Patient Safety Risks Research Articles

“We want to get out” – A qualitative study on reasons for nurses’ early retirement intentions

Abstract Background Nurses, the largest workforce in healthcare, play a central role in health systems. There is a severe global shortage of nurses, which is expected to worsen as a significant portion approaches retirement age. Early retirements can harm care quality and healthcare access, thus significantly impacting public health. Identifying reasons is crucial to prevent this trend. This study examined factors behind nurses’ early retirement intentions. Methods A descriptive qualitative study was conducted in an Irish hospital (July to September 2023) including individual interviews with 10 nurses aged 55 and over. A thematic analysis was conducted collaboratively by three researchers to identify key factors influencing nurses’ intentions to retire early. Results Five main themes emerged: 1) Health concerns, encompassing physical strain and psychological stress, significantly influencing early retirement intentions; 2) Struggling to balance job demands with personal responsibilities such as caring for ageing parents due to inflexible work schedules; 3) Need for more support from senior leaders to address staffing shortages and investment in aging nurses’ career and retirement planning to make staying more desirable and easier; 4) Feelings about nurses’ experience being undervalued in the evolving healthcare; and 5) Facing constant heavy responsibility in guiding new nurses, while simultaneously fearing patient safety risks and encountering generational differences. Conclusions Developing support systems for ageing nurses, encompassing strategies to ease workload strain, enhancing career opportunities, and promoting intergenerational collaboration are critical for reducing early retirement trends and sustaining a resilient healthcare workforce. By implementing tailored approaches, such as flexible scheduling and mentorship programs for ageing nurses, healthcare organisations can promote workforce longevity and enhance public health outcomes through improved care delivery. Key messages • Health challenges and struggles in work-life balance influence early retirement intentions among nurses, urging flexible work arrangements and improved recognition and leadership in healthcare. • To extend work careers, organisations must invest in ageing nurses’ career and retirement planning, value experience, and acknowledge potential challenges and benefits in intergenerational nursing.

An early economic evaluation of WireSafe™ to prevent guidewire retention in central venous catheter procedures

Background Guidewire retention (GWR) poses a patient safety risk during Central Venous Catheter (CVC) insertions and is listed as a ‘Never Event’ by the National Health Service England (NHSE). WireSafe™ is an intervention to prevent GWR, but its cost-effectiveness is uncertain. This study is an early economic evaluation comparing WireSafe™ to standard care from a UK healthcare perspective. Methods We conducted (i) a primary analysis of GWR related NHSE Never Events data in England between 2016 and 2020; and (ii) a cost-utility analysis, including healthcare costs and quality-adjusted life years (QALYS) for populations receiving CVC-insertions. We applied a cost-effectiveness threshold of £30,000 per QALY and considered three WireSafe™ costing scenarios (£18.50, £4.50, and £2.50). Results NHSE Never Events data showed 61 GWR cases, averaging 1 per month. Most incidents (92%) were identified during hospital stays, with one serious adverse outcome reported (peri-arrest). In a population of 200,000, we estimate WireSafe™ would prevent 59.92 wire retentions, 5.61 procedural adverse events, 0.3 cardiac adverse events, and 0.19 deaths, improving QALYs by 4.87. In the base case analysis WireSafe™ was not cost-effective and had an economically justifiable price of £2.44. There were high levels of uncertainty in the lowest cost-scenario (ICER 95% credible interval: Dominant; £793,398). Conclusions The health benefits of WireSafe™ are limited due to low GWR rates and high identification rates, making WireSafe™ viable only at low costs. Future research should prioritise obtaining more precise estimates of these parameter values which are key determinants of cost-effectiveness.

Critical patient safeguards for ambulatory surgery centers.

The role of ambulatory surgery centers in surgical care is evolving, as lower facility fees and improved patient experience increase the popularity of these venues. As care expands in ambulatory surgery center, so does the complexity of cases and patients cared for in these centers, which may pose a risk for patient safety. Anesthesiologists should lead multidisciplinary teams to screen for appropriate patients and procedures. Patient considerations go beyond physical status and include psychosocial factors. Ensuring patients understand preoperative instructions is crucial to decrease case cancellation rates and facilitate efficiency. Pediatric patients require special considerations including extra attention to preprocedure and postoperative care and instructions, PALS-certified staff, pediatric equipment and medications, as well as heightened awareness of respiratory complications. Procedural concerns start with the capabilities of the facility such as equipment, pharmacy, and staffing for each phase of care. However, nuances such as patient throughput in a given day, emergency preparedness, and after-hours staffing will affect both patient safety and staff morale. This article outlines the issues leaders need to consider to ensure patient safety in ambulatory surgery centers.

Introduction of a Novel Patient Safety Advisory: Evaluation of Perceived Information With a Modified QPP Questionnaire-A Case-Control Study.

Adverse events (AEs) may result in serious injuries or death. AEs occur in approximately 9.2% of hospitalizations, with a potential preventability of 43.5%. The aim of this study was to examine whether use of an illustrated patient safety advisory affected information transfer to inpatients regarding how they can participate in their own care to decrease the risk of AEs. All patients in the control (n = 129) and case/intervention (n = 511) groups received verbal information from healthcare personnel. The intervention group also received the illustrated patient safety advisory, "Your safety at the hospital." Before discharge, patients completed the Quality from the Patient's Perspective questionnaire. Mean patient age was 64.6/62.4 years in the intervention/control group, respectively, and 50% were men. Significant differences between groups were observed for most questions presented from the perceived reality of care perspective, in favor to the intervention group. Patients at surgical wards indicated higher scores on 9 of 12 Quality from the Patient's Perspective questions. Patients with hospital stays ≥4 days, at surgical wards, and living with someone else, placed higher subjective importance to questions concerning, e.g., protection/infection, nutrition, risk of falls and pressure ulcers, and discharge information. Using an illustrated patient safety advisory to complement oral information about patient safety risks resulted in positive responses and a significant difference was demonstrated in how information is perceived. The safety advisory could be used as a tool to decrease AEs. Patients who live alone may need more focused patient safety information to encourage involvement in their own care.

The analytical evaluation threshold for inorganic metal extractables and leachables analysis of medical devices

Chemical characterization of medical devices uses the analytical evaluation threshold (AET) to determine reportable organic extractables, as these chemicals may be of toxicological concern and should be addressed via toxicological risk assessment. The AET is not applicable to metal extractables due to the exclusion of toxicity data on inorganics from the dataset used to derive dose-based threshold (DBT) values. This results in minimal guidance for reporting metal extractables. Herein, an AET for metals, or mAET, is proposed as a reporting threshold for individual metal extractables. The mAET can ensure metals are reported that are at quantities that may present a patient safety risk. This may reduce the number of metals reported in a chemical characterization report, improving the efficiency of the overall biocompatibility evaluation by removing unneeded effort and resource time. Conversely, an analytical method’s ability to report all metals at toxicologically relevant levels can be confirmed by comparing method sensitivity to mAET values. DBTs were developed for 70 metals, permitting mAET values to be determined. These mAET values were then compared to metal reporting limits from 13 previously conducted chemical characterization studies, which used varying extraction designs and analytical methods, to determine the impact of the mAET.

Thermographic assessment of skin temperature after lumbar spine surgery: Useful method for detection of wound complications? A pilot study.

Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management. The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders. 62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient's sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels were noted and compared to thermographic measurement of local surface temperature in the wound area. Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p> 0.05). This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch.

Lessons learnt from a 2017 Irish national clinical claims review: a retrospective observational study

ObjectiveLearning from adverse outcomes in health and social care is critical to advancing a culture of patient safety and reducing the likelihood of future preventable harm to service users. This...

Bridging the gaps: A prospective analysis of root causes for rejection and incompleteness in blood requisition forms

IntroductionBlood request form (BRF) stands as a pivotal document in ensuring safe and effective blood transfusions within healthcare settings. Incomplete or erroneous data on BRF can heighten risk of adverse reactions and compromise patient safety. Aim of study was to assess level of completion of BRFs by clinicians and to evaluate root cause analysis (RCA) of incompleteness of BRFs and factors leading to their rejection. Materials and MethodsThis prospective study was carried out from February 2024 to April 2024 on BRFs received in the blood centre. They were audited and RCA for factors leading to their incompleteness and rejection were analysed. ResultsTotal number of BRFs received in blood centre was 14,468. 13,358 (92.3%) BRFs were accepted and 1,110 (7.7%) BRFs were rejected. 12,804 (95.85%) of accepted BRFs were incomplete. Weight was the most common missing parameter (89% {n = 11403}) while name of the requesting clinician was least common (2.5% {n-318}). 3.52% n = 510) BRFs were rejected due to mismatch in name and patient registration number on BRF and samples. 0.14% n = 21) BRFs were rejected due to hemolysed samples. RCA for incompleteness of BRFs showed that main reason was manpower (61–83%) while environment was least common (17–67%). RCA for rejection of BRFs showed that environment was most common cause (13.3–80.15%) while manpower was least common (9–19.85%). ConclusionRegular audits and personnel training, and quality assurance measures can help identify and address deficiencies in BRF completion to enhance patient safety and reduce incidence of transfusion-related errors and complications.

Inconsistent decision making in dental caries diagnosis and treatment: A case-based questionnaire survey.

Delayed implementation of new knowledge into clinical practice poses patient safety risks. This study investigates agreement on use of the dental caries interventions, sealing, and stepwise excavation. A cross-sectional questionnaire survey, based on 11 constructed cases with descriptions of patient symptoms, radiographic, and clinical findings. Interrater agreement on dental caries- and pulp diagnoses and interventions were measured with Cohen's and Light's κ. The data collection period was September 28 to November 5, 2021. To explore variations in use and knowledge factors, we examined Danish dentists' attitudes towardcontinuing education. Based on 243 responses, moderate interrater agreement for dental caries and pulp diagnoses and weak agreement on interventions were seen. The agreement with the gold standard for caries was moderate. No agreement was found for dental pulp diagnosis, and for interventions the agreement was weak. No pattern in agreement with the gold standard was seen in relation to case difficulty level. The majority reported knowing of and using stepwise excavation, in conflict with findings that less than half chose stepwise excavation in cases, where considered appropriate. One in four (25%) reported to be unfamiliar with sealing, and half (50%) use sealing regularly. Better access to continuing education and for universities to offer continuing education as alternatives to one-sidedprivate market were requested. Some patients may receive too radical treatment despite available less invasive evidence-based effective treatments. Dentists acknowledge the importance of continuing education. Easier access and perhaps more incentives for seeking out high-quality continuing education from trustworthy sources are needed.

First promising non-stimulant (guanfacine) transdermal patch for long-acting treatment of ADHD by solid dispersion technique

Guanfacine (GFC) extended-release tablet (Intuniv®) is an effective non-stimulant medication prescribed for attention deficit hyperactivity disorder (ADHD), presenting limitations regarding patient compliance and safety risks. The study aimed to design a novel long-acting transdermal delivery system of GFC to address these issues. Polyvinylpyrrolidone (PVP)-GFC solid dispersions were constructed by the co-evaporation method to improve drug-loading capacity to approximately 10 % (w/w). A PVP-GFC ratio of 3:1 was determined to prevent drug crystallization and promote rapid dissolution. The mechanisms underlying solid dispersion formation were revealed by XRD, DSC, molecular docking, FTIR, and Raman imaging. Hydrogen-bond interactions between PVP and GFC played a crucial role. The prescription and preparation process were optimized using single-factor and Box-Behnken design experiments. The optimized patch exhibited excellent crystallization resistance and adhesion for at least six months. Additionally, superior rheology, mechanical strength, in vitro drug release, and percutaneous permeation characteristics were observed. In human pharmacokinetic studies, the therapeutic efficacy, skin safety, and adhesion of transdermal patches were initially demonstrated for the three-day treatment of ADHD. Therefore, the innovative work expands the comprehension of solid dispersion techniques and facilitates the industrialization and commercialization of the first non-stimulant transdermal patches, providing a promising alternative for ADHD therapy.

A Real-Time Dashboard Approach to Decision Support: An Exercise in Co-Design.

Laboratory tests play an integral role in the delivery of quality health care. However, evidence indicates variations in diagnostic testing, which can lead to patient safety risks. Electronic decision support systems are often identified as key to reducing diagnostic error. However, such tools are often introduced into a clinical setting with little understanding of clinician workflow and how tools are likely to impact this. This study reports a qualitative co-design methodology and results from the first phase in the design and development of an analytics-driven, dashboard approach to supporting clinician test ordering in the Emergency Department.

Quality improvement in neonatal care through enhanced patient safety and clinical risk management: a before-and-after study about neonatal sepsis.

Neonatal sepsis, classified into early-onset and late-onset based on symptom timing, poses significant risks of morbidity and mortality, especially in low birth weight infants. Effective clinical risk management protocols are crucial in reducing these risks. This before-and-after study evaluated the impact of a newly implemented clinical risk management protocol in the Neonatology and Neonatal Intensive Care Unit (NICU) at Policlinico Hospital-University of Bari. The study included 399 neonates over three years, comparing pre- and post-protocol outcomes. Data collection focused on maternal and neonatal demographics, infection rates, and hospital stay lengths. Statistical analysis included t-tests, Wilcoxon-Mann-Whitney tests, and logistic regression models. The study found no significant differences in neonatal pathologies or demographics between pre- and post-protocol groups. However, post-protocol implementation showed a notable reduction in umbilical venous catheter (UVC) infections (p = 0.018) and improved hospital stay lengths. Blood and urine cultures did not show significant changes in microbial patterns post-protocol. The findings underscore the effectiveness of structured clinical risk management protocols in enhancing neonatal outcomes, particularly in reducing specific infection risks. Despite the study's limitations, including its observational nature and sample size, the results advocate for broader adoption and further research on these protocols in diverse healthcare settings. The positive outcomes highlight the importance of continuous clinical risk management efforts in high-risk neonatal environments.

Identifying the risk factors of patient safety in internet hospitals: A mixed methods study

ObjectiveThe purpose of this study was to identify key risk factors and their interrelationships for patient safety in internet hospitals from a system perspective, using mixed methods of qualitative and quantitative analysis. MethodsThis study constructed a comprehensive indicator system of patient safety risk factors in internet hospitals by qualitative analysis using the Patient Safety Systems (SEIPS) model as a framework. Risk factors were initially identified through a literature review and subsequently refined using a Delphi survey involving 24 experts related to internet hospitals in China. The identified indicators were quantitatively analyzed to determine key risk factors and their influencing mechanism using the Decision Making Trial and Evaluation Laboratory (DEMATEL) and Interpretive Structural Modeling (ISM) methods. ResultsThe qualitative analysis established a patient safety risk factor indicator system for internet hospitals, comprising 23 elements across six dimensions. Quantitative analysis employing the DEMATEL-ISM approach revealed that risk management has the highest centrality. Among cause factors, task complexity exerts the most significant impact on other factors, while network information security exhibits the highest absolute value among result factors. Risk factors are categorized into three levels: surface, deep, and root factors, with task complexity, legal and regulatory, and guidance policy being the root factors at the foundation of the system. ConclusionsOur study offered a systemic perspective on analyzing risk factors for patient safety in internet hospitals. Policymakers and managers of internet hospitals should take advantage of the interrelationships among these factors to mitigate patient safety risks by effectively controlling key factors. Public Interest SummaryIn the rapidly evolving landscape of internet hospitals, ensuring patient safety is paramount. This study aimed to comprehensively identify and understand key risk factors influencing patient safety within these digital healthcare platforms. Using mixed methods of qualitative and quantitative analysis, the study examined the intricate interplay of factors affecting patient safety. Our methodology involved constructing a risk factors indicator system based on the Patient Safety Systems (SEIPS) model. By employing the integrated Decision-Making Trial and Evaluation Laboratory along with the Interpretive Structural Modeling method, we unveiled the core risk factors and their intricate relationships. Recognizing the interconnectivity of these factors allows us to develop effective risk mitigation strategies that enhance patient safety in internet hospitals. This study encourages stakeholders to leverage the dynamic relationships among these factors to ensure safer online healthcare experiences for patients.

Telemedicine in Italy: Healthcare authorization profiles in the modern medico-legal reading.

The ruling n. 38485, 20 June 2019, of the Italian Supreme Court, III criminal section, addressed by the perspective of the law the very sensitive and new issue of telemedicine. This commentary deals with the issue of authorization of telemedicine activities by the health authority, starting from the Italian Court of Criminal Cassation, III section, decision n. 38485/2019. The case law explored the authorization of a health point, which carries out telemedicine services. Starting from the perspective discussed by Italian health regulations, the paper examines how the health act could be defined, with the possibilities offered by telecommunications, and how it now relates legally to the physical place where it takes place. Even if telemedicine opens the way to virtual spaces of health practice, the Ministry of Health Italian Guidelines pose functional and logistical issues to guarantee users' safety and health care system accountability. Then, functional requirements for health legitimate practice, and their continuous monitoring, together with the responsibilities of the service centers, health professionals and health facilities, are discussed. The questioning of States' health law, in a broad health system such as that of the Europe, characterized by autonomous health regulations, is extremely important for cross-border health policy with telemedicine, as overall regulatory compliance in health care is the ground criterion for risk prevention and patient safety, to be properly verified.

Assessing Clinical Reasoning and Decision-Making in Swedish Prehospital Emergency Care: A Mixed Methods Study With an Experimental Design

Clinical reasoning and decision-making in prehospital contexts are complex, and patient assessments may be influenced by stress or biases, thus potentially risking patient safety. Previous research has shown mixed results regarding cognitive interventions designed to counteract biases and improve decision-making. In educational settings, there are no tools that assess clinical reasoning while also measuring important decision-making outcomes. This study employed a mixed-methods design and a novel assessment model to evaluate clinical reasoning and decision-making among Swedish prehospital nurse specialists. Additionally, the effect of the metacognitive TWED mnemonic was investigated. Thirteen participants were randomly assigned to two groups and assessed patients in simulation settings, with groups switching cases after brief training on the TWED mnemonic. The primary outcomes included point-based scoring on decision-making, grading of potential risks of patient harm, and analysis of clinical reasoning through reflections. The results showed large variation, without overall differences between groups or demographics. A complex case presentation resulted in lower scores and greater risks of potential patient harm. Qualitative analysis highlighted participants’ ability to handle conflicting data, which correlated with better outcomes. The use of the TWED mnemonic may have increased commission bias. Further research is needed to validate and understand these findings.

How Many Is Too Many? Using Cognitive Load Theory to Determine the Maximum Safe Number of Inpatient Consultations for Trainees.

Cognitive load, specifically extraneous load (EL) reflective of distractions, may provide evidence of a lack of focus, potentially making additional work unsafe. The assessment of trainees performing inpatient consultations provides a helpful model for examining this question. The goal of this study was to provide useful information to clinical and educational leaders to optimize inpatient consultation services and rotations and mitigate potential patient safety risk. In 2019, using the Consult Cognitive Load instrument, the authors obtained EL data from inpatient consultations performed by internal medicine fellows and psychiatry residents across 5 University of California hospitals. In 2023, the authors constructed a Wright map to compare the participants' EL data with the number of prior initial consultations performed during the shift. Of 326 trainees contacted, 139 (43%) completed the EL survey items. The Wright map shows that trainees were estimated to agree that interruptions were already distracting at the first consultation of the shift. After 4 consultations, trainees were estimated to strongly agree that interruptions were distracting and to agree that emotions, extraneous information, and technology were distracting. The authors propose a quantitative, empirically driven, mean safety limit of 4 new inpatient consultations per shift for trainees to avoid cognitive overload, thereby potentially supporting patient safety. Clinical and educational leaders can adjust this limit to fit the unique needs of their practice setting. A similar approach using cognitive load and item response theory could be used to conduct patient safety research in other domains.

The Anatomy of Leadership: From Aspirational to Dark Side Leadership Traits

Leadership is all about others on your team and in your organization. Surgical professionals are most likely to follow leaders they trust to care about their professional and personal well-being, and are aligned with their values, while setting and implementing organizational strategy. Ironically, in order to lead others well, it is best and most effective if leaders are humble, vulnerable, and willing to learn more about themselves: specifically their behavioral tendencies when they both are at their best and when they are under duress. For us as leaders, this includes understanding our own predominant leadership style(s); and learning how to expand our leadership preferred tendencies to other styles that may be more effective in certain situations. The POSNA leadership program (PLP) enables participants and faculty to study effective leadership principles and theories; evaluate published examples of exceptional and disastrous leadership in volatile, uncertain, complex, and ambiguous (VUCA) real life situations; and have in-depth dialogue on how pediatric orthopaedic surgery leaders can learn from and positively model exemplary leadership characteristics and behaviors. Although our operating rooms, clinics, research and administrative areas are not battlefields, and we are healers not warriors, we and the teams we lead do face uncertain, ambiguous, complex and even volatile situations often enough to require implementation of those refined, high-level skills. Key Concepts(1)Like all leaders, surgeons have preferred leadership styles. Learning about, expanding, and adapting leadership style(s) to specific situations is important and impactful.(2)The most effective leaders are humble, have high integrity, think strategically, are decisive decision makers after input from their trusted professional teams.(3)Trust is the essential ingredient of leading successful teams and organizations. Building trust requires empathy, high task competency, the ability to actively listen and engage in dialogue before and during implementation of plan(s).(4)Volatile, Uncertain, Complex, and Ambiguous (VUCA) dilemmas and challenges occur. Leaders and teams who can manage stress, mobilize necessary resources, and respond in a timely fashion to each VUCA situation are most effective.(5)Disruptive behaviors in our profession are more common than ideal. Responding to unprofessional acts, managing perceptions, and redirection to acceptable behavior lessens safety risk for patients and improves team performance and professional well-being.

Variations in Alarm Burden, Source, and Cause Across Inpatient Units at a Children's Hospital.

Alarms at hospitals are frequent and can lead to alarm fatigue posing patient safety risks. We aimed to describe alarm burden over a 1-year period and explored variations in alarm rates stratified by unit type, alarm source, and cause. A retrospective study of inpatient alarm and patient census data at 1 children's hospital from January 1, 2019, to December 31, 2019, including 8 inpatient units: 6 medical/surgical unit (MSU), 1 PICU, and 1 NICU. Rates of alarms per patient day (appd) were calculated overall and by unit type, alarm source, and cause. Poisson regression was used for comparisons. There were 7 934 997 alarms over 84 077 patient days (94.4 appd). Significant differences in alarm rates existed across inpatient unit types (MSU 81.3 appd, PICU 90.7, NICU 117.5). Pulse oximetry (POx) probes were the alarm source with highest rate, followed by cardiorespiratory leads (54.4 appd versus 31). PICU had lowest rate of POx alarms (33.3 appd, MSU 37.6, NICU 92.6), whereas NICU had lowest rate of cardiorespiratory lead alarms (16.2 appd, MSU 40.1, PICU 31.4). Alarms stratified by cause displayed variation across unit types where "low oxygen saturation" had the highest overall rate, followed by "technical" alarms (43.4 appp versus 16.3). ICUs had higher rates of low oxygenation saturation alarms, but lower rates of technical alarms than MSUs. Clinical alarms are frequent and vary across unit types, sources, and causes. Unit-level alarm rates and frequent alarm sources (eg, POx) should be considered when implementing alarm reduction strategies.

From identifying patient safety risks to reporting patient complaints: A grounded theory study on patients' hospital experiences.

To explore how patients with hospital experience construct patient safety, from the identification of a patient safety risk to the decision to file a complaint. Patients play an important role in the prevention of adverse events in hospitals, but the ability of patients to act and influence their own safety is still challenged by multiple factors. Understanding how patients perceive risk and act to prevent harm may shed light on how to enhance patients' opportunities to participate in patient safety. The research design of this study is qualitative and exploratory. Twelve participants who had experienced Swedish hospital care were interviewed between June 2022 and July 2023. The method of analysis was constructivist grounded theory, focusing on social processes. The COREQ checklist for qualitative research was followed. Four categories were constructed: (1) defining the boundary between one's own capacity and that of the hospital, (2) acting to minimize the impact on one's safety, (3) finding oneself in the hands of healthcare professionals and (4) exploring the boundaries between normality and abnormality of the situation. This process was captured in the core category of navigating the path of least suffering. This illustrated how the participants constructed meaning about patient safety risks and showed that they prevented multiple adverse events. Provided that participants were able to act independently, they avoided a multitude of adverse events. When they were dependent on healthcare professionals, their safety became more vulnerable. Failure to respond to the participants' concerns could lead to long-term suffering. By responding immediately to patients' concerns about their safety, healthcare professionals can help prevent avoidable suffering and exhaustive searching for someone in the healthcare system who will take their needs seriously. A member check was performed with the help of one of the participants who read the findings to confirm familiarity.

Ethical Dilemmas of Using Artificial Intelligence in Medicine.

Artificial intelligence (AI) is considered the fourth industrial revolution that will change the evolution of humanity technically and relationally. Although the term has been around since 1956, it has only recently become apparent that AI can revolutionize technologies and has many applications in the medical field. The ethical dilemmas posed by the use of AI in medicine revolve around issues related to informed consent, respect for confidentiality, protection of personal data, and last but not least the accuracy of the information it uses. A literature search was conducted through PubMed, MEDLINE, Plus, Scopus, and Web of Science (2015-2022) using combinations of keywords, including: AI, future in medicine, and machine learning plus ethical dilemma. The ethical analysis of the issues raised by AI used in medicine must mainly address nonmaleficence and beneficence, both in correlation with patient safety risks, ability versus inability to detect correct information from inadequate or even incorrect information. The development of AI tools that can support medical practice can increase people's access to medical information, to obtain a second opinion, for example, but it is also a source of concern among health care professionals and especially bioethicists about how confidentiality is maintained and how to maintain cybersecurity. Another major risk may be related to the dehumanization of the medical act, given that, at least for now, empathy and compassion are accessible only to human beings. AI has not yet managed to overcome certain limits, lacking moral subjectivity, empathy, the level of critical thinking is still insufficient, but no matter who will practice preventive or curative medicine in the next period, they will not be able to ignore AI, which under human control can be an important tool in medical practice.