Medical-surgical Care Research Articles

Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project.

The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries (PIs) within the Veterans Health Administration (VHA) when slings and other transfer devices are left under patients. Health care staff (n=112) in patient safety and nursing at 77 unique VHA facilities responded to surveys between November and December 2019. Interviews (n=24) were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates (n=9) between January and March 2021. Feedback on practices and perceptions related to leaving slings and other transfer devices were evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of PIs were used to examine associations with staff-reported sling and other transfer device practices. Leaving slings under patients was associated with higher proportion of patients developing PIs in intensive care units (ICUs, P =.042) and medical-surgical care units (P =.025). In addition, use of sliding boards for seated transfer among short-stay residents in Community Living Centers was associated with higher PI occurrences (P =.017). Qualitative interviews found perceptions and guidance about PI risk related to slings and other transfer devices varied among staff who consider many factors when determining risk. There are perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with this preactice. Clinical decision support can help staff determine safe sling use. More work is needed to test the safety of common sling and transfer device practices and define best practices for communicating PI risk related to sling and transfer device use across the care continuum.

Methodology of forming a model of diagnosis-related groups for cases of medical care using surgery performed by laparoscopic access

Background. A wide range of endosurgical treatment methods in various medical care profiles and the need for uniformity of calculations required developing a unified approach to the formation of diagnosis-related groups (DRGs) for cases of surgical medical care provided by laparoscopic access.Objective: to develop a methodology for the formation of a DRG model for cases of medical care using surgery performed by laparoscopic access in the context of the following medical care profiles: “coloproctology”, “urology”, “surgery (abdominal)”, “obstetrics and gynecology”, “pediatric urology-andrology”, “pediatric surgery”.Material and methods. The methodology for the formation of DRGs to pay for cases of medical care using surgery with laparoscopic access included the implementation of several stages: analysis of scientific and methodological documents, analysis of regulatory legal documents on the research topic, standardized expert survey of federal and regional medical centers (carried out in August 2023), formation of DRGs in the context of each profile, and calculation of cost-intensity coefficients.Results. Due to significant increase in the cost-intensity coefficient in nine newly formed DRGs to pay for cases of medical care provided by surgery with laparoscopic access, financial support of this type of surgical medical care almost doubled. The formed DRGs with appropriate cost-intensity coefficients were included in the Program on State Guarantees to Deliver Free Medical Care to the Citizens for 2024 and for the planning period of 2025 and 2026.Conclusion. The methodology of forming DRGs to pay for cases of medical care using surgery performed by laparoscopic access with a unified methodology for calculating costs for medical care provided an integrated approach to the process of forming DRGs for cases of surgical medical care, and unification of calculations for different medical care profiles.

Abordaje y manejo médico-quirúrgico del paciente herido por traumatismo taurino

IntroductionBullfighting festivals are attributed to the cultural idiosyncrasies of the Ibero-American people, posing an extreme risk to the physical integrity of the participants. Spain is considered the country with the highest number of bull-related celebrations worldwide and, therefore, with the highest number of patients injured by bullfighting trauma treated, thus justifying a public health problem. The generalities associated with this type of trauma define the people injured as polytraumatised patients. In addition, it is important to know the kinematics of the injuries and their specific characteristics, in order to implement quality medical-surgical care. Methodsscientific review of the literature to promote a comprehensive guide for the medical-surgical management of patients injured by bullfighting trauma. ResultsWe described the guidelines to standardise protocols for in-hospital approach of patients injured by bullfighting trauma. ConclusionsBullfighting trauma is considered a real health problem in the emergency departments of the ibero-Americans countries, especially in Spain, where bullfighting is part of the national culture. The inherent characteristics of these animals cause injuries with special aspects, so it is important to know the generalities of bullfighting trauma. Because of the multidisciplinary approach, this guidelines are adressed to all healthcare providers involved in the management of these patients. It is essential to establish particular initial care for this type of injury, specific therapeutic action and follow-up based on the medical-surgical management of the trauma patient in order to reduce the associated morbidity and mortality.

Implementasi Five Moment Hand Hygiene Pada Perawat Di Ruang Rawat Medikal Bedah Rumah Sakit Santa Elisabeth Medan

The prevalence of nosocomial infections worldwide has become a serious concern for healthcare professionals, especially in hospitals. One contributing factor is the inadequate implementation of the five moments hand hygiene in handwashing procedures that do not conform to operational procedure standards. The aim of this research is to determine how the implementation of the five moments hand hygiene among nurses in the surgical medical care ward at Santa Elisabeth Hospital in Medan. This study utilized a descriptive cross-sectional approach, employing observation sheets. The sample size included 30 nurses in the Surgical Medical Care Ward at Santa Elisabeth Hospital in Medan, using total sampling technique. The measurement tool was an observation sheet, and the data analysis employed univariate analysis. The research findings revealed that, in the first moment before patient contact, 56.7% of nurses did not adhere to the practice, while 43.3% did. In the second moment, before aseptic procedures, 56.7% of nurses did not comply, and 43.3% did. In the third moment, after exposure to patient body fluids, all nurses (100%) adhered to the practice. In the fourth moment, after patient contact, all nurses (100%) complied. In the fifth moment, after contact with the patient's environment, all nurses (100%) followed the practice. It is hoped that nurses can consistently implement the five moments hand hygiene to prevent disease transmission and nosocomial infections, fostering a habit of incorporating these practices into nosocomial infection prevention.

Midwifery education in Ghana: Time for further advancement

Maternal mortality continues to remain high in Ghana. Similarly, gynaecological cancers contribute immensely to the leading causes of deaths among Ghanaian women of reproductive age. Midwives play an important role in the provision of direct care to these categories of patients. Nonetheless, the training of midwives, a critical workforce in Ghana over the past years, does not seem to commensurate with the roles they are required to perform, especially, at the referral hospitals. The purpose of this article is to discuss the discrepancy between competencies acquired by midwives through their education and the roles they are expected to perform at referral hospitals, and to make a recommendation for policy change. It is strongly recommended that a new cadre of midwives (nurse-midwives) with an undergraduate (bachelor’s degree) training in general nursing plus post-qualification clinical experience in medical-surgical care plus post graduate education in midwifery be trained to provide the level of advanced care required in the referral facilities.

Psychometric Analysis of the Brøset Violence Checklist in Medical–Surgical Nursing Units

Background: Workplace violence against nurses is a pervasive problem within hospital settings. Predictive tools which could assist with identifying patients who may commit violence while hospitalized are needed in the medical surgical care areas. The Brøset violence checklist (BVC) is a six‐item checklist to assess patients and determine if the patient may become violent within the next 24 hours. The BVC has been validated in psychiatric and emergency department settings but not yet established in the medical–surgical inpatient settings. The purpose of this retrospective secondary data study was to determine validity and reliability metrics for the BVC within medical–surgical inpatient settings.Methods: This study utilized data from the electronic health record and safety reporting system from four medical–surgical settings within a large academic healthcare system to establish sensitivity and specificity of the BVC as well as establish inter‐reliability of BVC users.Findings: Of the 36,155 BVC assessments on 4437 patients included in the analysis, the BVC was a good predictor of violence. As expected, the analysis found that the BVC was more specific to accurately identifying negative cases than it was sensitive to identifying positive cases with a specificity of 98% and a sensitivity of 64% and receiver operating characteristics yielded an area under the curve of 0.8. The BVC reliability indicated a strong positive association between nurses and auditors’ scores as confirmed by Kendall’s coefficient of concordance (W = 0.71, p < 0.001).Discussion: The BVC is a valid, reliable, and simple assessment tool to identify patients who may pose a risk for violence in medical–surgical units with strong inter‐reliability.Implications to Practice: Integrating the BVC into the medical–surgical clinical areas may provide a validated tool to support proactive interventions to care practices and reduce physical harm of healthcare workers.

A study to assess the efficacy of oral itraconazole as an add-on to steroids in allergic fungal rhinosinusitis in a tertiary care hospital

Background: Allergic fungal rhinosinusitis (AFRS) is a distinct type of chronic polypoid rhinosinusitis that affects atopic individuals. The incidence worldwide ranges from 5% to 10%, with geographic variation in epidemiology. It imposes a significant negative impact on quality of life, concomitantly generating socioeconomic losses. Failure to remove all sinus disease increases the likelihood of relapse; thus, the best outcome is achieved through coordinated medical-surgical care. The antifungal activity of itraconazole in addition to standard steroid therapy may provide greater relief to patients with AFRS following functional endoscopic sinus surgery (FESS) by decreasing the chances of recurrence and long-term use of steroids. Therefore, this study has been taken up. Aim and Objectives: The aims and objectives of the study are to evaluate the efficacy of oral itraconazole as an add-on to the standard steroid therapy in allergic fungal rhinosinusitis from baseline to 6 weeks. Materials and Methods: This study was conducted among 60 patients who underwent FESS and were administered medications postoperatively. The efficacy was measured by the sinonasal outcome test-20 score, the nasal endoscopic grade, and the Lund and Mackay score from baseline to 6 weeks. Continuous data were analyzed using the unpaired t-test, repeated measure analysis of variance, and paired t-test, whereas categorical data were analyzed using the Chi-square test. Results: Comparable efficacy was observed between the group treated with standard steroids alone and the group receiving a combination of standard steroids and itraconazole. No significant improvement was seen with oral itraconazole as an add-on therapy when compared with standard steroids at the end of 6 weeks. Conclusion: Oral itraconazole as an add-on therapy will reduce the chances of recurrence such as steroids, but in this study, there was no statistically significant reduction. The disease has a long natural course, and further follow-up is needed to establish the importance of itraconazole.

Management of Head and Neck Cellulitis in a Patient Immunocompetent

Head and neck cellulitis are severe infections, sometimes necrotizing, whose diagnosis is difficult at an early stage. We report the clinical observation of a 60-year-old patient who presented to the emergency room for a right laterocervical swelling associated with a deterioration in general condition. The head and neck CT scan revealed abscessed right cervical cellulitis. The patient underwent drainage and debridement in the operating room with wide necrosectomy and placement of a Delbet blade, associated with dual antibiotic therapy. The evolution was marked by an improvement in the patient's clinical condition. The aim of this work was to highlight the importance of emergency medical-surgical care, without forgetting the treatment of the portal of entry. The progression in the absence of treatment is towards sometimes fatal complications. The prognosis of these infections depends on the precocity of the treatment, its initial quality and the terrain.

An Analysis of Global Orthopedic Organizations Through the Lens of the Four Pillars of Global Surgery.

Introduction The mortality of orthopedic trauma is very high, however, a large proportion is considered preventable. Global orthopedics was historically centered around the direct delivery of nonsurgical and surgical medical care. There has been an evolution towards increased sustainability. Purpose The purpose of this paper is to evaluate the accomplishment of the four pillars of global surgery byfive commonly referenced orthopedic global surgery organizations. Methods This institutional review board (IRB)-exempt cross-sectional data studied Global Orthopedic Alliance, Operation Rainbow, the Institute for Global Orthopaedics and Traumatology (IGOT), One World Surgery (OWS), and the Canadian Orthopedic Association for Global Surgery (COAGS) through the lens of the four pillars of global surgery: knowledge exchange, advocacy, research initiative, surgical education. The knowledge exchange pillar was examined through the three most popular online knowledge exchange platforms in orthopedics. The advocacy pillar was examined through each organization's individually created website. The research initiative was examined through a comprehensive literature search. The surgical education pillar was examined through resident-level educational resources. The data was summarized descriptively. Results A total of four organizations demonstrated activity within the pillar of knowledge exchange. A total of three organizations demonstrated activity with the pillar of advocacy. A total of three groups demonstrated activity within the pillar of the research initiative. A total of two groups had activity within the pillar of surgical education. Conclusions The landscape regarding global orthopedic surgery programs has evolved greatly to encompass the four pillars of global surgery. Within the past 10 years, there has been increased emphasis on the knowledge exchange and research initiative pillars. Surgical education remainsthe pillar with the least emphasis. As global orthopedic surgery programs continue to evolve, increasing emphasis should be placed on all four of these pillars to increase sustainability.

The Program of All-Inclusive Care for the Elderly (PACE) in Improving Medical Surgical and Mental Health Care: a Literature Review

Models of care services for the elderly in terms of medical surgical care and mental health need to be improved. Elderly with disabilities are at high risk of adverse health outcomes, and the best model of care has yet to be determined. A good holistic care model to empower every individual in society to improve the quality of care needs to be recommended. For example, comprehensive health care programs such as the Program of All-Inclusive Care for the Elderly (PACE) for adults and the elderly. The research objective was to determine the effectiveness of PACE in improving medical-surgical care and mental health. The search strategy for English-language studies relevant to the topic was carried out using the ScienceDirect database, limited from 2011 to 2021. The keywords used were “PACE”, “Medical Surgical Treatment”, “Mental Health”, “elderly”. Article full text reviewed to select studies that fit the criteria. The inclusion criteria in this review are: the nursing service program model, namely PACE. The search used the keywords above with the ScienceDirect database that matched the inclusion criteria for only 7 articles. The PACE service model improves services in Medical Surgical and Mental Health care, and implement a collaborative care model using a comprehensive interdisciplinary team.

The surgical activity of medical organizations providing out-patient medical care in The Russian Federation

One of important directions in improving effectiveness of out-patient surgical medical care is development of in-patient replacement forms. The purpose of the study. is to investigate volume of surgical work performed in medical organizations providing outpatient care in the Russian Federation in 2010-2019. To evaluate changes in dynamics of number and structure of implemented surgical operations, number of operated patients in subdivisions of medical organizations providing outpatient medical care and in conditions of day-stay hospitals, data from the Federal statistical observation form № 30 for 2010-2019 was analyzed. The statistical and analytical methods were applied. It was established that in the Russian Federation, during 10 years, in subdivisions of medical organizations providing outpatient medical care, the number of implemented operations decreased from 5,639,983 to 4,962,020 (by 12.0%), and the number of operated patients - from 5,277,077 to 4,580,195 (by 13.2%). The structure of surgical interventions performed in medical organizations providing outpatient care has practically not changed (operations on the skin and subcutaneous tissue, oral cavity and maxillo-facial region, female genital organs, musculoskeletal system, organ of vision). The structure of surgical interventions practically had no changes (operations on skin and subcutaneous tissue, oral cavity and maxillo-facial region, female genital organs, musculoskeletal system, organ of vision). During the studied period, the number of operations performed in day-stay hospitals of medical organizations providing outpatient medical care increased from 181,659 to 720,633 (4.0 times), the number of operated patients - from 168,188 to 650,196 (3.9 times). Mainly in day-stay hospitals, operations are performed on organ of vision, female genital organs, skin and subcutaneous tissue. In 2010-2019, the percentage of operations performed in subdivisions of medical organizations providing outpatient medical care, decreased from 96.9% to 87.3%, and in day-stay hospitals increased from 3.1% to 12.7%. The study results testify expansion of volumes of surgical work in day-stay hospitals of medical organizations providing outpatient medical care.

The effectiveness of the approximation of specialized medical care to the sanitary losses zone using the multidisciplinary surgical reinforcement groups

The analysis of the organization and results of specialized surgical care in peacetime and wartime is presented. It is demonstrated that in order to comply with the principle of bringing medical care closer to the zone of emergency situations and/or combat operations, it is important to recruit military medical staff as multidisciplinary specialized surgical groups of medical reinforcement. By the forces and means of such a group, the conversion of medical institutions located closely to the centers of sanitary losses is carried out, followed by the reception of victims and the provision of emergency specialized (including high-tech) medical care of the surgical profile. The analysis of the reinforcement of the stages of medical evacuation for the provision of specialized (including high-tech) medical care of the surgery profile was carried out. During providing medical care to the injured and wounded in the North Caucasian armed conflict in the second half of the 20th early 21st centuries, the best results were achieved by deploying multidisciplinary military hospitals of the 1st echelon on the basis of garrison located near the area of military operations. The 1st echelon hospitals were reinforced by multidisciplinary medical reinforcement groups from military medical organizations of central subordination. Specialized (including high-tech) surgical medical care provided in multidisciplinary hospitals of the first echelon included general surgical procedures (35.4%), operations on the chest and abdominal cavity (19.8%), interventions performed by narrow specialists (otorhinolaryngological, maxillofacial, ophthalmological, urological) 17.7%, trauma operations (17.0%), interventions on arterial and venous vessels (8.2%), as well as on the brain (2.4%). During the evaluation of the experience of the medical reinforcement groups, their medical and statistical indicators are presented and proposals are made to change their staffing structures, taking into account the spectrum of damaging factors and the range of lesions in the event of natural and man-made emergencies, as well as during modern wars and armed conflicts.

Structured Nursing Rounds (SNR) Training Module on the Level of Patient Satisfaction

Structured Nursing rounds (SNR) are one of the quality indicators for the inpatients admitted in the Medical-Surgical care settings. Conducting systematic nursing care rounds is complementary to individual holistic nursing practice. It is one way of ensuring the highest standards in nursing care. We can also fruitfully reap its benefits. It improves patient satisfaction in the delivery of the quality of care.

Impact of the SARS-CoV-2 pandemic on ophthalmic care in Germany.

BackgroundSurvey by the commission for cross-sectoral ophthalmology, as a joint commission of the German Ophthalmological Society (DOG) and the Professional Association of German Ophthalmologists (BVA) on the effects of the SARS-CoV‑2 pandemic on ophthalmological patient care in Germany.MethodsOnline-based survey.ResultsA total of 1190 questionnaires were (partly) answered. With respect to outpatient care and consultations from 15 March to 15 April 2020, a total of 69 (5.8%) participants indicated unlimited, 756 (63.5%) reduced and 330 (27.7%) emergency care only, independent of the type of institution. Outpatient surgery was restricted to emergency surgery in 68% of clinics, 42.0% of inpatient wards, 45.0% of surgical medical care centers and group practices and 33.0% of private practices. Inpatient procedures were limited to emergency care in 75.0% of inpatient wards and in 71.0% of clinics. With the exception of endophthalmitis (+8.2%), the number of urgent indications and emergencies declined: retinal detachment (−34.8%), perforating eyeball injuries (−7.3%), acute glaucoma (−17.8%), central retinal artery occlusion and anterior ischemic optic neuropathy (−31.0%), others (−30.9%), penetrating keratoplasty and amniotic membrane transplantation (−59.1%). Institutional or professional policy requirements (76.0%) and appointment cancellation by patients (84.0%) were the most common reasons for limitations in ophthalmic patient care.ConclusionThe initial phase of the pandemic was characterized by a massive reduction in non-urgent conservative and surgical treatment that affected all areas of ophthalmology. Due to intensive care capacities required for COVID-19 patients, inpatient treatment was largely restricted to emergencies. Treatment of ophthalmological patients, including ocular emergencies and urgent treatment, was maintained across all sectors with a (considerable) decrease in the number of cases even in these groups.

Finite elemental analysis of local osteoporosis formation in the surgical treatment of fubilar fractures

Background.When providing surgical medical care to patients with fibular fractures, one of the most common types of treatment is fixing the fracture area with a metal plate with screws during metallosteosynthesis surgery. During treatment, bone tissue is often thinned in the area of the fracture, which significantly increases the duration of treatment.Aim.Establishment of the mechanism of formation of osteoporosis in the fracture area after the operation of osteosynthesis of the fibula.Material and methods.The finite element method is used to simulate the destruction process using ANSYS.Results.A comparative study of the location of formation of focal osteoporosis formed in the fracture area of the distal part of the fibula diaphysis, under a metal plate installed during osteosynthesis, and the area of formation of maximum equivalent loads in the experimental mathematical model of the stress-strain state revealed complete similarity of the location.Conclusions.The formation of a zone of local osteoporosis in the area of a fibular fracture after osteosynthesis surgery is explained by a combination of factors, which are the presence of a fibular fracture fixed with metal screws with a metal plate, the support of the foot on the foot with pressure on the fibula. The zone of local osteoporosis in the area of the fibula fracture after osteosynthesis surgery occurs from the compression of compact plates of the fracture edges with limited mobility under the metal fixing plate.

Impacts of the SARS-CoV-2 pandemic on ophthalmic care in Germany

HintergrundUmfrage der „Kommission Sektorenübergreifende Augenheilkunde“ als gemeinsame Kommission der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbandes der Augenärzte Deutschlands (BVA) zu den Auswirkungen der SARS-CoV-2-Pandemie auf die ophthalmologische Versorgung in Deutschland.MethodenOnline-basierte Umfrage.ErgebnisseInsgesamt wurden 1190 Fragebögen (teilweise) beantwortet. Die Ambulanz- bzw. Sprechstundentätigkeit in der Zeit vom 15.03. bis 15.04.2020 gaben 69 (5,8 %) Teilnehmer mit „uneingeschränkt“, 756 (63,5 %) mit „reduziert“ und 330 (27,7 %) als „ausschließliche Notfallversorgung“ an, unabhängig von der Art der Einrichtung. Ambulante Operationen waren in 68,0 % der Hauptabteilungen, 42,0 % der Belegabteilungen, 45,0 % der operativen MVZ und Gemeinschaftspraxen und 33,0 % der operativen Einzelpraxen notfallchirurgischen Eingriffen vorbehalten. Stationäre Eingriffe waren in 75,0 % der Belegabteilungen und in 71,0 % der Hauptabteilungen auf die Versorgung von Notfällen beschränkt. Die Fallzahlen dringlicher Indikationen und Notfälle waren mit Ausnahme der Endophthalmitis (+8,2 %) rückläufig: Amotio retinae (−34,8 %), Bulbusperforation (−7,3 %), Glaukomanfall (−17,8 %), ZAV und AION (−31 %), Sonstige (−30,9 %), perforierende Keratoplastik und Amnionmembrantransplantation (−59,1 %). Institutionelle oder berufspolitische Vorgaben (76,0 %) sowie Terminabsagen durch Patienten (84,0 %) waren der häufigste Grund für eine Einschränkung der ophthalmologischen Versorgung.SchlussfolgerungWährend der Pandemie kam es initial zu einer erheblichen Reduzierung nichtdringlicher konservativer und chirurgischer Behandlungen, von der alle Bereiche der Augenheilkunde betroffen waren. Aufgrund der für COVID-19-Patienten benötigten Intensivkapazitäten waren insbesondere stationäre Behandlungen weitgehend auf Notfälle beschränkt. Die Versorgung ophthalmologischer Patienten einschließlich Notfällen und dringlicher Behandlungen konnte sektorübergreifend aufrechterhalten werden, wobei für beide Gruppen ein (deutlicher) Rückgang der Fallzahlen beobachtet wurde.

Multidisciplinary management of the bone and joint infection complicating treatment of an open fracture of the lower limb

Bone and joint infections (BJI) of the lower limb can cause functional sequelae and in some cases have an impact on patient's life prognostic. One of the main objectives of multidisciplinary consultation team meetings (MTM) in the treatment of bone and joint infections is to provide an appropriate medical-surgical care, pooling skills of different organ specialists: infectious disease physicians, microbiologists, orthopedic surgeons and plastic surgeons. Treatment is based on aggressive debridement, bone stabilization, adequate antibiotic therapy, long-term coverage of the loss of skin substance and close clinical monitoring. The authors present their multidisciplinary diagnostic and therapeutic approaches to BJI complicating an open fracture at a referent center in the management of complex bone and joint infections.

Monitoring Hospital Use in the Epidemic

This study reviewed developments in hospitalization in the metropolitan area of Syracuse, New York during the initial months of the Coronavirus epidemic. The study was based on the use of inpatient discharge data and information contained in daily utilization reports for the three hospitals in the community distributed by the Hospital Executive Council. The data demonstrated that the medical-surgical and critical care inpatient census, as well as the emergency department volume peaked in January 2020 and declined gradually during February and the first half of March as a result of the seasonal influenza season prior to the epidemic. The data showed that with the onset of the epidemic in mid-March, the data identified substantial reductions in the use of inpatient beds and the emergency departments. The medical-surgical and critical care censuses declined by 31.2 and 29.3 percent respectively. This resulted from provider and public efforts to free inpatient beds for coronavirus patients. During April and May 2020, the use of medical-surgical beds and emergency departments in the Syracuse hospital gradually increased as the Coronavirus epidemic plateaued. Subsequent data will identify whether the use of inpatient medical - surgical beds and emergency department visits in the Syracuse hospitals return to the levels before the epidemic.

Patient Safety Culture Change over Time-Health Care Staffs’ Perceptions

Rationale and Aim: Patient safety is of great interest in health care organisations, worldwide. In Sweden, a national patient safety initiative was launched in 2011. The aim of this study was to examine and compare patient safety culture change over time from health care staffs’ perspective. A further aim was to examine factors that have had an effect on patient safety culture. Methods: Patient safety culture was assessed in 2009, 2011 and 2013 using the Swedish version of the Hospital Survey of Patient Safety Culture. Respondents in this study were registered nurses (n = 2149), enrolled nurses (n = 959), physicians (n = 355) and managers (n = 159) working in three health care divisions in a Swedish county council. Results: Patient safety culture decreased significantly over time for all but two dimensions. The dimension “Information to Patients/Relatives” was the only dimension to increase significantly over time. Health care staffs’ profession and health care division belonging had significant main effects on 14 and 8 dimensions, respectively. Managers and enrolled nurses scored patient safety culture significantly higher than registered nurses and physicians. Health care staff working in a mixed medical-surgical health care division scored significantly higher than those working in medical or surgical divisions did. Conclusions: Despite efforts for patient safety work in the county council, health care staffs’ perceptions of patient safety culture decreased over time. To improve hospital patient safety culture, managers and staff groups must meet and communicate with each other in order to create a common view of patient safety.

Advocacy: An Essential Competency of the Clinical Nurse Specialist.

In 1956 Dr Hildegarde Peplau established the first Clinical Nurse Specialist (CNS) program, resulting in the first advanced practice nursing role. The CNS is one of 4 advanced practice registered nurse (APRN) roles prepared by education at the master’s or doctoral level. Clinical nurse specialists are APRNs who provide expert care with a population health focus and historically have practiced mostly in acute care environments including critical care, medical surgical care, maternal/child care, and mental health. The key responsibilities of the role are to assess, diagnose, and manage patient problems and to work with the health care team to manage the health care of a patient population. Inherent in this role is serving as an advocate, one who “proactively speaks for another to ensure certain needs or wishes are met.”