Discursive textual analysis identified competencies in healthcare, communication and decision-making.

RESULTS

After characterizing participants, it was possible to understand the reality experienced by nursing professionals in air medical transport, highlighting the skills related to healthcare, communication and management, essential in all phases of air medical transport.

CONCLUSION

It was evident that nursing assumes unique skills in caring for airborne patients, using diverse knowledge and experiences in solving problems encountered in the aeromedical work process. The need to implement continuing education strategies was also highlighted. The findings serve as support for professionals and managers to identify gaps in knowledge, performance and management of professional schedules in aeromedical transport.

How to implement a PEWS in a resource-limited setting: A quantitative analysis of the bedside-PEWS implementation in a hospital in northeast Brazil

OBJECTIVES

Quantitative analysis of the implementation of the bedside paediatric early warning system (B-PEWS) in a resource-limited setting. The B-PEWS serves to pre-emptively identify hospitalised children who are at risk for cardiopulmonary arrest and subsequently to provide critical care in time.

METHODS

We performed a retrospective review through the medical data records of patients after discharge from the paediatric ward of a philanthropic hospital in Brazil. Nurses' performance using the system was measured with various parameters.

RESULTS

A total of 499 patients were included, and a total of 8024 scores were checked. During the 21-week research period, the implementation rate increased significantly from 66.5% (SD 26.0) in Period 1 to 93.1% (SD 16.6) in Period 2. The number of scores that resulted in a correct total score went from 7.5% in Period 1 to 32.2% in Period 2, p < 0.001. There was an improvement in the correct choice of age group between the two periods (from 32.2% to 53.4%). There was no difference in the mean admission time of patients in the two periods: in the first period 4.8 days (SD 2.9) and in the second period 4.8 days (SD 4.1).

CONCLUSIONS

It is possible to implement a PEWS in resource-limited settings while achieving high implementation rates. However, this is a time- and energy-consuming process. Having an active and involved team that is responsible for implementation is key for a successful implementation. Factors that likely hindered implementation were a large change in workflow for the nursing staff, non-native speakers as main investigators.

An in situ simulation program: a quantitative and qualitative prospective study identifying latent safety threats and examining participant experiences

OBJECTIVE

To explore the impact of in situ simulation training in regard to identification of latent safety threats and participant experiences.

DESIGN

A prospective study including quantitative and qualitative measures.

SETTING

A Danish hospital shifted from simulation training in centers outside the hospital to training where simulation was conducted where the situations normally took place and with the normal working teams.

PARTICIPANTS

A total of 58 local instructors were educated and subsequently conducted in situ simulations in own departments. After each simulation, a log file was completed containing information on location, the scenario, who took part, time, learning points and findings. Furthermore, interviews were conducted with leaders, instructors and simulation participants.

MAIN OUTCOME MEASURES

Identified latent safety threats and participant experiences.

RESULTS

From June 2017 until December 2018, 323 simulations were conducted representing 35 different wards. They consisted of 40 different scenarios and had both technical and non-technical learning goals. A total of 35 organizational issues were uncovered via the in situ simulation and practice was adjusted accordingly. A total of 11 interviews were conducted. Four themes emerged from the analysis: practice-orientation, endorsement, sense of security and additional impact.

CONCLUSION

Transferring simulation to in situ training resulted in a substantial number of organizational findings. The subsequent follow-up and changes in practice made awareness of what could be latent safety threats. Leaders, instructors and simulation participants experienced in situ simulation as relevant and profitable.