Provision Of Safe Care Research Articles

Safety on the ground: using critical incident technique to explore the factors influencing medical registrars’ provision of safe care

BackgroundAvoidable patient harm in hospitals is common, and doctors in training can provide underused but crucial insights into the influencers of patient safety as those working ‘on the ground’ within...

Patient Safety Climate, Quality of Care, and Intention of Nursing Professionals to Remain in Their Job During the COVID-19 Pandemic.

This study aimed to examine the relationship between patient safety climate, quality of care, and intention of nursing professionals to remain in their job. A cross-sectional study was carried out in a teaching hospital in Brazil wherein nursing professionals were surveyed. The Brazilian version of the Patient Safety Climate in Healthcare Organizations tool was applied to measure the patient safety climate. Spearman correlation coefficient and multiple linear regression models were applied for the analysis. A high percentage of problematic response was observed for most dimensions, except for fear of shame. Quality of care resulted in a strong correlation with organizational resources for safety and with overall emphasis on patient safety, and the nurse-perceived staffing adequacy was strongly correlated with organizational resources for safety. The multiple linear regression model showed higher scores in quality of care in dimensions related to organizational, work unit, and interpersonal aspects as well as in the adequacy of the number of professionals. A higher score in intention to stay in one's job was also found in the dimensions of fear of blame and punishment, provision of safe care, and adequacy of the number of professionals. The organizational and work unit aspects can lead to a better perception of the quality of care. Improving interpersonal relationships and increasing the number of professionals on staff were found to increase nurses' intention to remain in their jobs. Assessing a hospital's patient safety climate will enable improvement in the provision of safe and harm-free health care assistance.

New Landscape of Healthcare Quality in the Postpandemic Era from 2022~2023 Annual Taiwan Patient Safety Goals for Hospitals

<p>新冠肺炎疫情帶給醫療體系巨大衝擊，未來將進入新常態的時代，因此111-112年度醫療品質及病人安全工作目標納入了這三年的經驗與新法。目標一的重點是強化推動醫療團隊合作，並從政策的訊息發布與溝通來強化醫療團隊合作。目標二強調要建立醫療人員與醫療機構的韌性，預防醫療暴力事件的發生。另外醫療人員要認知資訊存在的病安風險、強化相關通報。目標三新增的重點為「落實手術麻醉整合照護，強化團隊合作」，並鼓勵術後加速恢復，以提升手術安全。目標四強調以團隊合作提供安全照護，預防病人跌倒。目標六增加推廣乾洗手設備，醫院應訂有重大疫情之因應機制。目標八後疫情的醫病溝通，要以多元數位模式與時俱進。新增目標九維護孕產兒安全，強調高危險妊娠辨識與處理能力。期望修訂後的醫療品質及病人安全工作目標能引導醫院在後疫情時代之病人安全有新的展望。</p> <p> </p><p>In view of the severe impact caused by the COVID-19 pandemic and the arrival of the new normal, the 2022–2023 Annual Taiwan Patient Safety Goals for Hospitals have incorporated the experience gained in the past 3 years to adopt new practices. Goal 1 emphasizes strengthening the promotian of TRM (Team Resource Management), through the communication and dissemination of policyrelated information. Goal 2 emphasizes enhancing the resilience of healthcare professionals and organizations, and to prevent medical violence. In addition, healthcare professionals should be aware of the information-related patient safety risks and strengthen reporting of such risks. Goal 3 new aims to "implement integrated care of surgical anesthesia and strengthen teamwork," encouraging enhanced recovery after surgery to improve surgical safety. Goal 4 emphasizes the importance of teamwork in the provision of safe care, which is crucial to the prevention of fall incidents. Goal 6 promotes the use of hand sanitizers, advocating the establishment of response measures for critical epidemic diseases in healthcare organizations. Goal 8 moves with time to use the multi-digital modes to facilitate doctor-patient communication in the post-pandemic era. New goal 9 is to maintain safe maternal and newborn care, emphasizing the ability to identify and deal with high-risk pregnancies. Revisions made to the Annual Taiwan Patient Safety Goals for Hospitals are expected to guide healthcare organizations in improving post-pandemic patient safety.</p> <p> </p>

Quality emergency care (QEC) in resource limited settings: A concept analysis

IntroductionProviding appropriate high-quality emergency care (QEC) commensurate with patients' needs is critical for continuity of care, patient safety, optimal clinical outcomes, reduced mortality, and patient satisfaction. This concept analysis aims to define and assist in understanding the concept of QEC in resource-limited settings. MethodsQuality emergency care concept analysis was conducted using Walker and Avant’s approach. Several literature review methods and dictionaries were used to explore the QEC concept. ResultsImmediate assessment, rapid diagnosis, and critical interventions are the attributes of QEC for life-threatening and time-sensitive conditions, leading to timely and safe care provision. DiscussionNurses serve as the backbone for most emergency care centers such as primary care, emergency department, and even prehospital care. The first few hours following a potential life- or limb-threatening condition are vital. The emergency care rendered to patients can significantly affect treatment's overall outcome; therefore, quality emergency care is critical.Conclusion.

Perceptions of providing safe care for frail older people at home: A qualitative study based on focus group interviews with home care staff.

Providing safe care is a core competence in healthcare. The concept usually refers to hospitals but, consistent with the increasing importance of integrated care, the provision of safe care needs to be extended to the context of home care, and more research is needed concerning home healthcare providers' perspectives in this context. The aim of this study was to describe care providers' perceptions of providing safe care for frail older persons living at home. A qualitative methodology was chosen. In total, 30 care providers agreed to participate. Data were collected through five focus group interviews and analysed using a phenomenographic approach. Three themes regarding care providers' perceptions of providing safe care emerged from the data: 'safe care is created in the encounter and interaction with the older person', 'safe care requires responsibility from the caregiver' and 'safe care is threatened by insufficient organisational resources'. The findings show that providing safe care is an endeavour that requires a holistic view among the care providers as well as effective collaboration within the team, but insufficient competence or a lack of time can make it difficult to safeguard the psychological and existential needs of older persons. Providing safe care in home environments encompasses more than just risk reduction. The findings highlight the importance of establishing and integrating team-based and person-centred care into home care settings. Traditional communication structures for inpatient care also need to be adapted to the cross-disciplinary work in municipalities. Care providers should be given the opportunity to develop and maintain their competences and to prioritise relationship-oriented care.

Responding to the COVID-19 pandemic: Development of a critical care nursing surge model to meet patient needs and maximise competencies

BackgroundThe current coronavirus disease 2019 (COVID-19) pandemic is creating unprecedented and unchartered demands on critical care units to meet patient needs and adapt the delivery of health services. Critical care nurses play a pivotal role in developing models of care that are effective, flexible, and safe. ObjectivesWe report on the accelerated development of a critical care nursing surge model responsive to escalating needs for intensive care capacity. MethodsWe conducted an exploratory prospective observational cohort study that included (i) a self-assessment and survey of learning needs of noncritical care nurses identified as candidate groups for redeployment in the intensive care unit and (ii) a pilot implementation of a team nursing model evaluated by individual questionnaires and the conduct of focus groups. We used descriptive statistics and qualitative content analysis to analyse the exploratory findings. ResultsWe surveyed 147 noncritical care nurses; 99 (67.3%) self-assessed at the lowest level of critical care competency, whereas 33 (24.3%) reported feeling able to help care for a critically ill patient under the direction of a critical care nurse. Identified learning needs included appropriate use of personal protective equipment in the intensive care unit (n = 123, 83.7%), use of specialised equipment (n = 103, 85.1%), basic mechanical ventilation, and vasoactive medication. We completed 11 team nursing pilot assignments with dyads of critical care and noncritical care nurses categorised in tiers of competencies. Nurses reported high levels of perceived support and provision of safe care; multiple recommendations were identified to improve the model of care delivery and communication. ConclusionsThe complexity, acuity, and unpredictability of the COVID-19 pandemic is placing new demands on critical care nurses to modify existing processes for care delivery while ensuring excellent outcomes and professional satisfaction. The study findings provide a road map to support nursing engagement in meeting patient needs.

Perspectives of Australian hospital leaders on the provision of safe care: implications for safety I and safety II

PurposeThere is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the perspectives of hospital leaders on the challenges of leading safe care.Design/methodology/approachThis paper reports the findings of a three-year longitudinal study of eight Australian hospitals. A representative sample of hospital leaders, comprising board members, senior and middle managers and clinical leaders, participated in focus groups twice a year from 2015 to 2017.FindingsAlthough the participating hospitals had safety I systems, the leaders consistently reported that they relied predominantly on their competent well-meaning staff to ensure patient safety, more of a safety II perspective. This trust was based on perceptions of the patient safety actions of staff, rather than actual knowledge about staff abilities or behaviours. The findings of this study suggest this hegemonic relational trust was a defence mechanism for leaders in complex adaptive systems (CASs) unable to influence care delivery at the front line and explores potential contributing factors to these perceptions.Practical implicationsIn CASs, leaders have limited control over the bedside care processes and so have little alternative but to trust in “good staff providing good care” as a strategy for safe care. However, trust, coupled with a predominantly safety 1 approach is not achieving harm reduction. The findings of the study suggest that the beliefs the leaders held about the role their staff play in assuring safe care contribute to the lack of progress in patient safety. The authors recommend three evidence-based leadership activities to transition to the proactive safety II approach to pursuing safe care.Originality/valueThis is the first longitudinal study to provide the perspectives of leaders on the provision of quality and safety in their hospitals. A large sample of board members, managers and clinical leaders provides extensive data on their perspectives on quality and safety.

‘ … breaks down silos’: allied health clinicians’ perceptions of informal interprofessional interactions in the healthcare workplace

ABSTRACT Informal interprofessional interactions have gained interest in recent interprofessional care, education, health services and social sciences research literature. Some of the established benefits associated with these interactions include enhanced communication, teamwork, research translation and the provision of safer care. Limited evidence about how informal interprofessional interactions are perceived by the allied health workforce, exists. The survey conducted at a large Australian health service explored allied health clinicians’ perceptions of the benefits, challenges and enablers of informal interprofessional interactions and their recommendations to improve opportunities for these workplace interactions. Sixty-four responses were analysed descriptively (for close-ended questions) and using a framework analysis approach, informed by Bourdieu’s social space theory (for open-ended questions). Perceived benefits were aligned with three themes: teams and organisations, individual clinicians and service-users. Challenges to, and enablers of, informal interprofessional interactions were identified according to five themes: socio-cultural practices, physical environment, timing-related factors, individual and organisational factors. Participant recommendations to increase opportunities for informal interprofessional workplace interactions for allied health reflected three of the aforementioned themes: socio-cultural practices, physical environment and organisational factors. This theoretically-informed analysis may aid in the development of strategies to support these types of workplace interactions and realise the benefits identified.

Service reconfiguration in the department of hand surgery during the UK COVID-19 lockdown: Birmingham experience

In early 2020, the COVID-19 pandemic swept through the UK and had a major impact on healthcare services. The Birmingham hand centre, one of the largest hand trauma units in...

Prevention and Control Measures toward Hospital-Acquired Infections among Patients, Relatives, and Health Professionals in Tertiary Health-care System

Background: Nurses, as well as other health workers, have an important role to play toward preventing hospital-acquired infections (HAIs) among the patients and themselves. The most important and basic techniques in the prevention and control of infection transmission are hand washing. Objectives: The study was aimed to investigate measures utilized by health-care professionals, in the prevention and control of nosocomial infections in the selected health facility. Materials and Methods: A descriptive questionnaire was designed and used to identify and describe the measures and role of health-care professionals in the prevention and control of HAI in the Federal Medical Centre, Yenagoa. One hundred and fifteen nurses were selected at random among the health facilities to partake in the survey. Results: Respondents had good knowledge on the transmission and prevention of HAIs and that universal precaution must be employed in all aspects of patient care. All nurses strongly agreed that gloves do not transmit pathogens that cause HAIs and 88.7% of the respondents strongly disagreed that over diluted solutions are effective in decontamination as long as instruments are soaked for long periods, nurses that participated in the survey demonstrates a very good attitude towards the prevention of nosocomial infections. Some showed that personal protective equipment reduced their efficiency during procedures. Conclusion: Nosocomial infections complicate patient care and prolong the stay of patients in hospitals. The provision of safe care through the acquired knowledge and demonstration of a positive attitude will promote the preventive measures and subsequent incidence of HAIs.

Examination of a Benchmark for Ethical Care Competence in Basic Nursing Education

Objectives: With rapid advancements in medical care, nurses are confronted with ethical issues on a daily basis. If new nurses are introduced to the clinical setting without having acquired sufficient ethical judgment skills in basic nursing education, they are unable to respond to the ethical dilemmas they face. This results in learned helplessness, which can lead to burnout and turnover. Therefore, it is imperative to develop educational programs where there is a natural progression from basic to continuing nursing. Therefore, in this study, we conducted a nationwide survey using the Nursing Student Care Ethical Competence Scale to present a benchmark for the assessment of this skill and facilitate continuity in nursing education. Methods: From February to March 2019, we conducted a questionnaire survey of 4930 final-year nursing students enrolled in nursing colleges, junior colleges, and technical schools nationwide. The survey consisted of 29 items on ethical behavior, 26 items on ethics knowledge, and seven items on personal attributes. For the analysis, we calculated percentiles for the five standards of nursing students’ ethical care competence: safe care provision, respecting self-determination, protecting personal information, providing the best care, and upholding patients’ dignity. Results: Responses were obtained from 1505 nursing students (collection rate 30.5%, valid response rate 30.5%). The 80th percentile (minimum value-maximum value) was 128 (38 - 145) points for the ethical competence of nursing students, 37 (11 - 40) points for safe care provision, 28 (4 - 31) points for respect for self-determination, 23 (5 - 25) points for protection of personal information, 23 (5 - 25) points for best care provision, and 13 (3 - 15) points for respect for personal dignity. Discussion: The 80th percentile was established as the benchmark for ethical care competence. Conclusion: Based on these criteria, nursing students can objectively assess their ethical behavior, allowing them to understand their strengths and weaknesses, articulate their challenges, and learn autonomously.

Patient safety climate in general public hospitals in China: differences associated with department and job type based on a cross-sectional survey

ObjectiveThis study analysed differences in the perceived patient safety climate among different working departments and job types in public general hospitals in China.DesignCross-sectional survey.SettingEighteen tertiary hospitals and 36 secondary hospitals...

Patient Safety Climate in General Public Hospitals in China: A Multiregion Study.

This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China. Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of "problematic responses" (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis. In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. "Fear of blame and punishment" and "fear of shame" had the highest PPRs and were prevalent in various types of hospitals. "Provision of safe care" and "organizational resources for safety" also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey. Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.

Perspectives on Patient Safety Among Practical Nursing Students.

Background Practical nursing students are students enrolled in a two-year college practical nursing diploma program. They are responsible for providing safe patient care to the patients they care for. Assessing students' perceptions of their own patient safety competencies can help educators identify gaps in their knowledge and skills and identify, at a curricula level, the concepts and information required to improve the quality of their care. Purpose To explore practical nursing students' confidence in what they are learning about patient safety within their nursing education. Methods This cross-sectional descriptive study used a modified version of the Health Professional Education in Patient Safety Survey. Results Overall, students expressed the greatest confidence in their abilities to provide care in Clinical Safety topics. More than 75% of the students' feared punishment when making an error and 88% have difficulty questioning other healthcare providers. Less than 30% of students stated that a system-level focus on errors was taught to them in their education programs. Conclusions More investigation is needed to understand what practical nursing students' fear about the provision of safe care. Additional focus on systems aspects of hazard identification and the prevention of errors needs to be present in nursing education programs.

Health literacy: how nurses can make a difference

Objective: To be a call to action to nurses and all health professionals to implement proven effective evidence based strategies that can decrease health literacy demands on health consumers, and improve health outcomes and the provision of safe person-centred health care. Primary argument: Health professionals, specifically nurses, are important providers of health information to health consumers. They influence the health literacy demands placed on health consumers through the way they organise, present and communicate information (Australian Commission on Safety and Quality in Health Care, 2014). All health professionals need to be cognisant of the range of effective strategies they can implement to reduce the health literacy demands on health consumers through effective interpersonal communication, health materials in the written and visual formats and the creation of health literate environments to improve health outcomes and the provision of safe care. Population measurements of functional health literacy levels (Australian Bureau of Statistics 2008) indicate that 59 per cent of the Australian population aged 15 to 74 years did not achieve an adequate health literacy skill level to meet the complex demands of everyday life and work in a knowledge-based economy. Objective: To be a call to action to nurses and all health professionals to implement proven effective evidence based strategies that can decrease health literacy demands on health consumers, and improve health outcomes and the provision of safe person-centred health care. Primary argument: Health professionals, specifically nurses, are important providers of health information to health consumers. They influence the health literacy demands placed on health consumers through the way they organise, present and communicate information (Australian Commission on Safety and Quality in Health Care, 2014). All health professionals need to be cognisant of the range of effective strategies they can implement to reduce the health literacy demands on health consumers through effective interpersonal communication, health materials in the written and visual formats and the creation of health literate environments to improve health outcomes and the provision of safe care.Population measurements of functional health literacy levels (Australian Bureau of Statistics 2008) indicate that 59 per cent of the Australian population aged 15 to 74 years did not achieve an adequate health literacy skill level to meet the complex demands of everyday life and work in a knowledge-based economy. Conclusion: An understanding by all health professionals of the concept of health literacy, and the evidence based strategies they can implement to decrease health literacy demands on health consumers is imperative to enhancing the involvement of health consumers in their care, improving health outcomes and in the provision of safe health care.

Developing person-centred analysis of harm in a paediatric hospital: a quality improvement report

The provision of safe care is complex and difficult to achieve. Awareness of what happens in real time is one of the ways to develop a safe system within a...

Patients’ Role in Their Own Safety—A Systematic Review of Patient Involvement in Safety

It is necessary to evaluate progress in the area of patient safety. However, although there has been an increase in number of quality and safety related studies have increased, the topics of patient involvement and patient safety are not automatically linked. The aim of this systematic review was to identify and evaluate the evidence contributed by studies of patient involvement in the provision of safe care. Inclusion criteria were studies undertaken to promote involvement in safety, covering patients’ attitudes, unsafe and safe care, risk reduction and handover practices during discharge from hospital to primary care. The results revealed three themes: satisfaction with and need for knowledge about healthcare and the health system, sharing responsibility and accountability for safety and the need to overcome language barriers to prevent harm and error. In conclusion, there is an increased focus on the role of the patient in the provision of safe care. Existing evidence is related to medication rather than patients’ capability and willingness to be involved. It is recommended that patient participation in the provision of safe care should be explored in relation to phenomena such as trust, responsibility, shared decision-making and powerlessness. It is also important to investigate the patient’s role with respect to patient rights.

Threats to patient safety in telenursing as revealed in Swedish telenurses' reflections on their dialogues

Telenursing is a rapidly expanding actor in the Swedish healthcare system, as in other Western nations. Although rare, tragic events occur within this context, and are reminders of the importance of giving patient safety the highest priority. As telenurses' main sources of information are their dialogues with the callers, the provision of safe care can depend on the quality of this dialogue. The aim of this study was to identify issues that could threaten patient safety in telenurses' dialogues with callers. As part of an educational intervention, a researcher visited a sample of six telenurses five to six times at their workplace to listen to and discuss, together with the telenurses, their dialogues with callers in stimulated recall sessions. Each call and the following discussion between researcher and telenurse was tape-recorded and transcribed as text, resulting in a total of 121 calls. Qualitative content analysis of the reflections and following discussions revealed that threats to patient safety could be related to the surrounding society, to the organisation of telenursing, to the telenurse and to the caller. This study gives insight into significant problem areas that can affect patient safety in telenursing in Sweden. Issues that need to be focused on in telenursing educational programmes and future research are suggested, as well as the need for organisational development.

A qualitative study on Iranian nurses’ experiences and perspectives on how to provide safe care in clinical practice

Nurses are the healthcare providers who are well positioned to strengthen patient safety through providing safe care in clinical practice. The purpose of this study was to explore and describe the experiences and perspectives of Iranian nurses in relation to how to provide safe care in clinical practice. A qualitative design by using a content analysis approach was applied for the data gathering and analysis. After employing a purposive sampling to choose 16 bachelor’s degree nurses working in the medical and surgical wards of a referral teaching hospital in an urban area of Iran, semi-structured interviews were conducted to collect data. During the data analysis, three main themes emerged: ‘providing safe care as the patient’s right’, with the subthemes: ‘feeling a personal commitment’ and ‘incorporating patients’ feelings of safety into providing safe care’, ‘encouraging reciprocal accountability in healthcare professionals’ and ‘leadership commitment to safe care’. The findings suggest that educators should provide more information during nurses’ education to focus on the moral duty to provide safe care. In addition, the provision of safe care needs the commitment and collaboration of all healthcare professionals, as well as the leadership of nursing for removing obstacles to nurses’ efforts to making the healthcare system safer.

Strengthening maternal and newborn health in rural Ethiopia: Early results from frontline health worker community maternal and newborn health training

Objectiveto describe early results from the Community Maternal and Newborn Health (CMNH) training programme of the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project. Designa non-experimental, descriptive design was employed to assess training implementation. Settingsix rural districts of Amhara and Oromiya regions, Ethiopia. Participants91 Health Extension Workers (HEWs) and 626 Guide Team members including Traditional Birth Attendants (TBAs) and volunteer Community Health Promoters (vCHPs). InterventionCMNH is one aspect of a broader strategy to improve maternal and newborn health at the community level in rural areas of Ethiopia where pregnant women have limited access to health facilities. Measurementsperformance testing of HEWs, TBAs, and vCHPs was conducted to assess transfer of knowledge and skills from CMNH Master Trainer level to CMNH Trainer level, and from CMNH Trainer level to CMNH Guide Team (GT) level on the topic areas of Prevent Problems before Baby is Born and Prevent Problems after Baby is Born. Findingspost-training performance scores were significantly higher than immediate pre-training scores for Amhara and Oromiya regions on both topic areas (p<0.001). For HEWs and GT members, respectively, average scores increased over 250% and 300% for Prevent Problems before Baby is Born, and over 300% and 400% for Prevent Problems after Baby is Born. Key conclusionsCMNH was successful in transferring knoweldge to HEWs at the CMNH Trainer level and to Guide Team members at the community level. In order for gains to be realised and sustained, the CMNH programme will be nested within an enabling environment created through behaviour change communication to increase demand for CMNH services, emphasising evidence-based maternal and newborn care practices, teamwork among frontline health workers, and an enhanced role of HEWs in provision of safe care during pregnancy, birth, and the early postnatal period.