Hospital Environment Research Articles

Automatic speech recognition for Indonesian medical dictation in cloud environment

<span lang="EN-US">This paper introduces SPWPM, an automatic speech recognition (ASR) system designed specifically for Indonesian medical dictation. The main objective of SPWPM is to assist medical professionals in producing medical reports and diagnosing patients. Deployed within a cloud computing service architecture, SPWPM strives to achieve a minimum speech recognition accuracy of 95%. The ASR model of SPWPM is developed using Kaldi and PyChain technologies—creating a comprehensive training dataset involving collaboration with PT Dua-Empat-Tujuh and Harapan Kita Hospital. Several optimization techniques were applied, including language modeling with smoothing, lexicon generation using the Grapheme-to-Phoneme Converter, and data augmentation. The readiness of this technology to assist hospital users was assessed through two evaluations: the SPWPM architecture test and the SPWPM speech recognition test. The results demonstrate the system's preparedness in accurately transcribing medical dictation, showcasing its potential to enhance medical reporting for healthcare professionals in hospital environments.</span>

Ultraviolet protection in eye and face protection against biological hazards.

In the development of eye and face protection standards against biological hazards, it is important to consider that the eye and face protectors may be used in the outdoor environment, where ultraviolet (UV) exposure from the sun is much higher than indoors. Workers affected include paramedics, ambulance officers and clinical testing personnel. Spectral transmittances (280-780 nm) were measured on eight face shields and one goggle of the types used in hospital and clinical environments, three overhead projector sheets and an occupational impact protective goggle. The UV and luminous transmittances were calculated according to the international and two national sunglass standards, and compared with the compliance requirements. All the face shields and goggle lenses were made of variants of the same material. All the samples, including the overhead projector sheets, complied with the requirements of the sunglass standards (for normal conditions, in the case of the American standard). Since all the lenses complied with the sunglass standards for UV protection, and there appears to be uniformity in the choice of materials in this product type, there is no need to make provision, as is the case for occupational eye and face protection standards, for protectors that do not provide UV protection. This makes labelling and advice to end users from eyecare and safety professionals much simpler.

Impact of Climate, Cynicism and Culture on Organizational Citizenship Behavior with Intervening Impact of Job Embeddedness

The standoff between management and the young doctor's organization (YDA) caused by periodic strikes has had major consequences for patients who do not receive medical attention when needed. This includes the stoppage of treatment in public hospital emergencies, which frequently results in patient deaths, reflecting a negative image of public hospitals. Analysis of the procedural imbalance and relationships between several organizational environment, culture, cynicism, citizenship behavior, and job embeddedness criteria in public-sector hospitals is the goal of this study. However, information gathered from the young doctors at Lahore's Public Sector Health Hospitals was necessary for this study to be successful. To compute the results, several statistical procedures were used, including factor analysis, regression, correlation, and reliability analysis. To examine the findings, information was gathered from 146 responders, who were young physicians. This study found that whereas JE mediates the association between organizational climate, cynicism, culture, and citizenship behavior among young doctors in Lahore's public sector hospitals, organizational climate has a considerable impact on OCB while organizational cynicism and culture have a small impact.

Nurse-sensitive quality and benchmarking in hospitals striving for Magnet® or Pathway® designation: A qualitative study.

To examine if and how selected German hospitals use nurse-sensitive clinical indicators and perspectives on national/international benchmarking. Qualitative study. In 2020, 18 expert interviews were conducted with key informants from five purposively selected hospitals, being the first in Germany implementing Magnet® or Pathway®. Interviews were analyzed using content analysis with deductive-inductive coding. The study followed the COREQ guideline. Three major themes emerged: first, limited pre-existence of and necessity for nurse-sensitive data. Although most interviewees reported data collection for hospital-acquired pressure ulcers and falls with injuries, implementation varied and interviewees highlighted the necessity to develop additional nurse-sensitive indicators for the German context. Second, the theme creating an enabling data environment comprised building clinicians' acceptance, establishing a data culture, and reducing workload by using electronic health records. Third, challenges and opportunities in establishing benchmarking were identified but most interviewees called for a national or European benchmarking system. The need for further development of nurse-sensitive clinical indicators and its implementation in practice was highlighted. Several actions were suggested at hospital level to establish an enabling data environment in clinical care, including a nationwide or European benchmarking system. Involving nurses in data collection, comparison and benchmarking of nurse-sensitive indicators and their use in practice can improve quality of patient care. Nurse-sensitive indicators were rarely collected, and a need for action was identified. The study results show research needs on nurse-sensitive indicators for Germany and Europe. Measures were identified to create an enabling data environment in hospitals. An initiative was started in Germany to establish a nurse-sensitive benchmarking capacity. Clinical practitioners and nurse/clinical managers were interviewed.

Design and Development of Multi-Featured Medical Stretcher

The multi-featured medical stretcher represents a significant leap forward in patient care and hospital operations. Its innovative design combines various features aimed at enhancing both patient comfort and healthcare worker efficiency. At the core of its design is a commitment to making patient movement easier and safer. Through its adjustable height mechanism, the stretcher can be tailored to individual patient needs and seamlessly integrated into various medical procedures. This adaptability not only enhances patient comfort but also facilitates smoother transitions between different stages of care. Furthermore, the inclusion of storage compartments ensures that essential medical supplies are readily accessible, minimizing disruptions during patient transport and treatment. This organizational feature not only saves time but also contributes to a more efficient workflow for healthcare workers. Importantly, the stretcher's ability to move patients from stretcher to bed with minimal human assistance is a game-changer. By reducing the reliance on manpower for transfers, it streamlines hospital operations and minimizes the risk of patient discomfort or injury during movement. Overall, the multi-featured medical stretcher represents a significant advancement in hospital equipment, offering a comprehensive solution to the challenges associated with patient transport. Its integration of comfort-enhancing features and efficiency-boosting functionalities marks a substantial improvement in patient care delivery and contributes to a smoother and safer hospital environment for both patients and healthcare workers alike.

Burden of atrial fibrillation risk and outcomes amongst patients attending cardiology and elderly medicine services: prospective in-hospital implementation of the FIND-AF algorithm

Abstract Background Screening for silent AF is becoming increasingly important (1, 2), and the FIND-AF algorithms can use routinely-collected data to identify individuals at higher risk for undiagnosed AF (3). There may be a much higher prevalence of patients at risk for AF and its complications in a hospital environment compared with the community (4). Purpose We prospectively implemented the FIND-AF algorithm within cardiology and geriatric services to quantify the burden of AF risk amongst all-comers, and to understand their outcomes over the next 6 months. Methods We prospectively implemented the FIND-AF algorithm in the cardiology and geriatric departments of three UK hospitals for consecutive inpatient or outpatient attendances from February 1 to July 13th 2023. We assessed the number of individuals attending each service eligible for an AF screening protocol (exclusion criteria: age <30 years, history of AF, on a palliative care pathway, use of oral anticoagulation), and calculated the burden of AF risk in each service. Patients were followed up for 6 months for the primary outcome of incident AF, heart failure (HF), stroke/transient ischaemic attack (TIA)/systemic embolism, and death. Incident diagnoses were the first record of that condition in primary or secondary care records. Rate ratios (RRs) with 95% confidence intervals (CIs) for combined incident cardiovascular outcomes or death were derived through Poisson regression for predicted higher versus lower AF risk. Results Of 467 consecutive patients, 364 were eligible for AF screening. 66 were excluded due to a previous diagnosis of AF, 25 were already prescribed a long-term oral anticoagulant, 5 were on a palliative care pathway and 7 were aged <30 years. Baseline characteristics of each cohort are summarised in Table 1. Of patients eligible for AF screening, those attending geriatrics were at higher risk of incident AF than patients attending cardiology (median FIND-AF score: geriatrics, 0.015, 95% CI 0.008 - 0.024; cardiology, 0.005, 95% CI 0.001-0.015; p<0.05; distributions of risk summarised in Figure 1) and had a higher stroke risk. Absolute risk of AF was greater than 5% within the next 6 months for 11.6% and 9.1% of geriatric and cardiology patients, respectively. Of the eligible cohort, 328 had follow up at 6 months, with 46 experiencing the primary outcome (9, 7, 3, and 27 recorded cases of AF, HF, stroke/TIA, and death, respectively). The higher predicted risk cohort, compared to lower predicted risk, had a higher risk of combined incident AF, heart failure, or stroke/TIA/systemic embolism (Rate ratio: 5.59, 95% CI 1.13-101.01) and death (RR 9.68, 2.06-172.85). Conclusions The FIND-AF algorithm can be prospectively implemented in hospital records to identify cardiology and geriatric patients at risk of incident AF, heart failure, thromboembolic disease and death. There is an opportunity to conduct risk-guided screening in the context of hospital attendances.

Does Digital Leadership Impact the Performance of Lower-Middle-Class Hospitals?

Even though Indonesia has a large number of hospitals and has experienced significant progress in realizing Universal Health Coverage (UHC), service performance is still relatively low, so many patients seek treatment abroad. The performance of services and care systems in hospitals is often associated with low use of digital technology. The complexity of adopting digital technology in a hospital environment is not an easy thing to do, with the majority of users carrying out digital technology functions being health officers and professionals. This research aims to explore the influence of Digital Leadership in encouraging the adoption of digital technology and its influence on Hospital Performance. Survey data conducted on 285 leaders of Class C and D hospitals spread throughout Indonesia, through Structural Equation Modeling (SEM) analysis using Lisrel 8.80, it was found that there was a positive and significant influence on the role of Digital Adoption Capability as a mediation on Hospital Performance. It was found that Digital Leadership has a positive and significant influence on hospital performance both directly and through the mediation of Digital Adoption Capability. Environmental Dynamism factors have also been proven to significantly influence hospital management’s desire to improve performance through the adoption of digital technology. The model resulting from this research provides a comprehensive view of hospital management in developing effective digital technology adoption strategies in facing an ever-changing environment.

Children’s Hospital Environment Design Based on AHP/QFD and Other Theoretical Models

Children’s Hospital Environment Design Based on AHP/QFD and Other Theoretical Models

Enhancing Security Within Restricted Hospital Zones by Integrating Finger Vein Authentication

The integration of finger vein authentication technology to enhance security measures within restricted zones in hospital environments, is the aim of this project. An advanced biometric technique called finger vein authentication uses each person's individual vein patterns to confirm their identification. It is especially desirable for applications where security is critical, such financial transactions, healthcare, and access control, because it provides a very safe and non-intrusive means of authentication. Although there has been considerable success with traditional finger vein authentication methods, deep learning techniques have completely changed this field. A branch of artificial intelligence called deep learning has shown impressive results in pattern recognition and picture analysis, which makes it a prime contender for improving the precision and dependability of finger vein authentication systems. Finger vein authentication utilizes biometric characteristics unique to everyone, providing a highly secure method of identity verification. By implementing this technology, hospitals can bolster access control, prevent unauthorized entry into sensitive areas, and safeguard patient information and critical resources. The project aims to implement finger vein authentication systems to regulate access to restricted areas such as operating rooms, medication storage areas, and patient information sections. Authorized personnel will undergo authentication via finger vein scans for entry, ensuring that only authorized individuals can access these zones.

Understanding experiences, unmet needs and priorities related to post-stroke aphasia care: stage one of an experience-based co-design project

ObjectivePeople with post-stroke aphasia (language/communication impairment) and their supporters report mixed satisfaction with stroke and aphasia care. To date, however, their journey of care and the key service interactions that...

Integrating family caregivers in older adults' hospital stays: a needed cultural shift.

This study aimed to examine perceived barriers and facilitators to caregiver inclusion in the hospital care of older adult family members or friends through the perspectives of (1) hospitalized older adults, (2) caregivers of a hospitalized older adult, (3) healthcare clinicians, and (4) policymakers. This qualitative descriptive exploratory study utilized semi-structured interviews with N = 24 participants and was analyzed using a framework method. Eight codes arose that were categorized into four domains guided by the Social Ecological Model. Individual-level factors were determined both for the caregiver and for the clinician. Relationship-level factors were revealed pertaining to communication style and method. Hospital-level factors included hospital environment and resources. Societal-level factors included healthcare climate and policies. Findings indicated that hospital workflows and policies inadequately support family caregivers. This study highlights potential solutions to caregivers' integration into hospital workflows.

Oral care practices for patients in intensive care unit: A systematic review.

To critically analyse and discuss oral hygiene protocols in the hospital environment in patients admitted to the ICU, through a systematic review of the literature. The electronic search was performed on Pubmed, Cochrane, Web of Science and Google Scholar databases. The indexing keywords according to the PRISMA protocol were: 'hospital dentistry', 'oral health', 'oral care' and 'intensive care unit'. The initial search resulted in a total of 2671 articles. Pre-selection based on titles led to the exclusion of 2510 articles and the remaining 36 were selected for abstract reading. After analysing the eligibility of the articles, eight studies were included in the review and submitted to qualitative analysis. It can be concluded that cleaning with a soft bristle brush, use of chlorhexidine and lip moisturizing are methods commonly used in dental care actions in patients hospitalized in intensive care units.

Prevalence of burnout syndrome in hospital health professionals and associated factors

The hospital environment presents unique challenges compared to other healthcare sectors, such as caring for patients in delicate conditions, long work hours, shift work, and multiple professional commitments. These characteristics can compromise the quality of life of workers and increase the risk of developing Burnout Syndrome. This study aims to examine the prevalence of Burnout Syndrome among healthcare professionals working in a hospital environment, as well as to identify associated factors. A cross-sectional study was conducted with a sample of 209 professionals. Participants completed a self-administered questionnaire containing sociodemographic and occupational information, as well as the Maslach Burnout Inventory-Human Services Survey. The prevalence of Burnout Syndrome was 28.7% (n=60). Professionals with incomes up to R$5000.00 and those in their first job showed a higher likelihood of experiencing this disorder. These findings suggest a moderate prevalence of Burnout Syndrome and underscore the importance of remuneration in valuing workers, as well as the potential association between inexperience and difficulty in coping with the demands of healthcare work.

Assessment of the surface contamination of the primary packaging of oral antineoplastic drugs and secondary packaging of chemotherapy preparations at a Swiss hospital.

Due to the high toxicity of antineoplastic drugs, handling their packaging could lead to the chemical contamination of hospital environments and exposure risks to healthcare professionals and patients. This study aimed to assess the contamination of two main surfaces: the outer primary packaging of oral antineoplastic drug formulations (n = 36) available on the Swiss market and the surface of secondary packaging of injectable antineoplastic drug preparations (n = 60) produced by the pharmacy of a Swiss hospital and carriers used for transport (n = 5). Samples were collected using a validated wipe sampling method. The simultaneous analysis of 24 antineoplastic drugs: 5-fluorouracil, busulfan, carboplatin, cyclophosphamide, cytarabine, dacarbazine, daunorubicin, docetaxel, doxorubicin, epirubicin, etoposide, gemcitabine, idarubicin, ifosfamide, irinotecan, methotrexate, oxaliplatin, paclitaxel, pemetrexed, raltitrexed, topotecan, treosulfan, vinblastine, vincristine) and 1 antiviral compound (ganciclovir) was performed by UHPLC-MS/MS. A total of 58% and 90% positive results were obtained for the primary packaging of oral chemotherapies and for the secondary packaging of injectable preparations, respectively. The highest quantities found on the primary packaging for oral chemotherapies and on the surface of closed leak-proof bags were 111 ng of methotrexate and 19 ng of gemcitabine, respectively. Gemcitabine (69%) and cyclophosphamide (38%) were the two most common contaminants found on the packaging of injectable preparations and carriers, regardless of the chemotherapy preparations. Trace levels (ng) of antineoplastic drugs can be found on most surfaces of all evaluated pharmaceutical products. Thus, suitable personal protective equipment is mandatory for healthcare professional handling antineoplastic drugs.

Therapeutic Transformation through Healing Environment. Evaluation of Post Surgical Facilities Optimization in Selected Tertiary Healthcare Facilities in Post Covid-19 Kpk, Pakistan

Background: Healing environments in post-surgical wards are crucial for patient recovery. Despite their importance, there is a lack of such environments in many hospitals in Khyber Pukhtunkhwa (KPK), Pakistan, which affects patient outcomes. Objective: This study aimed to assess the presence of healing environment factors in post-surgical wards of selected tertiary care hospitals in KPK, Pakistan, and to determine patient satisfaction with these factors. Methods: The study utilized a purposive sampling technique to select 200 respondents from five tertiary care hospitals in KPK: Ayub Teaching Hospital (H1) in Abbottabad, Khyber Teaching Hospital (H2) in Peshawar, Government Lady Reading Teaching Hospital (H3) in Peshawar, Hayatabad Medical Complex (H4) in Peshawar, and Saidu Group of Teaching Hospitals (H5) in Saidu Shareef. Data were collected using structured questionnaires and observational studies conducted in November and December 2022. Observational data focused on five healing environment factors: access to nature, control and choices, positive distractions, social support, and environmental stressors. Ethical approval was obtained, and informed consent was secured from all participants. Data were analyzed using descriptive and inferential statistics to identify the presence and impact of healing environment factors. Results: The study revealed that social support was the only significantly present factor across all hospitals, largely due to cultural and religious practices rather than intentional design. Access to nature, control and choices, and positive distractions were notably lacking. Specifically, 60-70% of respondents reported the presence of social support, while only 20-30% indicated the presence of other healing environment factors. Environmental stressors were absent in two hospitals, indicating a variance in the quality of the healing environment across different settings. Conclusion: The absence of key healing environment factors in post-surgical wards highlights a significant gap in hospital design, impacting patient recovery and satisfaction. Integrating healing environment principles into hospital design can enhance patient outcomes and satisfaction. Future interventions should consider these elements to create more effective and supportive healthcare environments.

Nurse perceptions of practice environment, quality of care and patient safety across four hospital levels within the public health sector of South Africa

Improving the practice environment, quality of care and patient safety are global health priorities. In South Africa, quality of care and patient safety are among the top goals of the National Department of Health; nevertheless, empirical data regarding the condition of the nursing practice environment, quality of care and patient safety in public hospitals is lacking.AimThis study examined nurses’ perceptions of the practice environment, quality of care and patient safety across four hospital levels (central, tertiary, provincial and district) within the public health sector of South Africa.MethodsThis was a cross-sectional survey design. We used multi-phase sampling to recruit all categories of nursing staff from central (n = 408), tertiary (n = 254), provincial (n = 401) and district (n = 244 [large n = 81; medium n = 83 and small n = 80]) public hospitals in all nine provinces of South Africa. After ethical approval, a self-reported questionnaire with subscales on the practice environment, quality of care and patient safety was administered. Data was collected from April 2021 to June 2022, with a response rate of 43.1%. ANOVA type Hierarchical Linear Modelling (HLM) was used to present the differences in nurses’ perceptions across four hospital levels.ResultsNurses rated the overall practice environment as poor (M = 2.46; SD = 0.65), especially with regard to the subscales of nurse participation in hospital affairs (M = 2.22; SD = 0.76), staffing and resource adequacy (M = 2.23; SD = 0.80), and nurse leadership, management, and support of nurses (M = 2.39; SD = 0.81). One-fifth (19.59%; n = 248) of nurses rated the overall grade of patient safety in their units as poor or failing, and more than one third (38.45%; n = 486) reported that the quality of care delivered to patient was fair or poor. Statistical and practical significant results indicated that central hospitals most often presented more positive perceptions of the practice environment, quality of care and patient safety, while small district hospitals often presented the most negative. The practice environment was most highly correlated with quality of care and patient safety outcomes.ConclusionThere is a need to strengthen compliance with existing policies that enhance quality of care and patient safety. This includes the need to create positive practice environments in all public hospitals, but with an increased focus on smaller hospital settings.

Radar in the darkness. The dreams and art of a psychotherapist in a forensic institution

Under the assault of disturbing experiences that seem sealed into a bodily discourse, there appears an increased permeability between the dream space and the psychotherapy space. It is in the forensic in-patient hospital environment that I have commonly sat with a calm and compliant patient to find myself grappling with an overwhelming pull toward sleep. Such tiredness in countertransference can be understood as a manifestation of the weight of buried or repressed disturbance which can only seemingly be registered at a bodily level. Forensic patients are usually the subject of vilification from the courtrooms to sensationalist media reports in a system that further bottlenecks their emotional lives. It seems to me that sometimes there can be a fine line between continuing the trend of condemnation and the taking up of clinical responsibility. It is perhaps one of the most helpful aspects of psychoanalytic work, that we consider the projective processes involved in the criminal justice system. That we look to ourselves and our own countertransference for greater clinical clarity, a radar in the darkness. It is with this in mind that I write an introspective paper focussing on the lens of my own dream life and artistic responses to the environment of a forensic institution.

Assessing the Relationship between Demographic Attributes and Patients' Views of Hospital Environment

The objective of this study was to examine the relationship between patient demographic factors (gender, age, marital status) and their perception of a patient-friendly hospital environment. A cross-sectional study was conducted using a questionnaire to collect data from 41 patients at a hospital in Kathmandu, Nepal. The questionnaire assessed perceptions of privacy, visitation, amenities, way finding, and other aspects that contribute to a patient-friendly environment. Correlation analysis was used to analyze the relationship between demographic variables and overall satisfaction. Most respondents were younger, female patients. Descriptive analysis found neutral to average satisfaction across different environment domains. Correlation analysis showed no significant relationships between gender, age, marital status and perception of a patient-friendly environment (p>0.05 for all). Patient demographics did not appear to influence perceptions of a patient-friendly environment in this study. While most domains scored neutrally, opportunities remain to enhance certain areas like bathroom accessibility and parking. Larger studies are needed to further understand how hospitals can optimize their physical environments to better support patients.

Emergence of multidrug-resistant Staphylococcus haemolyticus in neonatal intensive care unit in Southern France, a genomic study

ABSTRACT An emergence of multidrug-resistant (MDR) Staphylococcus haemolyticus has been observed in the neonatal intensive care unit (NICU) of Nîmes University Hospital in southern France. A case–control analysis was conducted on 96 neonates, to identify risk factors associated with S. haemolyticus infection, focusing on clinical outcomes. Forty-eight MDR S. haemolyticus strains, isolated from neonates between October 2019 and July 2022, were investigated using routine in vitro procedures and whole-genome sequencing. Additionally, five S. haemolyticus isolates from adult patients were sequenced to identify clusters circulating within the hospital environment. The incidence of neonatal S. haemolyticus was significantly associated with low birth weight, lower gestational age, and central catheter use (p < 0.001). Sepsis was the most frequent clinical manifestation in this series (20/46, 43.5%) and was associated with five deaths. Based on whole-genome analysis, three S. haemolyticus genotypes were predicted: ST1 (6/53, 11%), ST25 (3/53, 5.7%), and ST29 (44/53, 83%), which included the subcluster II-A, predominantly emerging in the neonatal department. All strains were profiled in silico to be resistant to methicillin, erythromycin, aminoglycosides, and fluoroquinolones, consistent with in vitro antibiotic susceptibility tests. Moreover, in silico prediction of biofilm formation and virulence-encoding genes supported the association of ST29 with severe clinical outcomes, while the persistence in the NICU could be explained by the presence of antiseptic and heavy metal resistance-encoding genes. The clonality of S. haemolyticus ST29 subcluster II-A isolates confirms healthcare transmission causing severe infections. Based on these results, reinforced hygiene measures are necessary to eradicate the nosocomial transmission of MDR strains.

Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study.

To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). A patient representative has been involved in planning this study.