Patient Safety Attitudes among Doctors and Nurses: Associations with Workload, Adverse Events, Experience

Authentic Nursing Leadership and Safety Climate Across Hospital Settings During the COVID-19 Pandemic: A Cross-Sectional Study

AIM

To analyse the relationship between authentic nursing leadership and safety climates across hospital settings during the COVID-19 pandemic.

BACKGROUND

Authentic nursing leadership shapes the safety climate by fostering positive perceptions of workplace policies, processes, procedures and practices that influence how safety is prioritised and addressed within an organisation.

DESIGN

A cross-sectional study.

METHODS

Our study was conducted from December 2021 to December 2022 in six Brazilian hospitals. Participants were nursing staff working in General Medicine Units, Intensive Care Units (ICU) and Emergency Departments (ED) who provided care to patients with COVID-19. The Authentic Leadership Questionnaire and the Safety Attitudes Questionnaire were used to measure nursing staff perceptions of authentic leadership and safety climates. Data were analysed using descriptive and inferential statistics.

RESULTS

391 nursing staff across six hospitals participated. Self-awareness significantly enhanced perceptions of the safety climates. Additionally, being a Registered Nurse and working in the ICU were positively associated with achieving safe climates in the working environment. In contrast, working in EDs was significantly negatively related to safety climates.

CONCLUSIONS

The COVID-19 pandemic underscored a lack of authentic nursing leadership and unsafe climates. Therefore, it is critical to implement educational strategies that foster authentic leadership, particularly focusing on self-awareness, to promote more positive safety climates. Ensuring that leadership and safety climates are relationship-focused is critical to enhancing patient outcomes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nursing staff's perceptions of authentic leadership and safety climates are important in making more informed decisions about patient management.

IMPACT

Since self-awareness increases positive perceptions of safety climates, nursing staff should exercise it to guide their actions in facing future health crises.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Higher self-awareness in relationships with others is a predictor of safety climates and can lead to enhanced patient outcomes.

Attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals: a cross-sectional survey

OBJECTIVES

To assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety.

DESIGN

An institution-based, cross-sectional survey was carried out from July to August 2023.

SETTING

10 governmental teaching hospitals in Tehran, Iran.

PARTICIPANTS

The study participants comprised a random sample of 186 nurses and 90 physicians who had worked for at least 6 months in their current hospitals.

OUTCOME MEASURES

The primary outcome measures were mean and SD scores for individual items and the nine main patient safety domains assessed by the Attitudes Toward Patient Safety Questionnaire-III. The secondary outcome measure was the proportion of physicians and nurses who responded positively to each item, expressed as percentages for each group.

RESULTS

Physicians and nurses exhibited moderately positive attitudes towards patient safety (mean scores of 3.79±0.33 and 3.83±0.36, respectively). Both professional groups reported the most positive attitudes in the same dimensions: 'team functioning' and 'working hours as a cause for error' (mean scores of >4 out of 5). Conversely, the lowest scores were observed in 'importance of patient safety in the curriculum', indicating potential gaps in their understanding of patient safety (mean scores of <3.5 out of 5). Physicians displayed significantly more positive attitudes in the domain of 'error inevitability', while nurses held more positive attitudes in 'error reporting confidence' and 'disclosure responsibility' (p<0.05). Multiple linear regression analysis demonstrated that the factors associated with more positive attitudes towards patient safety included lower workload (B=0.131; 95% CI 0.047 to 0.215; p=0.002), reporting of adverse events (B=0.100; 95% CI 0.009 to 0.191; p=0.030) and receiving patient safety training (B=0.134; 95% CI 0.019 to 0.249; p< 0.023).

CONCLUSION

Both professional groups demonstrated moderately positive attitudes towards patient safety. However, the findings highlighted the need for future patient safety training to prioritise enhancement of healthcare professionals' understanding of medical errors. Such training initiatives should be engaging and directly relevant to the specific needs of both nurses and physicians, ensuring its perceived value to their ongoing professional development. Furthermore, fostering a supportive and blame-free environment that encourages the reporting of medical errors is crucial.

Examination of the relationship between nurses' adherence to medication administration principles and their attitudes toward patient safety

BACKGROUND

Preventing errors associated with medication administration is achievable through nurses' adherence to correct principles.

OBJECTIVE

This study aims to investigate the relationship between nurses' adherence to medication administration principles and their attitudes toward patient safety.

METHOD

This study adopts a descriptive and relationship-seeking research design. A total of 310 nurses who met the inclusion criteria participated in the study. Data collection tools included the "Nurse Information Form," "Medication Administration Principles Adherence Form," and "Patient Safety Attitude Scale".

RESULTS

Among the participating nurses, 32.9% (n = 102) reported experiencing a medication administration error, and 77.7% (n = 241) witnessed such an error. The study revealed a statistically significant positive relationship between nurses' adherence to medication administration principles and their attitudes toward patient safety (p < 0.001).

CONCLUSIONS

This study underscores the importance of nurses' adherence to medication administration principles in ensuring patient safety.

Components of safe nursing care in the intensive care units: a qualitative study

BACKGROUND

Patient safety is a global health issue that affects patients worldwide. Providing safe care in the intensive care units (ICUs) is one of the most crucial tasks for nurses. Numerous factors can impact the capacity of nurses to deliver safe care within ICUs. Consequently, this study was undertaken with the aim of identifying the components of safe nursing care in ICUs.

METHODS

The current research constitutes a qualitative conventional content analysis study conducted from January 2022 to June 2022. The study participants comprised nurses, intensivists, nurse responsible for patient safety, paramedic, patients, and patients' family member, totaling 21 individuals selected through purposive sampling. Data collection involved individual, in-depth, and semi-structured interviews. Subsequently, data analysis was performed utilizing the approach outlined by Graneheim and Lundman (Nurse Educ Today 24(2):105-12, 2004), leading to the identification of participants' perspectives.

RESULTS

Three themes were identified as components of safe nursing care in ICUs. These themes include professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment).

CONCLUSIONS

The findings of this study underscore the significance of advocating for safe nursing practices in ICUs by emphasizing professional conduct, holistic care, and safety-focused organizational structures. These results align with existing research, suggesting that by introducing tailored interventions and tactics informed by these elements, a safer environment for nursing care can be established for ICUs patients.

Photovoice and Health Perception in a Group of Early-Career Nurses

Background. Nurses' perceptions of health are essential to decision making and communicating with clients. However, little is known about their own perceptions of this phenomenon. This study focuses on health-related beliefs among young nurses enrolled in a master's-level nursing program using a modified photovoice methodology. Methods. The study population was 87 nurses undergoing a master's degree in nursing at Jagiellonian University Medical College in Krakow, Poland, participating in an obligatory health psychology course. For the modified photovoice activity, the participants took three photos related to their perceptions of (1) health, (2) health protective factors, and (3) health risk factors. The data interpretation involved a thematic analysis of these photos and captions; a narrative analysis to distinguish between documentary and symbolic photos; and a descriptive analysis of the photo production. Results. Eighty-seven students completed the photography assignment. The mean age was 22.1 years (SD = 1.1). Most photos (91%) documented real-life health behaviours. Some photos (9%) used everyday objects such as sunflowers to create symbols related to health. A photo series showed a model of the human brain in different environments and activities. Conclusions. Student participation in the photovoice activity appeared to strengthen observation and interpretation skills, which are essential to client care. Students used this opportunity to reflect on their own lives and environments and show their perceptions of health, health protective factors, and health risks. The activity planted seeds for changes in students' health perceptions and critical thinking. Future research could explore whether participation in a modified photovoice activity as experiential learning in a required health psychology course contributes to changes in master's-level nursing students' personal health behaviours and client care.

Development and psychometric evaluation of a pneumatic tourniquet work standards scale

OBJECTIVE

Pneumatic tourniquets are among the most essential equipment for controlling bleeding in orthopedic surgeries. However, incorrect application of pneumatic tourniquets is accompanied by many hazards and complications for patients. Evaluation of surgical teams' use of pneumatic tourniquets and establishment of protocols can play an important role in improving patient safety, minimizing risks, and increasing the lifetime of this equipment. Accordingly, the present study was conducted to develop and assess the psychometric properties of a pneumatic tourniquet work standards scale.

METHODS

The present study is a methodological work carried out in two stages. In the first stage, an initial version of the scale was developed based on existing research and panel reviews. In the second stage, the psychometric properties of the scale were tested in terms of face validity (measured qualitatively and quantitatively), content validity (measured qualitatively and quantitatively), item analysis, construct validity, and reliability (internal consistency and stability).

RESULTS

The initial version of the scale consisted of 91 items. After several meetings of the research team, the number of items decreased to 81. In the course of face and content validity testing, 40 items were eliminated, leaving 41 items on the scale when it entered the construct validity testing stage. For evaluation of construct validity, a sample of 300 operating room nurses was recruited. The Exploratory Factor Analysis (EFA) results showed a structure supported by seven factors and 41 items. The reliability of the scale was confirmed by internal consistency analysis, with a good Cronbach's alpha (0.85), and test-retest analysis, with good values of ICC (0.95).

CONCLUSION

The present instrument is a reliable and valid scale which fills the gap in assessment of surgical team members' use of pneumatic tourniquets. The developed scale can be employed by researchers and managers of medical centers to identify hazards in applying pneumatic tourniquets and devise educational programs to eliminate or reduce the existing issues.

Knowledge, attitude and practice regarding constipation in pregnancy among pregnant women in Shanghai: a cross-sectional study

Objective

This study aims to investigate the Knowledge, Attitude, and Practice (KAP) pertaining to constipation during pregnancy among pregnant women in Shanghai.

Methods

Demographic data and KAP scores were collected using a questionnaire. Differences across groups were analyzed using either Wilcoxon-Mann-Whitney tests or Kruskal-Wallis analysis of variance. Spearman's correlation analysis was utilized to evaluate the relationships between KAP scores. Multivariable logistic regression analyses were conducted to identify factors that influence KAP scores.

Results

Encompassing 241 individuals (46.6%) aged between 30 and 34 years, with 349 participants (67.5%) being nulliparous. The median scores for knowledge (possible range: 0-26), attitude (possible range: 7-35), and practice (possible range: 14-70) were 22 (18, 24), 26 (23, 29), and 51 (46, 56), respectively. Multivariate analysis indicated that being a medical professional (OR = 2.222, p = 0.043) and receiving education on constipation during pregnancy (OR = 0.432, p < 0.001) were significantly associated with higher knowledge scores. Factors significantly associated with practice included being aged 30-34 years (OR = 2.745, p < 0.001), aged 35 years and above (OR = 2.514, p < 0.001), working in education (OR = 2.310, p = 0.012), and not experiencing constipation before pregnancy (OR = 1.894, p = 0.001).

Conclusion

Pregnant women demonstrated satisfactory knowledge, positive attitudes, and proactive practices concerning constipation during pregnancy. To further augment clinical practice, healthcare providers should tailor educational interventions and guidance specifically for pregnant women who are not medical professionals and those who have not received education and guidance related to constipation during pregnancy.

Differences in the depression and burnout networks between doctors and nurses: evidence from a network analysis

BACKGROUND

Previous studies have demonstrated a strong association between depression and job burnout among healthcare professionals, but the results have been inconsistent, and there is a lack of in-depth exploration of such a relationship among different healthcare professions. The present study aims to investigate the interrelationships between depression and burnout among Chinese healthcare professionals and whether there are differences in the networks of these symptoms between doctors and nurses.

METHODS

The Maslach Burnout Inventory-General Survey and the 2-item Patient Health Questionnaire were employed to assess job burnout and depression among 3,684 healthcare professionals. The translation has been refined to ensure accuracy and academic suitability. Subsequently, network analysis was conducted on 2,244 participants with a higher level of job burnout to identify core symptoms and explore the associations between job burnout and depression.

RESULTS

The present study showed a network association between lack of interest and pleasure in things and being exhausted from work, excessive tiredness facing work, tendency to collapse at work, and lack of passion for work than before among healthcare professionals, as well as a notable difference in the network association between lack of interest and pleasure in things and lack of passion for work than before between nurses and doctors.

CONCLUSIONS

The depression-burnout network structures differ between doctors and nurses, highlighting the need for targeted intervention measures for both groups.

The influence of hospital accreditation on nurses' perceptions of patient safety culture

OBJECTIVES

Hospitals' accreditation process is carried out to enhance the quality of hospitals' care and patient safety practices as well. The current study aimed to investigate the influence of hospitals' accreditation on patient safety culture as perceived by Jordanian hospitals among nurses.

METHODS

A descriptive cross-sectional correlational survey was used for the current study, where the data were obtained from 395 nurses by convenient sampling technique who were working in 3 accredited hospitals with 254 nurses, and 3 non-accredited hospitals with 141 nurses, with a response rate of 89%.

RESULTS

The overall patient safety culture was (71.9%). Moreover, the results of the current study revealed that there were no statistically significant differences between the perceptions of nurses in accredited and non-accredited hospitals in terms of perceptions of patient safety culture.

CONCLUSION

The current study will add new knowledge about nurses' perceptions of patient safety culture in both accredited and non-accredited hospitals in Jordan which in turn will provide valid evidence to healthcare stakeholders if the accreditation status positively affects the nurses' perceptions of patient safety culture or not. Continuous evaluation of the accreditation application needs to be carried out to improve healthcare services as well as quality and patient safety.

Chinese Healthcare Workers' Knowledge, Attitudes, and Practices in Diabetic Kidney Management: A Multi-Centered Cross-Sectional Study

Background

Given the importance of diabetic kidney disease (DKD) management, this study aims to explore the knowledge, attitudes, and practices in disease management demonstrated by healthcare workers from the nephrology department.

Materials and Methods

This study is a multi-centered cross-sectional study, and adopts snowball sampling, with 530 healthcare workers being recruited to complete a questionnaire covering areas such as demographic characteristics, knowledge, attitude, and practices (KAP) of DKD management. This data was analyzed using descriptive statistics and binary logistics analysis.

Results

In this study, 530 healthcare workers were studied, including 94 doctors and 436 nurses. The participants were mainly from general tertiary hospitals in 14 provinces. For Chinese nurse, the results indicate that both poor knowledge level (Odds Ratio (OR) =0.63, 95% Confidence Interval (CI): 0.42-0.94) and having experience in further medical training in nephrology (OR=1.92, 95% CI: 1.20-3.08) are associated with the practice levels. For Chinese doctors, having not experience in further medical training in nephrology (OR=0.36, 95% CI: 0.15-0.83) are associated with their practice levels.

Conclusion

In summary, Chinese doctors and nurses in this study showed positive attitudes towards DKD management, but their knowledge and practical skills were lacking. This underscores a notable gap in achieving optimal DKD care. Notably, nurses' knowledge influenced their management practices, and additional nephrology training correlated with better engagement. To improve patient care, enhancing nephrology healthcare professional training and addressing knowledge-practice disparities are recommended.

Knowledge, attitudes, and practices toward Patient Safety among nurses in health centers

OBJECTIVE

To assess knowledge, attitudes, and practices (KAPs) toward patient safety among nurses working at primary and comprehensive health care centers in Jordan; to identify factors that predict KAPs among nurses.

METHODS

A descriptive cross-sectional design was conducted using a convenience sample of 307 primary health care nurses in Jordan. A self-reported questionnaire (KAPs) toward patient safety was distributed to the nurses between August 2022 and October 2022.

RESULTS

The results revealed that the mean score of knowledge was 9.51 out of 11 (SD = 1.35), the mean score of attitudes was 57.66 out of 75 (SD = 9.17), and the mean score of practices was 5.64 out of 8 (SD = 1.72). Where 59% of participants reported good knowledge about patient safety. 61% of participants reported positive attitudes toward patient safety. A significant regression equation was found (R² = 0.073, F= (2.94), p = 0 0.003). Age and having information on patient safety during continuing education were significant predictors of the attitude score (p ≤ 0.05).

CONCLUSION

It is necessary to implement patient safety education programs and training.

Exploring the influencing factors of patient safety competency of clinical nurses: a cross-sectional study based on latent profile analysis

BACKGROUND

Clinical nurses play an important role in ensuring patient safety. Nurses' work experience, organizational environment, psychological cognition, and behavior can all lead to patient safety issues. Improving nurses' attention to patient safety issues and enhancing their competence in dealing with complex medical safety issues can help avoid preventable nursing adverse events. Therefore, it is necessary to actively identify the latent profiles of patient safety competency of clinical nurses and to explore the influencing factors.

METHODS

A cross-sectional design was conducted. A total of 782 Chinese registered nurses were included in the study. Demographic characteristics questionnaire, Error Management Climate scale, Security Questionnaire, Proactive Behavior Performance scale and Patient Safety Competency Self-Rating Scale of Nurses were used. Latent profile analysis (LPA) was performed to categorize nurses into latent subgroups with patient safety competency differences. Multinomial logistic regression was conducted to explore the influencing factors of nurses' patient safety competency (PSC) in different latent profiles.

RESULTS

A total of 782 questionnaires were valid. Nurses' PSC was positively related to error management climate, and psychological safety and proactive behavior. The PSC score was 121.31 (SD = 19.51), showing that the PSC of clinical nurses was at the level of the medium on the high side. The error management climate score was 70.28 (SD = 11.93), which was at a relatively high level. The psychological safety score was 61.21 (SD = 13.44), indicating a moderate to low level. The proactive behavior score was 37.60 (SD = 7.33), which was at a high level. The latent profile analysis result showed that three groups of profile models were fitted acceding to the evaluation of PSC. They were defined as Low-competency Group (74 (9.5%)), Medium-competency Group (378 (48.3%)) and High-competency Group (330 (42.2%). Working years, professional titles, departments, error management climate, psychological security and proactive behavior were the influencing factors of PSC in three latent profiles.

CONCLUSIONS

The PSC of clinical nurses had obvious classification characteristics, and the main influencing factors were working years, professional titles, working departments, error management climate, psychological security and proactive behavior. This study suggests that managers should pay attention to the continuous cultivation of patient safety competence among clinical nurses, provide targeted intervention measures for nurses at different work stages, professional titles, and departments, and use efficient management strategies to create a positive error management atmosphere. In patient safety management, providing nurses with more psychological security is conducive to stimulating more proactive behaviors and continuously improving the level of patient safety competence.

Psychometric evaluation of the Persian version of Emergency Medical Services- Safety Attitudes Questionnaire (EMS-SAQ)

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.

A qualitative study on patients' and health care professionals' perspectives regarding care delivered during CIED operation

BACKGROUND

Cardiac implantable electronic devices (CIEDs) has proven to be an invaluable tool in the practice of cardiology. Patients who have undergone CIED surgery with local anesthesia may result in fear, insecurity and suffering. Some studies have put efforts on ways to improve intraoperative experience of patients with local anesthesia, but researches concerning experiences of CIED patients during surgery is in its infancy.

METHODS

Based on semi-structured and in-depth interviews, a qualitative design was conducted in a tertiary general hospital in China from May 2022 to July 2023.Purposeful sampling of 17 patients received CIED surgery and 20 medical staff were interviewed. Thematic analysis with an inductive approach was used to identify dominant themes.

RESULTS

Four themes emerged from the data: (1) Safety and success is priority; (2) Humanistic Caring is a must yet be lacking; (3) Paradox of surgery information given; (4) Ways to improve surgery experiences in the operation.

CONCLUSIONS

Intraoperative care is significant for CIED surgery. To improve care experience during surgery, healthcare professionals should pay attention to patients' safety and the factors that affecting humanistic caring in clinical practice. In addition, information support should consider information-seeking styles and personal needs. Besides, the four approaches presented in this study are effective to improve the intraoperative care experience.

Leadership styles on job satisfaction and security among healthcare workers during the COVID-19 pandemic

BACKGROUND

Hospitals employ many social workers, whose tasks are complicated and arduous. Quality of life assessments by healthcare professionals (HCWs) are essential for better healthcare and skillful health service delivery. HCWs have been under tremendous mental and psychological strain and at high risk of virus acquisition since the COVID-19 pandemic outbreak.

OBJECTIVE

This study evaluated public hospital efficiency issues and remedies in the Kingdom of Saudi Arabia.

METHODS

The study examined leadership styles and job satisfaction among Saudi Arabian healthcare workers (HCWs). Between September 1 and December 31, 2021, a descriptive cross-sectional investigation was conducted. During the COVID-19 pandemic, a verified web-based survey reached the appropriate sample and data was collected. A web-based self-administered survey collected demographic data, leadership style using Multifactor Leadership Questionnaire Form 6-S (MLQ-6S), and health care employee satisfaction (SEHC) from HCWs.

RESULTS

Leadership styles affected HCW job satisfaction, according to this study. Individual concern, idealized influence, contingent compensation, and inspiring motivation were negatively correlated with work satisfaction ratings.

CONCLUSION

Creating a special training programme for new leaders should cover leadership styles and approaches, the skills needed to foster a productive workplace with high-quality care, and the creation of motivated work opportunities that can boost worker engagement and satisfaction.

Perceptions of Patient Safety Culture among Triage Nurses in the Emergency Department: A Cross-Sectional Study

The patient safety culture is key to ensuring patient safety in healthcare organizations. The triage environment is inherently demanding for patient safety and is characterized by high stress, rapid decision-making, and quick action. In several countries, including Slovenia, there is a lack of studies on the patient safety culture among triage nurses. This study aimed to assess the perceptions of the patient safety culture among triage nurses. A cross-sectional survey design was used. The Emergency Medical Services-Safety Attitudes Questionnaire, distributed to triage nurses, was used to collect data. A total of 201 triage nurses participated in this study. The results revealed that the overall average perception of the patient safety culture was 57.27% (SD = 57.27), indicating that the perception of the patient safety culture among triage nurses in the emergency department was non-positive and requires improvement. "Job Satisfaction" received the highest score (63.18%; SD = 17.19), while "Working Conditions" received the lowest (49.91%; SD = 17.37). The perception of positive and negative safety culture responses was statistically significant for age (χ2 (3) = 17.750, p ≤ 0.001), education (χ2 (2) = 6.957, p = 0.031) and length of working experience (χ2 (3) = 8.875, p = 0.031). The findings emphasize the significance of improving the safety culture in relation to several areas of patient care during the triage process. This research serves as a crucial foundation for enhancing patient safety in triage, providing quality care, and reducing adverse events.

[Exploring facilitators and barriers to implementing expanded nursing roles in MexicoEstudo de facilitadores e barreiras para a implementação de funções ampliadas de enfermagem no México]

Objective

To explore the perceptions of nursing professionals regarding facilitators and barriers to the implementation of expanded nursing functions in a state in central Mexico.

Methods

Qualitative descriptive phenomenological study. During 2022, 18 semi-structured interviews were conducted with three types of informants: a) head nurses at state-level facilities; b) head nurses at local-level facilities; and c) heads of health units and operational nursing staff who have direct contact with patients.

Results

The following facilitators were identified: willingness to adopt the strategy (seen as favorable by managers and acceptable by nursing staff); reorganization of functions (simplification of processes and analysis of the situation of health units); access to training; and characteristics of nursing staff (professionalization, work experience, and favorable attitude). Barriers included: conditions at the first level of care (personnel shortages, too many administrative activities, lack of physical space, materials, supplies, and consumables), resistance to change (professional jealousy of other disciplines and duplication of tasks), staff salaries, lack of training, not trusted with expanded duties, and attitude of patients (resistance to nursing care).

Conclusions

By understanding the perceptions of nursing professionals, we can identify key elements for the successful expansion of nursing functions through expansion of the competencies of operational staff. Reorganization and proper management at different levels of decision-making will be necessary.

Attitudes of undergraduate medical students toward patients' safety in Jordan: a multi-center cross-sectional study

BACKGROUND

Patient safety practices are crucial in healthcare as they aim to reduce harm, medical errors, and ensure favorable outcomes for patients. Therefore, this study aims to examine the attitudes towards patient safety among undergraduate medical students in Jordanian medical schools.

METHODS

A descriptive cross-sectional study was conducted among undergraduate medical students. Participants completed the Attitudes to Patient Safety Questionnaire- III (APSQ-III), which examines students' attitudes in 26 items distributed in nine domains. Results are represented as mean ± standard deviation for all participants and subgroups.

RESULTS

Our study included 1226 medical students. They reported positive attitudes toward patient safety with a mean score of 4.9 (SD ± 0.65). Participants scored the highest score in "Working hours as error cause" followed by "Team functioning". Gender, academic-year, and first-generation student status had a significant association with certain patient safety domains. Females scored significantly higher than males in four domains, while males scored higher in one domain. First-generation medical students had a significantly lower score for "Professional incompetence as error cause". Interestingly, pre-clinical students recorded more positive attitudes in "Patient safety training received" and "Disclosure responsibility" domains.

CONCLUSION

Undergraduate medical students in Jordan demonstrated positive attitudes towards patient safety concepts. Our study provides baseline data to improve current educational programs and enhance the patient safety culture among medical students. Additional studies are needed to delve into actual attitudes toward patient safety and to assess how educational programs contribute to the cultivation of this culture.

Patient Safety Culture, Infection Prevention, and Patient Safety in the Operating Room: Health Workers' Perspective

Introduction

A hospital's patient safety culture affects surgical outcomes. Operating room safety culture has been overlooked despite the importance of patient safety. The AHRQ's Hospital Survey on Patient Safety Culture (HSOPSC) has been used worldwide to assess and enhance patient safety culture. This study examined how patient safety culture and infection prevention effect patient safety in the Operating Room (OR).

Methods

This observational study used an online survey and included 143 OR workers. Descriptive statistics and multilinear regression were used to examine how patient safety culture and infection prevention affects level of patient safety.

Results

Most responders worked in excellent-accredited general hospitals. Most responders were male, aged between 26 to 40 years old, and had bachelor's degrees. Most were hospital-experienced nurses. Less than half had worked in units for over ten years. Organizational Learning - Continuous Improvement; Teamwork and Handoffs; and Information Exchange had the most positive responses in the OR. However, Staffing, Work Pace, and Patient Safety ranked lowest. Organizational Learning - Continuous Improvement and Hospital Management Support for Infection Prevention Efforts were found to affect OR patient safety level perceptions.

Conclusion

According to the findings of our study, the overall patient safety culture in the operating room remains weak which highlights the importance of continuing efforts to improve patient safety in the OR. Further study could be directed to identify organizational learning in infection prevention to enhance the patient safety in the OR.

Fatigue in nurses and medication administration errors: A scoping review

BACKGROUND

Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs.

OBJECTIVE

Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings.

METHOD

Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue.

RESULTS

Thirty-eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies.

RELEVANCE TO CLINICAL PRACTICE

Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re-evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.

Practice and effect evaluation of early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department: a retrospective cohort study

OBJECTIVE

To explore the practice and effect evaluation of the early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department.

METHODS

A total of 239 sepsis patients, who were treated in the emergency department of our hospital from January to September 2020, were selected as the participants of this study, and a retrospective analysis was performed. According to different methods of fluid resuscitation, they were divided into an improved group and a control group. One hundred and twelve patients who received restrictive fluid resuscitation were in the improved group; another 127 patients who received adequate fluid resuscitation were in the control group. The ICU stay time, ventilator use time, and 28-day mortality rate of the two groups were observed. The hemodynamic indices, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and complications of the two groups before and after treatment were compared.

RESULTS

After treatment, in the improved group, the APACHE II and SOFA scores were lower than in the control group, fluid replacement decreased, lactate clearance increased, ICU admission time shortened and the proportion of ventilator time to ICU admission time decreased. The incidence of acute respiratory distress syndrome (ARDS), cTn I and brain natriuretic peptic in the improved group were significantly lower than those in the control group. From the dimension within the group, the APACHE II score, SOFA score, heart rate and shock index were lower after treatment than before treatment in both the improved and control groups.

CONCLUSION

Restricted fluid resuscitation can effectively alleviate the condition of emergency sepsis patients, improve hemodynamics, reduce the incidence of ARDS, and prevent patient deaths. It is worthy of clinical application.

Identification of behavioural changes in reporting adverse events early during COVID-19: An ambulatory care perspective in Israel

This study examined adverse event reporting centred on three significant dates in the months before the pandemic arrived in Israel. On these dates, broad media coverage exposed citizens and health care providers with indications about the forthcoming pandemic. The current study tracked whether parameters related to reporting adverse medical events provided early indications that a large crisis was unfolding. The method for analysing the data was based on a statistical test called Regression Discontinuity Design, which helped identify parameters related to medical reporting patterns which significantly changed. The examination indicated nurses' reports were unique in relation to others and indicated three phases: (1) upon declaration of the upcoming pandemic, there was a rise in reporting; (2) when the disease was named, there was moderation and maintenance in a steady quantity of reports, and finally, (3) when the first case arrived in Israel, a slight decrease in reporting began. Nurses' behaviours manifested as changes in reporting patterns. In this process of increase, moderation and decrease, it can be concluded that these are three stages that may characterise the beginning of a large event. The research method presented reinforces the need for forming tools by which significant events such as the COVID-19 pandemic can be identified quickly, and aid in proper planning of resources, optimise staffing and maximise utilization of the health systems.

Knowledge, risk assessment, practices, self-efficacy, attitudes, and behaviour's towards venous thromboembolism among nurses: A systematic review

AIM

This study reviewed the literature on nurses' knowledge, risk assessment practices, self-efficacy, attitudes, and behaviours towards venous thromboembolism (VTE).

DESIGN

A systematic review following PRISMA guidelines.

METHODS

CINAHL (via EBSCO), MEDLINE (via PubMed), and Web of Science were electronic databases used to find studies published from 2010 to November 2020 in English language. A Hoy critical appraisal checklist was used to assess the risk of bias and methodologic quality.

RESULTS

This study included fourteen studies conducted on 8628 Registered Nurses. Nine of the fourteen studies examined nurses' general knowledge level regarding VTE, and five showed that most nurses had a good knowledge of VTE. Of the 14 studies, six assessed nurses' risk assessment knowledge regarding VTE, and three showed that nurses had low knowledge of VTE risk assessment. Eleven studies assessed nurses' practices concerning VTE prophylaxis; 5 of the 11 studies reported that nurses had poor and unsatisfactory levels of VTE practice. Three of the 14 studies showed that nurses had low self-efficacy and varied beliefs. The most frequent recommendations were to create continuous educational programs and in-service training programs (n = 11), followed by creating institutional protocols standardizing VTE (n = 6).

CONCLUSIONS

Comprehensive educational programs and campaigns based on well-established and standardized tools should be provided to nurses to improve their VTE knowledge.

Perceived Relationship Between Horizontal Violence and Patient Safety Culture Among Nurses

Objective

Despite the value of undertaking patient safety culture, its association with horizontal violence in nursing workplace is still understudied. This study aimed to investigate the association between the perceived patient safety culture and its relationship with horizontal violence among nurses working in Jordan.

Methods

A cross-sectional correlational design was used. Nurses working in major governmental hospitals in Jordan were conveniently recruited to complete an online self-administered questionnaire, which included the following tools: Hospital Survey on Patient Safety Culture and Negative Behaviours in Healthcare (NBHC) Survey. The survey was designed to measure attitudes and perceptions on patient safety culture at multiple levels of a healthcare organization with ten dimensions. The Negative Behaviours in Healthcare (NBHC) survey was developed as an adaptation of the Lateral Violence in Nursing Survey (LVNS) with 25 items and two open-ended questions.

Results

A total of 330 nurses responded to the questionnaire. Nurses moderately perceived patient safety culture (HSOPS mean = 3.5, SD = 1.1). Low incidence of horizontal violence was claimed (mean = 2.1, SD = 1.1). However, it was associated with moderate negative correlation with patient safety culture (r = -0.53, p < 0.001). Regression model revealed that patient safety culture explained an additional 53% of the variance of horizontal violence after controlling the effects of age and length of clinical experience (R-square change: 0.560, SE: 19.7, P: 0.001, CI: 1.21-1.57).

Conclusion

Despite its low incidence, patient safety culture was found influential to the horizontal violence based on the perspectives of nurses in Jordan. Patient safety culture can be incorporated with other factors that contribute to the development of horizontal violence in nursing workplace.

Awareness of reporting practices and barriers to incident reporting among nurses

BACKGROUND

Adequate incident reporting practices for clinical incident among nurses and even all healthcare providers in clinical practice settings is crucial to enhance patient safety and improve the quality of care delivery. This study aimed to investigate the level of awareness of incident reporting practices and identify the barriers that impact incident reporting among Jordanian nurses.

METHODS

A descriptive design using a cross-sectional survey was employed among 308 nurses in 15 different hospitals in Jordan. Data collection was conducted between November 2019 and July 2020 using an Incident Reporting Scale.

RESULTS

The participants showed a high level of awareness of the incident reporting with a mean score of 7.3 (SD = 2.5), representing 94.8% of the highest score. Nurses perceived their reporting practices at the medium level, with a mean score of 2.23 out of 4. The main reporting barriers included worrying about disciplinary actions, fearing being blamed, and forgetting to make a report. In regard to awareness of incident reporting, there were statistically significant differences in the mean for total awareness of the incident reporting system scores according to the type of hospital (p < .005*). In regard to self-perceived reporting practices, nurses working in accredited hospitals demonstrated statistically significant differences in self-perceived reporting practices (t = 0.62, p < .005).

CONCLUSIONS

The current results provide empirical results about perceived incident reporting practices and perceived barriers to reporting frequently. Recommendations are made to urge nursing policymakers and legislators to provide solutions for those barriers, such as managing staffing issues, nursing shortage, nurses' empowerment, and fear of disciplinary actions by front-line nurse managers.

Patient safety culture and associated factors among nurses working at public hospitals in Gamo Zone, Southern Ethiopia

BACKGROUND

Patient safety culture is the prevention of errors and adverse effects to patients associated with health care delivery. It is a vital component in the provision of quality care. In healthcare settings where there is a safety culture, the people (providers, staff, administrators, and patients/families) are engaged, encouraged, and supported to make care safer. Though it is an essential component in the provision of quality care, little is known about its level, contributory, and hindering factors from the nurses' perspectives. This study aimed to assess patient safety culture and associated factors among nurses working at public Hospitals in Gamo Zone, Southern Ethiopia.

METHODS

This institution-based cross-sectional study was conducted among 398 nurses working at public hospitals in Gamo Zone. Data were collected by pretested, well-structured self-administered questionnaire from June 1 to 30, 2022. The collected data were checked, coded, and entered into Epi-data version 4.6.0.2 and were exported to SPSS version 25 for analyses. Bivariable and multivariable logistic regression was done to identify independent factors associated with patients' safety culture.

RESULTS

This study revealed that 202(50.8%), 95% CI: (46%-56%) of the participants had indicated good patient safety culture. From factors analysis, having an educational status of a bachelor's degree and above [AOR = 2.26, 95%CI: (1.13-4.52)], working in a surgical ward [AOR = 5.48, 95%CI: (1.96-15.34)], not being blamed when medical errors happened [AOR = 3.60, 95%CI: (1.82 - 7.14)], and working 40 up to 49 h per week [AOR = 0.30, 95%CI: (0.13 - 0.74)] were identified to be significantly associated with good patient safety culture.

CONCLUSION

Based on the study findings, it could be observed that good patient safety culture was indicated only by half of the study participants. Implementing actions that support dimensions of patient safety culture, and creating opportunities for continuous educational advancement is recommended. Moreover, Hospital administrators, nurses' directors, and healthcare policy-makers should work in collaboration to improve the patient safety culture, and also it would be better to create a blame-free environment to promote event reporting practices.

Determining Factors of Alarm Fatigue among Nurses in Intensive Care Units-A Polish Pilot Study

INTRODUCTION

With the development of medical technology, clinical alarms from various medical devices, which are rapidly increasing, are becoming a new problem in intensive care units. The aim of this study was to evaluate alarm fatigue in Polish nurses employed in Intensive Care Units and identify the factors associated with alarm fatigue.

METHODS

A cross-sectional study. The study used the nurses' alarm fatigue questionnaire by Torabizadeh. The study covered 400 Intensive Care Unit nurses. The data were collected from February to June 2021.

RESULTS

The overall mean score of alarm fatigue was 25.8 ± 5.8. Participation in training programs related to the use of monitoring devices available in the ward, both regularly (ß = -0.21) and once (ß = -0.17), negatively correlated with nurses' alarm fatigue. On the other hand, alarm fatigue was positively associated with 12 h shifts [vs. 8 h shifts and 24 h shifts] (ß = 0.11) and employment in Intensive Cardiac Surveillance Units-including Cardiac Surgery [vs. other Intensive Care Units] (ß = 0.10).

CONCLUSION

Monitoring device alarms constitute a significant burden on Polish Intensive Care Unit nurses, in particular those who do not take part in training on the operation of monitoring devices available in their ward. It is necessary to improve Intensive Care Unit personnel's awareness of the consequences of overburdening and alarm fatigue, as well as to identify fatigue-related factors.

Nurses' knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus

BACKGROUND

The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses' role in nutritional management of diabetes. This study aimed to evaluate nurses' knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes.

METHODS

This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses' KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis.

RESULTS

The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses' attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008).

CONCLUSION

Nurses' knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

A cross-sectional study of knowledge, attitudes, barriers and practices of cervical cancer screening among nurses in selected hospitals in the Eastern Cape Province, South Africa

BACKGROUND

Cervical cancer is a preventable but highly prevalent cancer in many low -and middle-income countries including South Africa. Cervical cancer outcomes can be improved with improved vaccination, a well-coordinated and efficient screening programme, increased community awareness and uptake, and increased knowledge and advocacy of health professionals. This study therefore aimed to ascertain the knowledge, attitudes, practices and barriers of cervical cancer screening among nurses of selected rural hospitals in South Africa.

METHODS

A quantitative cross-sectional study was conducted in five hospitals in the Eastern Cape Province of South Africa between October and December 2021. A self-administered questionnaire was used to assess demographic characteristics of nurses and cervical cancer knowledge, attitudes, barriers and practices. A knowledge score of 65% was deemed adequate. Data were captured in Microsoft Excel Office 2016 and exported to STATA version 17.0 for analysis. Descriptive data analyses were used to report the results.

RESULTS

A total of 119 nurses participated in the study with just under two thirds (77/119, 64.7%) being professional nurses. Only 15.1% (18/119) of participants were assessed as having obtained a good knowledge score of ≥ 65%. The majority of these (16/18, 88.9%) were professional nurses. Of the participants with a good knowledge score, 61.1% (11/18) were from Nelson Mandela Academic Hospital, the only teaching hospital studied. Cervical cancer was deemed to be a disease of public health importance by 74.0% (88/119). However, only 27.7% (33/119) performed cervical cancer screening. Most of the participants (116/119, 97.5%) had an interest of attending more cervical cancer training.

CONCLUSION

The majority of nurse participants did not have adequate knowledge about cervical cancer and screening, and few performed screening tests. Despite this, there is a high level of interest in being trained. Meeting these training needs is of utmost importance to implementing a comprehensive cervical cancer screening programme in South Africa.

Variation in Communication and Family Visiting Policies in Italian Intensive Care Units during the COVID-19 Pandemic: A Secondary Analysis of the COVISIT International Survey

BACKGROUND

During COVID-19 pandemic, restrictions to in-person visiting of caregivers to patients admitted to intensive care units (ICU) were applied in many countries. Our aim was to describe the variations in communication and family visiting policies in Italian ICUs during the pandemic.

METHODS

A secondary analysis from the COVISIT international survey was conducted, focusing on data from Italy.

RESULTS

Italian ICUs provided 118 (18%) responses out of 667 responses collected worldwide. A total of 12 Italian ICUs were at the peak of COVID-19 admissions at the time of the survey and 42/118 had 90% or more of patients admitted to ICU affected by COVID-19. During the COVID-19 peak, 74% of Italian ICUs adopted a no-in-person-visiting policy. This remained the most common strategy (67%) at the time of the survey. Information to families was provided by regular phone calls (81% in Italy versus 47% for the rest of the world). Virtual visiting was available for 69% and most commonly performed using devices provided by the ICU (71% in Italy versus 36% outside Italy).

CONCLUSION

Our study showed that restrictions to the ICU applied during the COVID-19 pandemic were still in use at the time of the survey. The main means of communication with caregivers were telephone and virtual meetings.

A cross-sectional study in college-based nursing education: The influence of core self-evaluation and career calling on study engagement in nursing undergraduates

AIM

To investigate undergraduate nursing students' general study engagement using intra-individual assessment and to evaluate the impact of core self-evaluation and career calling on study engagement.

DESIGN

A descriptive and cross-sectional design.

METHODS

Data were collected using a self-administered questionnaire survey. Four hundred and twenty nursing students from first- to fourth (final)-academic year in Guangzhou Medical University were invited to participate in the spring of 2021. The Cronbach's alpha, one-way analysis of variance, Bonferroni post hoc analysis, Pearson correlation analysis and multiple stepwise regression analysis were used to analyse the data.

RESULTS

The first- and fourth-year undergraduates showed significantly higher levels of study engagement (first-year undergraduates, 3.52 ± 0.59; fourth-year undergraduates, 3.54 ± 0.64), core self-evaluation (first-year undergraduates, 3.04 ± 0.48; fourth-year undergraduates, 3.11 ± 0.45) and career calling (first-year undergraduates, 3.65 ± 0.47; fourth-year undergraduates, 3.69 ± 0.50) than those of second-year undergraduates (study engagement, 3.32 ± 0.61; core self-evaluation, 2.93 ± 0.52; career calling, 3.41 ± 0.50) and third-year undergraduates (study engagement, 3.16 ± 0.61; core self-evaluation, 2.88 ± 0.50; career calling, 3.34 ± 0.38). The Pearson correlation analysis among nursing students revealed a significant positive correlation between core self-evaluation, career calling and study engagement (p < 0.01). A partial mediation effect of career calling was present in the relationship between core self-evaluation and study engagement.

Nursing Care and Barriers for Prevention of Venous Thromboembolism in Total Knee and Hip Arthroplasty Patients: A Qualitative Study

Purpose

To determine barriers to preventing venous thromboembolism in total knee and hip arthroplasty patients by surgical nurses.

Methods

This qualitative study used a phenomenological approach. The semi-structured interview questionnaire included two questions focused on nursing care practices for VTE prevention and barriers faced during VTE prophylaxis in total knee and hip arthroplasty patients. Study data were collected from 10 surgical nurses through semi-structured interviews in July 2021.

Results

After analyzing the data, two main themes, five categories, and fourteen subcategories were developed. The main themes included "Nursing care" and "Barriers." Two categories were reflected in terms of nursing care: general care and mechanical prophylaxis. Regarding barriers, the analysis of the interview reflected three main categories: "lack of professional competence", "work conditions challenges", and "resistance from patients".

Conclusion

Educational institutions must play a critical role in preparing surgical nurses by establishing clinical nurse specialist programs and post-graduate diplomas programs that sufficiently prepare nurses for clinical settings.

Incidence, knowledge, attitude and practice toward needle stick injury among nursing students in Saudi Arabia

Background

Needle stick injuries constitute the greatest threat to nursing students during clinical practice because of accidental exposure to body fluids and infected blood. The purpose of this study was to (1) determine the prevalence of needle stick injuries and (2) measure the level of knowledge, attitude and practice among nursing students about needle stick injuries.

Methods

Three hundred participants undergraduate nursing students at a private college in Saudi Arabia were included, of whom 281 participated, for an effective response rate of 82%.

Results

The participants showed good knowledge scores with a mean score of 6.4 (SD = 1.4), and results showed that students had positive attitudes (Mean = 27.1, SD = 4.12). Students reported a low level of needle stick practice (Mean = 14.1, SD = 2.0). The total prevalence of needle stick injuries in the sample was 14.1%. The majority, 65.1%, reported one incidence in the last year, while (24.4%) 15 students reported two incident of needle stick injuries. Recapping was the most prevalent (74.1%), followed by during injection (22.3%). Most students did not write a report (77.4%), and being worried and afraid were the main reasons for non-reports (91.2%). The results showed that female students and seniors scored higher level in all needle stick injuries domains (knowledge, attitude and practice) than male students and juniors. Students who had needle stick injuries more than three times last year reported a lower level of all needle stick injury domains than other groups (Mean = 1.5, SD =1.1; Mean = 19.5, SD =1.1; Mean = 9.5, SD =1.1, respectively).

Conclusion

Although the student's showed good knowledge and positive attitudes in NSI, the students reported a low level of needle stick practice. Raising awareness among nursing students and conducting continuing education related to sharp devices and safety and how to write an incident reporting is highly recommended.

Assessment of the Critical Care Work Environment of Intensive Care Unit Nurses in Saudi Arabia

Background

Nurses play a major role in the delivery of complex and challenging critical care in intensive care units (ICUs). Assessment of work environment is essential indicators of hospital management and can be applied to workforce planning and identifying nursing profession needs. The American Association of Critical-Care Nurses (AACN) recognized six standards for a healthy work environment and developed the Healthy Work Environment Assessment Tool (HWEAT). The aim of this study was to assess the work environment of ICU nurses in Jazan, Saudi Arabia.

Methods

This cross-sectional study was conducted at public and private hospitals. Data were collected using a self-administered questionnaire that included the sociodemographic characteristics and the AACN HWEAT. Data were analyzed to obtain descriptive and inferential statistics. The Mann-Whitney U and Kruskal-Wallis tests were employed to compare demographic data, on the basis of the overall mean HWEAT score.

Results

The study participants were 238 ICU nurses, who were predominantly female (83%). The mean overall HWEAT score was 3.55±1.03, which is within the "good" range, and was higher for male nurses (3.66), nurses aged ≥41 years (3.76), and nurses with postgraduate education (4.04), work experiences of >10 years (3.63), and alternate work shifts (3.6). Nurses in private hospitals had significantly higher overall scores than nurses in public hospitals (3.83 vs 3.19, P<0.001). All HWEAT standards ("effective decision-making", "authentic leadership", "appropriate staffing", "true collaboration", "skilled communication", and "meaningful recognition") were rated as good (mean range, 3.43-3.63).

Conclusion

The study results could assist hospitals in prioritizing the adoption of AACN HWE standards. A target benchmark of "good" was established for both the overall score and each standard, which indicates a good work environment as perceived by ICU nurses. In Addition, interpersonal differences should be considered when developing improvement initiatives.

Adverse events: an expensive and avoidable hospital problem

INTRODUCTION

Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care.

METHODS

This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs.

RESULTS

A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE.

CONCLUSIONS

The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient's death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messagesAdverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization.Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels.Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.

Compliance of non-pharmacological preventive practice of venous thromboembolism among Jordanian nurses

Many practices, such as non-pharmacological preventive practices, have demonstrated significant improvement and reduced the venous thromboembolism incidence. This study aims at investigating the compliance with non-pharmacological preventive practice of venous thromboembolism guidelines among Jordanian intensive care and medical and surgical nurses. Descriptive and cross-sectional with the non-participant observational design was used. This study recruited 271 registered nurses in adult medical-surgical units and intensive care units of 12 different government hospitals in Jordan's middle and north regions. The observational checklist included 10 preventive practices based on the non-pharmacological preventive of venous thromboembolism guidelines. In the observational checklist, the highest score was 20, and the lowest was 0. If the nurse received equal to or higher than (>14) score were classified as sufficient compliance, while insufficient compliance was (≤14) score. The observations period started from September 2019 until March 2020. The participants' overall mean venous thromboembolism compliance score was insufficient compliance (10.6 ± 1.6). The majority of nurses were classified as insufficient compliance 67%. "Doing foot exercise and early ambulation 2 times per day 50.3%" and "checked the integrity of the patient's skin at regular intervals 50.0%" were the highest practices done rightly and completely by half of the participants. The participants who had a bachelor of nursing degree, staff nurse, and works in the intensive care unit, are less experienced and have no previous venous thromboembolism education reported low venous thromboembolism compliance. This study presents expanded compliance regarding venous thromboembolism preventive practices among Jordanian intensive care and medical & surgical nurses, so the policymakers need to develop an initiative to improve nurses' compliance.

Attitudes of Critical Care Nurses towards Teamwork and Patient Safety in Saudi Arabia: A Descriptive Cross-Sectional Assessment

The study aimed to assess the teamwork and safety attitudes among the critical care unit (CCU) nurses in Saudi Arabia. A descriptive cross-sectional study was carried out in public tertiary hospitals in Al-Madinah, Saudi Arabia. All participants answered a three-part questionnaire that included demographic data, a teamwork attitude questionnaire (T-TAQ), and the Safety Attitudes Questionnaire (SAQ). The analysis revealed that the majority of the nurses were female, n = 52 (76.5%), and almost half of the nurses were aged from 29 to 39 years, n = 29 (42.6%). Teamwork attitude values are found to be relatively stable in all subscales, ranging from 1.63 (SD = 1.23) to higher at 2.92 (SD = 1.32). Of the six dimensions of SAQ, job satisfaction (M = 70, SD 21.46) had the highest positive rate and was approached with a positive attitude, followed by teamwork (M = 66.09, SD 15.12) and safety climate (M = 67.11, SD 17.70). The analysis also shows work experience was the influencing factor of teamwork attitude and safety attitude of nurses, recording beta values of 0.24, p < 0.05 and 0.10, p < 0.001, respectively. The results also identified an association between teamwork and safety attitudes. The study reflected the positive attitudes towards teamwork and less positive attitudes toward patient safety among critical care nurses in Saudi Arabia. Collaborative team performance among nurses improves the medical care quality and patients’ safety, decreasing the occurrence rate of adverse events.

Knowledge, Practice, Compliance, and Barriers toward Ventilator-Associated Pneumonia among Critical Care Nurses in Eastern Mediterranean Region: A Systematic Review

BACKGROUND

Ventilator-associated pneumonia (VAP) has been identified as a serious complication among hospitalized patients and is associated with prolonged hospitalizations and increased costs. The purpose of this study was to examine the knowledge, practices, compliance, and barriers related to ventilator-associated pneumonia among critical care nurses in the eastern Mediterranean region.

METHODS

The PRISMA guidelines guided this systematic review. Four electronic databases (EMBASE, MEDLINE (via PubMed), SCOPUS, and Web of Science) were used to find studies that were published from 2000 to October 2021.

RESULTS

Knowledge of ventilator-associated pneumonia was the highest outcome measure used in 14 of the 23 studies. The review results confirmed that nurses demonstrated low levels of knowledge of ventilator-associated pneumonia, with 11 studies assessing critical care nurses' compliance with and practice with respect to ventilator-associated pneumonia. Overall, the results showed that most sampled nurses had insufficient levels of compliance with and practices related to ventilator-associated pneumonia. The main barriers reported across the reviewed studies were a lack of education (N = 6), shortage of nursing staff (N = 5), lack of policies and protocols (N = 4), and lack of time (N = 4).

CONCLUSIONS

The review confirmed the need for comprehensive interventions to improve critical care nurses' knowledge, compliance, and practice toward ventilator-associated pneumonia. Nurse managers must address barriers that impact nurses' levels of knowledge, compliance with, and practices related to ventilator-associated pneumonia.

"TRIPLE-A: ACQUAINT, ANALYZE, AND ACT": THE INSIGHTS OF NURSE EDUCATORS TOWARD A BETTER UNDERSTANDING OF WORKPLACE VIOLENCE IN SAUDI ARABIA

AIM

To investigate the experiences and insights of nurse educators in order to acquire a better understanding of the nature and various factors associated with workplace violence, which could lead to the establishment of future actions and recommendations to eliminate or reduce aggression, abuse, incivility, and any other forms of violence in the health sector.

BACKGROUND

Workplace violence is one of the social phenomena that has not been fully explored in various settings such as educational institutions and healthcare facilities. A worker who had experienced violence could provide valuable insights that could help to better understand and sustainably protect an individual, a group, or an organization from workplace violence and its unfavorable consequences.

METHODS

Qualitative descriptive phenomenological study. A total of 18 nurse educators who met the inclusion criteria were enrolled as the study participants in a government university located in the Eastern Region of Saudi Arabia. Purposive sampling method was used in the recruitment. In addition, a semi-structured interview guide was employed to explore the participants' experiences and insights from February to June 2021. Data were analyzed using Colaizzi methods, and a COREQ checklist was utilized to report the study's results.

RESULTS

The participants' narratives generated three major themes, namely the "Triple-A": (1) "acquaint"; (2) "analyze"; and (3) "act," to better understand workplace violence themes.

CONCLUSION

The "Triple-A: Acquaint, analyze, and act" workplace violence themes can serve as a simple guide to better understand the nature and different factors associated with workplace violence: "acquaint" illustrates self-awareness; "analyze" pertains to the recognition to possible indications and signals; and "act" depicts an individual's proactiveness and responsiveness to workplace violence and conceivably catalyzes the decrease of this social hazard's prevalence.

IMPLICATION FOR NURSING MANAGEMENT

Leaders and managers in the nursing field should prioritize their participation in developing creative strategies and their implementation of policies to manage and mitigate violence in the workplace, such as initiating ongoing education (acquaint), creating robust procedures for reporting and referral (analyze), and establishing support networks, listening to victims' experiences, and promoting respect to individual differences (act).

Acceptance, Attitudes, and Barriers of Vaccine Booster Dose among Nursing Students: A Multicounty Survey

AIM

This study investigated the acceptance and attitudes of nursing students toward the COVID-19 vaccine booster dose in two Gulf Cooperation Countries and the potential influencing factors for taking a COVID-19 vaccine booster dose.

BACKGROUND

The world is still battling coronavirus because of the emerged of variants and protection against COVID-19 has waned over time. Vaccination is a powerful and effective method of reducing the outbreak of COVID-19 and decreasing the loss of lives.

DESIGN

This research was a survey using a cross-sectional design.

METHODS

The study's sample was two nursing colleges. The study tool was adopted according to recent information concerning the COVID-19 vaccine published by the World Health Organization. Data was collected through an online survey during March to April 2022.

RESULTS

A total of 216 nursing students completed the survey, of which 69.4 % (n = 150) were male students and more than half of the participants were from Saudi Arabia (55.1%, n = 119). Two-thirds of the students (75.5%, n = 161) reported that they agreed to receive a COVID-19 vaccine booster. The total attitude scores for the students ranged from 28 to 35, with a mean score of 15.8 (SD = 2.5), representing 73% of the highest possible score, with 79.3% were classified as 'positive attitude toward booster dose of COVID-19. Vaccine booster might cause infection, vaccine booster ineffective, worried about adverse effects, and not safe were major barriers influencing the acceptance of the COVID-19 vaccine booster.

CONCLUSION

Nursing students revealed high acceptance rates related to COVID-19 vaccine booster. However, more attention should be paid from nursing educators to barriers influencing the acceptance of the COVID-19 vaccine booster. Preparing nursing students with positive attitude of COVID-19 vaccine booster is very important to patient and community safety.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing educators and managers must make an effort to educate the nursing students regarding safety and effectiveness from COVID-19 vaccine booster and ensure that is necessary to reduce their perception of the injury of COVID-19 infection.

Students’ Perception of Quality of Learning Experience (Structure, Process and Outcome): Discipline Versus Problem Based Medical Curriculum and the Mediation Role of Process Quality

Problem-based learning (PBL) is now incorporated into the curricula of most medical schools around the world. In comparison to the traditional curriculum, less is known about the influence of the adoption and implementation of a problem-based curriculum on the perceived structures, processes, and outcomes of learning experiences reported by students. The purpose of this study was twofold: (1) to compare the quality of learning experience of students enrolled in traditional discipline-based and problem-based medical curricula and (2) to explore the mediation effect of the process quality between the relationship of the structural quality and students’ perception of learning experience outcomes. Through the distribution of an electronic survey, all 3rd and 4th year medical students enrolled in the discipline-based curriculum and the problem-based curriculum were invited to participate in the study. The students from both curricula completed the Student Experience Survey (SES), which was developed by the National Center for Academic Accreditation and Evaluation. Descriptive statistics, independent sample t-test and Hayes Macro regression analysis were used. Students enrolled in the problem-based curriculum had higher perceived support and sufficient advice with higher perceived quality of learning experiences compared with students enrolled in the traditional curriculum, however they reported less enjoyment of their university life. The structural factors (t = 19.83, p ≤ 0.001) and process factors (t = 9.21, p ≤ 0.001) were associated with an increase in students’ reported outcomes by 0.67 and 0.49, respectively. These findings explain the mechanism by which the structural factors, such as maintaining adequate facilities and support, may help in enhancing the process quality (e.g., learner-centered learning), which in turn can enhance learning experience outcomes.

Evaluating the D&M IS Success Model in the Context of Accounting Information System and Sustainable Decision Making

The Accounting Information System (AIS) is generally employed for the automation of operational processes and the enhancement of company efficiencies, but more recently, AIS developments have had a great effect on the process of sustainable decision-making among organizations. However, previous research on the AIS and its capabilities attributed its success to critical success factors. Therefore, in the current work, De Lone and Mc Lean’s Information System (D&M IS) Success Model is evaluated in terms of AIS in Jordanian organizations. The current study primarily aimed to determine the influence of system quality, service quality, information quality, system use and user satisfaction on AIS use, which is argued to eventually enhance the quality and sustainability of decision-making. The study employed a quantitative approach using a self-administered questionnaire for data collection involving 101 decision-makers who are familiar with AIS usage. Following the collection of data, it was validated using Structural Equation Modeling (SEM)—PLS. Based on the obtained results, system quality and information quality significant affected system use, but service quality did not. In turn, AIS was found to have a significant effect on user satisfaction. Furthermore, system use and user satisfaction had positive effects on AIS, which eventually affected the sustainability of decision-making, representing the net AIS benefits. The study contributes to existing IS literature, particularly in the field of determining the factors that influence the AIS net benefits, with the proposed model validated in Jordanian organizations using AIS. The study can be used as a guide to shed light on the importance of AIS and it also provides implications, limitations and opportunities for future studies.

Actual Use of Mobile Learning Technologies during Social Distancing Circumstances: Case Study of King Faisal University Students

The most current highly infectious disease, which has become a global health challenge permeating entire sectors of society, is COVID-19. In the education sector, the transmission of COVID-19 has been curbed through the closure of institutions and the facilitation of online learning. The main objective of this study was to propose an integrated model of the unified theory of acceptance and use of technology combined with the DeLone and McLean model, to examine the influence of quality features, namely, performance expectancy (PE), effort expectancy (EE), facilitating conditions (FC), and social influence (SI), on the intentions and satisfaction of users toward mobile learning (m-learning) use in the context of Saudi learning institutions. The study obtained m-learning user data using an online questionnaire, after which the data were exposed to partial least squares structural equation modeling to test the proposed research model. The findings supported the influence of PE, EE, and FC on intention toward m-learning use but did not support the significant influence of SI. Moreover, system, intention, and user satisfaction were found to positively and significantly influence m-learning-system usage, with system, information, and service quality being top drivers of such user intention and satisfaction. The results reflect the required information concerning the strategies of higher institutions to enhance m-learning-system acceptance among students, with general implications for learning acceptance and usage.

Exposure Detection Applications Acceptance: The Case of COVID-19

The pandemic's context is rife with numerous dangerous threats and high fear levels, influencing human decision-making. Such characteristics are identified by investigating the acceptance of exposure detection apps from the technology acceptance model (TAM) perspective. This study purposed a model to investigate protection technology acceptance, specifically exposure detection apps in the context of COVID-19. Quantitative study approach and a cross-section design targeted 586 participants from Saudi Arabia. As the study model is complex, the study hypotheses were analysed using the structural equation modelling-partial least squares (SEM-PLS3) approach. The findings support the entire model hypothesis except the link between social media awareness and exposure detection apps' intention. Mediation of COVID-19 anxiety and influence was confirmed as well. The current paper contributes to the technologies acceptance domain by developing a context-driven model comprising the major pandemic characteristics that lead to various patterns of technology acceptance. This study also fills the literature gap regarding mediating effects of social influence and COVID-19 anxiety in the relationship between trust in government and exposure detection apps implementation, and between COVID-19 anxiety and exposure detection apps implementation, respectively. The results may assist government agencies, health policymakers, and health organisations in the wide world and specifically Saudi Arabia, in their attempts to contain the COVID-19 pandemic spread.

The Relationship between Emotional Intelligence and Pain Management Awareness among Nurses

Background: Pain management, a crucial part of nursing care, is considered one of the most basic patient rights. To properly treat patients’ pain, nurses need a high degree of pain management awareness (PMA). The researchers hypothesized that nurses’ pain management awareness is affected by their emotional intelligence (EI). Purpose: Because there is a dearth of studies on this topic, the purpose of this study was to describe the relationship between emotional intelligence and pain management awareness in a sample of nurses. Methods: The study employed a descriptive design with a quantitative approach to analyze data from a survey designed with the simple random sample technique. The questionnaires were completed by 330 nurses working at six governmental hospitals in Saudi Arabia. The Statistical Package for the Social Sciences (V23) and Analysis of Moment Structures (V23) were used to determine the reliability and validity of the questionnaires and analyze the causal relationships among the variables. Results: The results revealed a significant positive relationship between nurses’ emotional intelligence and their pain management awareness. Conclusions: These findings suggest that having emotional intelligence is an important nurse characteristic for effective pain management awareness and possibly the provision of pain management care. Clinical Implications: Hospital and nurse managers as well as administration should consider using the emotional intelligence variables utilized in this study to develop ways to improve pain management awareness among nurses. Such efforts may help improve hospital and patient outcomes related to pain management.