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Mehta LS, Churchwell K, Coleman D, Davidson J, Furie K, Ijioma NN, Katz JN, Moutier C, Rove JY, Summers R, Vela A, Shanafelt T. Fostering Psychological Safety and Supporting Mental Health Among Cardiovascular Health Care Workers: A Science Advisory From the American Heart Association. Circulation 2024; 150:e51-e61. [PMID: 38813685 DOI: 10.1161/cir.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The psychological safety of health care workers is an important but often overlooked aspect of the rising rates of burnout and workforce shortages. In addition, mental health conditions are prevalent among health care workers, but the associated stigma is a significant barrier to accessing adequate care. More efforts are therefore needed to foster health care work environments that are safe and supportive of self-care. The purpose of this brief document is to promote a culture of psychological safety in health care organizations. We review ways in which organizations can create a psychologically safe workplace, the benefits of a psychologically safe workplace, and strategies to promote mental health and reduce suicide risk.
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Iyizoba-Ebozue Z, Fatimilehin A, O'Reilly K, Obaro AE. Cultivating Inclusivity and Bridging Gaps Through Reverse Mentoring: A Feasibility Study Within the Royal College of Radiologists. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00281-4. [PMID: 39025731 DOI: 10.1016/j.clon.2024.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/11/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
AIM The Royal College of Radiologists (RCR) recognizes the importance of addressing differential attainment, bridging existing disparities, and fostering diversity and equity. MATERIALS AND METHODS A joint-faculty reverse mentoring (RM) pilot launched from July 2023 to January 2024. Participation was voluntary, mentors (trainees) from ethnic minority backgrounds and mentees (RCR officers) were recruited across the UK. Mentoring pairs engaged in regular meetings focused on sharing lived experiences and informal discussions. Data were collected through prepilot and postpilot surveys, virtual question polls at induction meeting, and written reports. Data were analyzed using descriptive statistics and thematic analysis for quantitative and qualitative data, respectively. RESULTS Eight matched pairs met predominantly online, on average 4 times over 6 months. Discussions covered a wide range of topics exploring systemic biases and professional development. Expectations expressed were to learn from others' experiences and achieve personal and professional growth. The prepilot survey revealed that 50% of respondents had experienced or witnessed racial discrimination, with only 28.5% feeling capable of supporting colleagues facing challenges. By mid-pilot, meaningful connections were established, allowing mentors to share experiences, and foster safe spaces. The postpilot survey results indicated that 90% of respondents felt better equipped to support colleagues facing challenges related to protected characteristics. Key lessons included understanding cultural differences, resilience, and empowering participants to drive change. CONCLUSIONS The exchange of perspectives and experiences between individuals from diverse backgrounds and levels of expertise enhanced mutual understanding and inclusivity. This dynamic process has the potential to catalyze positive change across diverse domains, underlining its significance in shaping a more equitable postgraduate training landscape.
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Affiliation(s)
- Z Iyizoba-Ebozue
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.
| | - A Fatimilehin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - K O'Reilly
- Loughborough University, Loughborough, UK
| | - A E Obaro
- St Mark's Hospital & Academic Institute, London, Uk
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Chance EA, Florence D, Sardi Abdoul I. The effectiveness of checklists and error reporting systems in enhancing patient safety and reducing medical errors in hospital settings: A narrative review. Int J Nurs Sci 2024; 11:387-398. [PMID: 39156684 PMCID: PMC11329062 DOI: 10.1016/j.ijnss.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 08/20/2024] Open
Abstract
Objectives This narrative review aimed to explore the impact of checklists and error reporting systems on hospital patient safety and medical errors. Methods A systematic search of academic databases from 2013 to 2023 was conducted, and peer-reviewed studies meeting inclusion criteria were assessed for methodological rigor. The review highlights evidence supporting the efficacy of checklists in reducing medication errors, surgical complications, and other adverse events. Error reporting systems foster transparency, encouraging professionals to report incidents and identify systemic vulnerabilities. Results Checklists and error reporting systems are interconnected. Interprofessional collaboration is emphasized in checklist implementation. In this review, limitations arise due to the different methodologies used in the articles and potential publication bias. In addition, language restrictions may exclude valuable non-English research. While positive impacts are evident, success depends on organizational culture and resources. Conclusions This review contributes to patient safety knowledge by examining the relevant literature, emphasizing the importance of interventions, and calling for further research into their effectiveness across diverse healthcare and cultural settings. Understanding these dynamics is crucial for healthcare providers to optimize patient safety outcomes.
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Gyberg A, Brezicka T, Wijk H, Ulin K. From identifying patient safety risks to reporting patient complaints: A grounded theory study on patients' hospital experiences. J Clin Nurs 2024. [PMID: 38951123 DOI: 10.1111/jocn.17355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024]
Abstract
AIM To explore how patients with hospital experience construct patient safety, from the identification of a patient safety risk to the decision to file a complaint. BACKGROUND Patients play an important role in the prevention of adverse events in hospitals, but the ability of patients to act and influence their own safety is still challenged by multiple factors. Understanding how patients perceive risk and act to prevent harm may shed light on how to enhance patients' opportunities to participate in patient safety. DESIGN The research design of this study is qualitative and exploratory. METHODS Twelve participants who had experienced Swedish hospital care were interviewed between June 2022 and July 2023. The method of analysis was constructivist grounded theory, focusing on social processes. The COREQ checklist for qualitative research was followed. RESULTS Four categories were constructed: (1) defining the boundary between one's own capacity and that of the hospital, (2) acting to minimize the impact on one's safety, (3) finding oneself in the hands of healthcare professionals and (4) exploring the boundaries between normality and abnormality of the situation. This process was captured in the core category of navigating the path of least suffering. This illustrated how the participants constructed meaning about patient safety risks and showed that they prevented multiple adverse events. CONCLUSIONS Provided that participants were able to act independently, they avoided a multitude of adverse events. When they were dependent on healthcare professionals, their safety became more vulnerable. Failure to respond to the participants' concerns could lead to long-term suffering. RELEVANCE TO CLINICAL PRACTICE By responding immediately to patients' concerns about their safety, healthcare professionals can help prevent avoidable suffering and exhaustive searching for someone in the healthcare system who will take their needs seriously. PATIENT CONTRIBUTION A member check was performed with the help of one of the participants who read the findings to confirm familiarity.
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Affiliation(s)
- Anna Gyberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics, and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Brezicka
- Department of Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center of Health Care Architecture, Chalmers University, Gothenburg, Sweden
| | - Kerstin Ulin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics, and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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de Lisser R, Lauderdale J, Dietrich MS, Ramanujam R, Stolldorf DP. The Social Ecology of Burnout: A framework for research on nurse practitioner burnout. Nurs Outlook 2024; 72:102188. [PMID: 38788272 DOI: 10.1016/j.outlook.2024.102188] [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: 10/06/2023] [Revised: 03/08/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The U.S. health system is burdened by rising costs, workforce shortages, and unremitting burnout. Well-being interventions have emerged in response, yet data suggest that the work environment is the problem. Nurse practitioner (NP) burnout is associated with structural and relational factors in the work environment, practice autonomy, and hierarchical leadership. PURPOSE We explore the unique social, cultural, and political environment in which NPs work through the lens of social ecology and present the Social Ecology of Burnout (SEB) framework. METHODS We review current burnout frameworks in the context of the NP practice environment and discuss the SEB, specifically exploring psychological safety and its influence on burnout. FINDINGS Psychological safety, work environment, and policy are presented within the SEB and solutions which empower NPs are considered. DISCUSSION Our framework can serve as a guide for future nursing research, practice, and policy.
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Affiliation(s)
- Rosalind de Lisser
- School of Nursing, Vanderbilt University, Nashville, TN; Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA.
| | | | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Rangaraj Ramanujam
- Center for Health Care Programs, Owen Graduate School of Management, Vanderbilt University, Nashville, TN
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Giruzzi ME, Fuller KA, Dryden KL, Hazen MR, Robinson JD. A Cycle of Reinforcing Challenges and Ideas for Action in Experiential Settings. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100710. [PMID: 38750821 DOI: 10.1016/j.ajpe.2024.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024]
Abstract
Evidence suggests that both pharmacy students and preceptors are struggling in the experiential setting. Underlying this phenomenon is a potential interconnected and cyclic set of behaviors being reinforced between students and preceptors. These behaviors can contribute to or are the result of higher levels of burnout and a decrease in the development of student clinical skills and subsequent performance on rotation. In this review, the authors investigate various challenges commonly encountered in the experiential environment. These challenges can range from an observed decrease in student engagement, motivation, and critical thinking skills to an increase in preceptor burnout and culture shifts in the clinical practice environments. These factors all ultimately impact patient care and overall student performance. For each challenge identified, strategies will be presented that can be implemented by students, preceptors, and pharmacy programs to break the cyclic pattern identified.
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Affiliation(s)
- Megan E Giruzzi
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA.
| | - Kathryn A Fuller
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kate L Dryden
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Malia R Hazen
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Jennifer D Robinson
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
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Brown W, Santhosh L, Stewart NH, Adamson R, Lee MM. The ABCs of Cultivating Psychological Safety for Clinical Learner Growth. J Grad Med Educ 2024; 16:124-127. [PMID: 38993303 PMCID: PMC11234300 DOI: 10.4300/jgme-d-23-00589.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Affiliation(s)
- Wade Brown
- is Assistant Professor of Medicine and Associate Program Director, Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Lekshmi Santhosh
- is Associate Professor of Medicine and Associate Program Director, Divisions of Pulmonary and Critical Care Medicine and Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Nancy H Stewart
- is Assistant Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Rosemary Adamson
- is Staff Physician, Pulmonary and Critical Care Medicine, Veterans Affairs Puget Sound Healthcare System, and Associate Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; and
| | - May M Lee
- is Associate Professor of Medicine and Program Director, Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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Vikan M, Deilkås EC, Valeberg BT, Bjørnnes AK, Husby VS, Haugen AS, Danielsen SO. The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway. Patient Saf Surg 2024; 18:7. [PMID: 38374077 PMCID: PMC10877820 DOI: 10.1186/s13037-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. METHODS This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. RESULTS The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. CONCLUSIONS This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.
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Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Ellen Ct Deilkås
- Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Berit T Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Ann K Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Vigdis S Husby
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Department of Health Sciences Aalesund, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Arvid S Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Stein O Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
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Ghasempour M, Ghahramanian A, Zamanzadeh V, Valizadeh L, Killam LA, Asghari-Jafarabadi M, Purabdollah M. Identifying self-presentation components among nursing students with unsafe clinical practice: a qualitative study. BMC MEDICAL EDUCATION 2023; 23:524. [PMID: 37480066 PMCID: PMC10362558 DOI: 10.1186/s12909-023-04486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Maintaining patient safety is a practical standard that is a priority in nursing education. One of the main roles of clinical instructors is to evaluate students and identify if students exhibit unsafe clinical practice early to support their remediation. This study was conducted to identify self-presentation components among nursing students with unsafe clinical practice. METHODS This qualitative study was conducted with 18 faculty members, nursing students, and supervisors of medical centers. Data collection was done through purposive sampling and semi-structured interviews. Data analysis was done using conventional qualitative content analysis using MAXQDA10 software. RESULTS One main category labelled self-presentation emerged from the data along with three subcategories of defensive/protective behaviors, assertive behaviors, and aggressive behaviors. CONCLUSION In various clinical situations, students use defensive, assertive, and aggressive tactics to maintain their professional identity and present a positive image of themselves when they make a mistake or predict that they will be evaluated on their performance. Therefore, it seems that the first vital step to preventing unsafe behaviors and reporting medical errors is to create appropriate structures for identification, learning, guidance, and evaluation based on progress and fostering a growth mindset among students and clinical educators.
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Affiliation(s)
- Mostafa Ghasempour
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Laura A. Killam
- School of Health Sciences, Nursing, and Emergency Services, Cambrian College, Sudbury, ON Canada
- School of Nursing, Nipissing University, North Bay, ON Canada
| | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC 3144 Australia
- Biostatistics Unit, School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
- Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168 Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Purabdollah
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Wawersik DM, Boutin ER, Gore T, Palaganas JC. Perspectives on developing moral courage in pre-licensure education: A qualitative study. Nurse Educ Pract 2023; 70:103646. [PMID: 37216793 DOI: 10.1016/j.nepr.2023.103646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 02/11/2023] [Accepted: 04/16/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Error reporting and speaking up are mechanisms to reduce the incidence of healthcare errors. However, organizational policies don't always align with individuals' perceptions and beliefs to promote these mechanisms. When this misalignment produces fear, moral courage, which is taking action regardless of personal consequences, becomes necessary. Teaching moral courage in pre-licensure education may set a foundation for individuals to speak up in post-licensure careers. AIM To explore health professionals' perceptions of healthcare reporting and organizational culture to inform pre-licensure education on how to promote moral courage. METHODS Thematic analysis of four semi-structured focus groups with fourteen health professions educators followed by in-depth, semi-structured individual interviews. FINDINGS Organizational factors, characteristics that an individual must possess to enact moral courage and priority methods to guide moral courage were identified. CONCLUSIONS This study outlines the need for leadership education in moral courage and offers educational interventions to promote reporting and aid in developing moral courage academic guidelines to improve healthcare error reporting and speaking up behaviors.
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Affiliation(s)
- Dawn M Wawersik
- MGH Institute of Health Professions, USA; Henry Ford College, USA; Nova Southeastern University, USA.
| | | | - Teresa Gore
- Ron and Kathy Assaf College of Nursing, USA; Nova Southeastern University, USA
| | - Janice C Palaganas
- MGH Institute of Health Professions, USA; Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, USA
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