Fear Of Reprisal Research Articles

Barriers to and facilitators of medication error reporting from the viewpoints of nurses and midwives working in gynecology wards of Tabriz hospitals

Medication error reporting (MER) is an effective way to prevent their repetition in the future. The present study aimed to determine the frequency and factors associated with the causes of MEs and to identify barriers to and facilitators of MER. This descriptive-analytical cross- sectional study was conducted with proportional random sampling on 220 midwives or nurses working in public and private hospitals in Tabriz, Iran. In this study, data were collected using Haddon’s matrix. Data were analyzed using descriptive and inferential statistics. The prevalence of MEs in this study was 36.2%. The most common causes of MEs related to weakness of nurses, wards, management and physicians were nursing staff shortage (30.5%), ward work density (51.8%), low ratio of nurses and midwives per patient (70.7%), and illegible prescriptions (76.4%), respectively. Major barriers to MER reported by nurses and midwives were blaming the individual rather than the system (67.7%). Facilitators of MER were anonymous MRE system and feeling safe about working environment. Staff also reported that if reporting is beneficial (preventing future errors, correcting practice, increasing accountability), the odds of reporting MER will increase (54.5%). Given the underlying cause of MEs from the participants' point of view (staff shortage, fear of reprisal and reprimand), it is suggested that the system and health managers adopt appropriate strategies to reduce these important factors (reducing work density and creating a friendly environment).

Building Better Leaders to Update Oncology Care Post-Pandemic

Building Better Leaders to Update Oncology Care Post-Pandemic

What a Catch: Safety Intervention to Reframe Newborn Falls and Drops.

Parental fatigue rates after childbirth are high and may be associated with newborn drops that cause injury. Newborn drops and near-misses are potentially underreported due to parental embarrassment, shame, fear of reprisal, or guilt. Although newborn drops are rare, the leaders of mother-baby units need to enhance transparency of risk to assure a culture of safety. To describe components and outcomes of the What A Catch program, aimed at preventing newborn drops and addressing near-misses. The What A Catch program was implemented in two hospital mother-baby units. The five components of the program included maintaining a respite nursery, using visual management, positively framing situational communication and actions after a near-miss, safe and appropriate staffing, and celebrating and transparently displaying program successes. Data were collected on near-miss event rates and caregivers and families provided postevent comments. The perinatal team embraced the program at both sites. Of 9,578 live births over 1 year, 202 near-misses or good catches were documented. Program leaders revise display the board multiple times per week. Replication of this program is needed to determine if all five components are necessary to optimize a culture of safety. Future research may determine the scope of risk factors associated with newborn drops and near-misses, so that anticipated risk factors can be mitigated.

P92 Power dynamics in healthcare teams – a barrier to team effectiveness and patient safety: A systematic review

IntroductionHierarchies in healthcare teams are pervasive and widely acknowledged as impacting on working cultures. This review explores the impact of power dynamics in multidisciplinary healthcare teams on patient safety and team effectiveness.MethodsA systematic review was conducted using five academic databases (PubMed, CINAHL, PsycInfo, Cochrane Library, Embase) between January 2010-2020. Potentially relevant articles were selected based on title and abstract review, followed by full text review, data extraction and data appraisal. Consistent with PRISMA guidelines, two researchers independently carried out all stages, from data screening to quality appraisal. A narrative synthesis was conducted.ResultsThe databases searches yielded a total of 869 studies. 28 studies met the eligibility criteria and were included in the synthesis. Of these, 20 articles associated power dynamics with team effectiveness and 19 linked power dynamics to patient safety outcomes. Hierarchical power dynamics inhibit team communication and speaking up behaviours, which impacts team effectiveness and patient safety. Barriers to speaking up include workplace policies; respect for seniors’ experience; time pressures; feelings of intimidation and powerlessness; fears of reprisal and repercussions; perceived poor self-efficacy; lack of confidence and role clarity.ConclusionHierarchies and power dynamics have a profoundly negative effect on patient safety and team effectiveness through their negative impact on communication and speaking up behaviours. Whilst hierarchies cannot be abolished, to improve team communication and collaboration, healthcare organisations and training programmes should consider initiatives that break down silos and promote an inclusive approach to patient care. Initiatives that target the practice of collective leadership and an open and supportive work environment have been shown to improve communication and team effectiveness.Theme: Cross-disciplinary research

Voice or silence: antecedents of whistleblowing intentions

Purpose This study aims to examine the effects of peer ethical behavior and individual differences in valuation of fairness vs loyalty on whistleblowing intentions in academic settings. This study also tests the underlying mechanism responsible for the effects of peer behavior on reporting intentions, namely, fear of reprisal. Design/methodology/approach A survey was conducted with 947 undergraduate students. The model was tested using ordinary least squares regression models followed by bootstrapped mediation analyses. Findings Results showed that the effects of peer ethical behavior on whistleblowing intentions are mediated by fear of retaliation. Moreover, the findings indicated that, for low-severity transgressions, there is an interactive effect between fear of retaliation and endorsement of fairness over loyalty on whistleblowing intentions. Research limitations/implications When the misconduct is seen as minor, a potential whistleblower may understand that the expected costs outweigh the possible benefits of blowing the whistle. In such situations, higher fear of retaliation would undermine the effects of individual’s endorsement of fairness over loyalty on reporting intentions. Practical implications As the social environment significantly affects someone’s whistleblowing intentions, there should be visible efforts to improve and to foster an ethical infrastructure in organizations. Social implications As fear of retaliation by peers is one of the most important determinants affecting the decision to report misconduct in general, there must be serious efforts from leaders to mitigate any threat of retaliation to those who come forward. Originality/value This work contributes to the discussion about individual and situational antecedents of whistleblowing. More importantly, it sheds light on one potential boundary condition for the influence of the fairness–loyalty tradeoff on whistleblowing decisions: severity of the transgression. The findings provide initial evidence that, for low-severity transgressions, fear of retaliation weakens the positive effects of one’s moral compass in terms of preference for fairness over loyalty on whistleblowing intentions.

An Evaluation of The Effect of Contract Employment to The Socio-Economic Welfare of The Contract Employees Under The Current Economic Conditions In South Africa

The purpose of this study was to identify the conditions under-which the fixed term contract employees operate in comparison to the permanent employees. The study also looked at the perceived job insecurity and how this would affect the attitude towards working and fulfilling their roles. Job satisfaction, motivation, performance and turnover intentions were looked at with a focus on motivation for performance, special reference was made to reasons why the fixed term contract employee would perform. Data was collected from 50 employees fixed term contract employees of the university and the results came up with these findings. The findings point out to interesting –performance coming from fear of reprisals and accusation of underperformance leading to refusal by the employer to renew the contract. Much concern was shown around the difference in attitude towards work with the permanent employees taking their jobs for granted. The fixed term contract employs had low job satisfaction, felt that they were under a form of slavery and felt that they were unfairly treated. There was a strong commitment to wanting to improve themselves with others considering the age as serious threat to their desire to develop themselves. Generally, their aspirations were towards getting a permanent job so that they can be able to feed their children and dependents.

ANTICIPATING HARASSMENT: METOO AND THE CHANGING NORMS OF EXECUTIVE CONTRACTS

The MeToo movement exposed the pervasiveness of high-level, sex-based misconduct at major public companies. It also revealed a workplace culture seemingly permissive of such behavior. Companies responded slowly and imposed few consequences, often allowing culpable executives to depart with lucrative exit packages. Why did companies reward rather than penalize perpetrators? And what will it take to change this culture? In this Article, we shed new theoretical and empirical light on these questions using the lens of CEO employment contracts. Economic theory posits that CEO employment agreements are not negotiated at arms’ length, resulting in terms that are highly favorable to the executive. We argue that these include generous protections against termination, which leave room for executives to engage in misconduct without fear of reprisal. The MeToo movement represented a major shock to these bargaining dynamics. Facing new reputational and liability risks, we hypothesize that companies will push back on executive bargaining power and exert greater control over CEOs’ behavior—in particular, by reserving broader power to terminate CEOs for sex-based misconduct. To test our theory, we collect and code a novel dataset of CEO employment contracts executed before and after MeToo. In the wake of MeToo, we find a significant and growing rise in the prevalence of contracts that allow companies to terminate CEOs without severance pay in response to harassment, discrimination, and violations of company policy. We discuss the implications of these “MeToo termination rights” for corporate governance, executive contracting, and gender equity. We conclude that our results offer promising evidence of increased corporate control of CEO behavior and greater accountability for sex-based misconduct in the wake of the MeToo movement.

Exploring a Model of Whistle Blowing System for Malaysian Municipal Council

A municipal council is one of the local authorities established under the auspice of Malaysian local government. The objective is to deliver services to a community under its jurisdiction in a sustainable manner, but evidences indicated that the service qualities have deteriorated due to numerous malpractices. The malpractices could be prevented should any of the insiders who witness the incidences whistle blow to those who have power to act. However, not many are willing to report for fear of reprisal, retaliation and even life threatening. Despite that a whistleblowing system is established to encourage whistleblowing, such system has yet to be formed in any of Malaysian municipal councils. Intrigued with the issue, the objective of this study is to explore a model of whistle blowing system for a Malaysian municipal council. A hermeneutic phenomenography study was conducted in which data were gathered through in-depth interviews and focus group discussions. The participants consisted of four top management and sixty officials from a Malaysian municipal council. Data were analyzed qualitatively using Nvivo 14 and triangulated with other source of documents. The findings from emergent themes proposed a model of the whistleblowing system that consisted of four elements namely protection, internal control policies, incentives and ethical culture. This discovery provides useful insights to policy makers, relevant authorities, and academic fraternities of the model of whistle blowing system that will alleviate malpractices and thus elevate the transparency, efficiency and integrity of the municipal council to the fullest.

Barriers to bystander CPR in deprived communities: Findings from a qualitative study.

Study aimRates of out of hospital cardiac arrest are higher in deprived communities. Bystander Cardiopulmonary Resuscitation (BCPR) can double the chance of survival but occurs less often in these communities in comparison to more affluent communities. People living in deprived communities are, therefore, doubly disadvantaged and there is limited evidence to explain why BCPR rates are lower. The aim of this paper is to examine the barriers to administering BCPR in deprived communities.MethodMixed method qualitative study with ten single sex focus groups (n = 61) conducted in deprived communities across central Scotland and 18 semi-structured interviews with stakeholders from the UK, Europe and the USA.ResultsTwo key themes related to confidence and environmental factors were identified to summarise the perceived barriers to administering BCPR in deprived communities. Barriers related to confidence included: self-efficacy; knowledge and awareness of how, and when, to administer CPR; accessing CPR training; having previous experience of administering BCPR; who required CPR; and whether the bystander was physically fit to give CPR. Environmental barriers focused on the safety of the physical environment in which people lived, and fear of reprisal from gangs or the police.ConclusionsBarriers to administering BCPR identified in the general population are relevant to people living in deprived communities but are exacerbated by a range of contextual, individual and environmental factors. A one-size-fits-all approach is not sufficient to promote ‘CPR readiness’ in deprived communities. Future approaches to working with disadvantaged communities should be tailored to the local community.

Nimble, Together: A Training Program's Response to the COVID-19 Pandemic.

Nimble, Together: A Training Program's Response to the COVID-19 Pandemic.

“To say it out loud is to kill your own childhood.” – An exploration of the first person perspective of barriers to disclosing child sexual abuse

Background: Child sexual abuse (CSA) is a serious threat to a child’s existence and development. Yet, on average it takes 17 years before victims disclose their abuse. Objective: The purpose of this study was to explore barriers to disclose sexual abuse from the perspective of adult survivors of CSA. Participants and Setting: 12 survivors of CSA (nine women and three men), aged 18–57 years old. The study was conducted in one of the largest cities in Norway where there has been a particular focus on disclosure of sexual abuse. Methods: We conducted semi-structured interviews, and interview transcripts were analyzed using a hermeneutic-phenomenological approach to thematic analysis. Results: Our analysis resulted in three themes: Fear of reprisals; CSA stains – Negative implications for self-representation; and The complicating effect of ambiguity. Conclusions: Our main finding was that CSA affects self-representation in ways that become significant barriers to disclosure. An important and unexpected implication of our findings is that society’s focus on informing people about CSA to facilitate disclosure, might instead, work as a barrier. Thus, it is crucial to explore this potential effect further when developing future interventions to facilitate early disclosure of CSA.

Percepção da equipe multidisciplinar acerca dos cuidados à criança e ao adolescente vítima de violência

Conhecer a percepção da equipe multidisciplinar acerca dos cuidados prestados à criança e ao adolescente vítima de violência. Trata-se de uma revisão integrativa de literatura realizada a partir de 15 artigos publicados no período entre 2012 a 2017 nas bases de dados SCIELO, LILACS e BDENF. Estes foram separados e categorizados, interligando-os para obter um conjunto de proposições e conclusões dos autores selecionados. Desse modo, a assistência prestada pela equipe multidisciplinar é dificultada pela má formação dos profissionais, excesso na carga horária de trabalho, medo de represálias por parte dos agressores e a falta de apoio de mecanismos de referências. Portanto, estratégias de prevenção somadas à existência de uma rede de apoio aos profissionais seriam capazes de reduzir os erros no diagnóstico e tratamento do fenômeno em questão, assim, os profissionais estando capacitados e os setores empenhados poderão garantir os direitos ao desenvolvimento saudável dessas crianças e adolescentes.

NURSING PROFESSIONALS AND ADVERSE EVENT REPORTING

ABSTRACT Objective: to identify how nurses report adverse events; to know what elements influence adverse event reporting and which reporting strategies they suggest. Method: qualitative study with a convergent care research design, conducted in a critical patient unit of a private health center in the region of Magallanes, Chile. Thirteen nurses participate in the study, through interviews and a discussion group. Results: the nurses who report adverse events do so verbally and in writing to the nurse coordinator immediately. Failure to report adverse events is mainly due to lack of knowledge of the safety culture, fear of reprisals and punishment within the workplace. As adverse event reporting strategies, they suggest continuing education about the safety culture, raising awareness and trust in that error reporting will not be met with punishment and that the error will lead to an improvement plan that avoids committing the same error on another occasion, improving communication and leadership. Conclusion: although nurses report adverse events, they are concerned with punishment, indicating the need to review the patient safety culture at a critical care unit in the study context.

Subjetividades femeninas y escuela: prácticas y discursos en 6° de primaria

The paper shows the results of a research carried out to analyze the construction of femininities in the school. An ethnography was carried out in a 6th grade). The data was collected in field notes, taken in situ, and transcribed to a field diary. Also, six focus groups and twelve individual interviews were held. Results show the existence of a hierarchy of femininities in the classroom. There is a dominant femininity and other feminities that coexist with it and that charge more or less prominence depending on their greater or lesser proximity to it. The results demonstrate the need to perform pedagogical tasks that allow to reflect about the construction of femininities and masculinities, fostering the development of different gender identities without fear of reprisal or exclusion.

Role of culture and law in sustaining trokosi institution in southern Ghana

The study carefully examined trokosi—the keeping of virgins (henceforth referring always to girls and not boys) in traditional religious shrines in Ghana, using a shrine in Afife as a case study. The study tried to find out whether culture, including its primary constituent, religion, and law play any role in sustaining the trokosi institution in spite of efforts by the Ghana Government and human rights activists to eliminate it. The study used qualitative approach that involved in-depth interviews with key informants, local people, and observation. The primary data was supplemented by relevant secondary data. The research identified that trokosi as an institution persists because of its use of religio-cultural techniques such as social structuring and meaning. Other findings that sustain the institution include the overt endorsement of the religio-cultural institution by local and international human rights laws; government‘s inability to enforce criminal laws; government officials‘ and trokosi practitioners‘ fear of reprisals from the traditional god that is the basis of the institution; and indigenes‘ adamancy to preserve trokosi as a religio-cultural heritage even if it infringes on fundamental human rights of women and girls. The study is important because, among other things, it contributes to existing discourses on religious and cultural institutions and practices both locally and internationally.

Professional practice behaviour: Identification and validation of key indicators

Introduction Professional behaviour is regarded as an important competency for occupational therapy practice, yet little guidance exists for indicators underpinning development or remediation in the educational or practice settings. This study sought to confirm the content validity of observable professional behaviour indicators from an existing evaluation framework for representativeness and relevance for occupational therapy practice. Methods A modified Delphi approach was conducted with expert panellists ( n = 30) consisting of regulators, administrators, faculty members, practitioners, and students for professional behaviour indicator consensus, together with a cross-sectional survey of practitioners ( n = 119). Fleiss’ κ and χ2 contingency tables were completed for agreement across panellists, and between panellist and survey groups. Cross-case qualitative analyses identified facilitators and barriers for professional behaviour practice. Results Content validity of 17 professional behaviour indicators was achieved, with >85% agreement from the expert panellists and the cross-sectional survey group. Main professional behaviour reporting issues in practice included fear of reprisal, lack of formal policies, and an unsupportive culture. Support from others, documented workplace policies, and self-regulation/duty to monitor were the critical facilitators for supporting professional behaviour in practice. Conclusion The professional behaviour indicators in this study offer observable behaviours from which assessment rubrics or tools may be developed. Further study is warranted.

Temporal dynamics of solidarity and corruption-reporting practices: an appraisal of Durkheim’s theoretical assumptions in Nigeria

ABSTRACTThis article reviews how citizens’ corruption-reporting practices have challenged some established assertions of the classical thoughts of Durkheim on solidarity to trigger ‘imodoye’ – the third-tier solidarity in Nigeria. Gleaning data from secondary sources, it acknowledges the disclosure-fostering bonds of the mechanical (first-tier) solidarity and the disclosure-suppressing anomie of the organic (second-tier) solidarity. The widely presumed contempt of Buhari for impunity and his use of whistleblowers to make criminals refill the treasury they had treacherously emptied distinguish ‘imodoye’ solidarity as a new norm of reward-driven and disclosure-enabling anticorruption proposal. This article concludes that rewards neutralize the fear of reprisal and intensify the culture of whistle-blowing. The government should establish Imodoye Public Agricultural Settlement Agenda (IPASA) as a prison-extension facility for productive-payback services and Ownership Verification Number (OVN) to make anti-graft agencies track criminal investment of stolen money in the real-estate corridor.

Implementing a survey for patients to provide safety experience feedback following a care transition: a feasibility study

BackgroundThe aim was to determine the feasibility of implementing a patient safety survey which measures patients’ experiences of their own safety relating to a care transition. This included limited-efficacy testing, determining acceptability (to patients and staff), and investigating integration with existing systems and practices from the staff perspective.MethodsMixed methods study in 16 wards across four hospitals, from two English NHS Trusts and four clinical areas; cardiology, care of older people, orthopaedics, stroke. Limited-efficacy testing of a previously validated survey was conducted through collection of patient reports of safety experiences, and thematic comparison with staff safety incident reports. Patient acceptability was determined through analysis of survey response rates and semi-structured interviews. Staff acceptability and integration were investigated through analysis of survey distribution rates, semi-structured interviews and focus groups.ResultsPatients returned 366 valid surveys (16.4% response rate) from 2824 distributed surveys (25.1% distribution rate). Older age was a contributing factor to lower responses. Delays were the largest safety concern for patients. Staff incident report themes included five not present in the safety survey data (documentation, pressure ulcers, devices or equipment, staffing shortages, and patient actions). Patient interviews (n = 28) identified that providing feedback was acceptable, subject to certain conditions being met; cognitive-cultural (patient understanding and prioritisation of safety), structural-procedural (opportunities, means and ease of providing feedback without fear of reprisals), and learning and change (closure of the feedback loop). Staff (n = 21) valued patient feedback but barriers to collecting and using the feedback included resource limitations, staff turnover and reluctance to over-burden patients.ConclusionsPatients can provide meaningful feedback on their experiences and perceptions of safety in the context of care transitions. Providing this feedback was acceptable to some patients, subject to certain conditions being met. Safety experience feedback from patients was also acceptable to staff; quantitative data was perceived as useful to identify potential risks, and qualitative data informed types of changes required to improve care. However, patient feedback was not integrated into any quality improvement initiatives, suggesting there are still significant challenges to healthcare teams or organisations utilising patient feedback, particularly in relation to care transitions.

Psychological safety on the healthcare team.

In Brief For patients to receive optimal care that integrates the specialized knowledge of all team members, each party needs to feel free to voice their concerns and engage in skilled communication without fear of reprisal. Learn how to promote psychological safety among team members to positively transform the work environment and improve patient care.

Assessment of Rapid Response Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest

Rapid response teams (RRTs) are foundational to hospital response to deteriorating conditions of patients. However, little is known about differences in RRT organization and function across top-performing and non-top-performing hospitals for in-hospital cardiac arrest (IHCA) care. To evaluate differences in design and implementation of RRTs at top-performing and non-top-performing sites for survival of IHCA, which is known to be associated with hospital performance on IHCA incidence. A qualitative analysis was performed of data from semistructured interviews of 158 hospital staff members (nurses, physicians, administrators, and staff) during site visits to 9 hospitals participating in the Get With The Guidelines-Resuscitation program and consistently ranked in the top, middle, and bottom quartiles for IHCA survival during 2012-2014. Site visits were conducted from April 19, 2016, to July 27, 2017. Data analysis was completed in January 2019. Semistructured in-depth interviews were performed and thematic analysis was conducted on strategies for IHCA prevention, including RRT roles and responsibilities. Of the 158 participants, 72 were nurses (45.6%), 27 physicians (17.1%), 27 clinical staff (17.1%), and 32 administrators (20.3%). Between 12 and 30 people at each hospital participated in interviews. Differences in RRTs at top-performing and non-top-performing sites were found in the following 4 domains: team design and composition, RRT engagement in surveillance of at-risk patients, empowerment of bedside nurses to activate the RRT, and collaboration with bedside nurses during and after a rapid response. At top-performing hospitals, RRTs were typically staffed with dedicated team members without competing clinical responsibilities, who provided expertise to bedside nurses in managing patients who were at risk for deterioration, and collaborated with nurses during and after a rapid response. Bedside nurses were empowered to activate RRTs based on their judgment and experience without fear of reprisal from physicians or hospital staff. In contrast, RRT members at non-top-performing hospitals had competing clinical responsibilities and were generally less engaged with bedside nurses. Nurses at non-top-performing hospitals reported concerns about potential consequences from activating the RRT. This qualitative study's findings suggest that top-performing hospitals feature RRTs with dedicated staff without competing clinical responsibilities, that work collaboratively with bedside nurses, and that can be activated without fear of reprisal. These findings provide unique insights into RRTs at hospitals with better IHCA outcomes.