Self-reported Incidents Research Articles

Occupational Injuries Prone to Infectious Risks amongst Healthcare Personnel in Kuwait: A Retrospective Study

Objective: The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials (OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the factors associated with these incidents. Subjects and Methods: An epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included. Results: The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7% of the HCP at risk. Their mean age was 32.31 ± 6.98 years. The majority were nurses: 166 (66.7%), followed by doctors: 35 (14.1%), technicians: 26 (10.4%) and housekeeping personnel: 22 (8.8%). Needle stick injury was the most common type of exposure, in 189 (75.9%), followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7%), were caused by hollow-bore needles. Exposure to blood represented 96.8%, mostly during drawing blood and the insertion or removal of needles from patients [88 (35.4%)] and when performing surgical interventions [56 (22.6%)]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 (9.6%)] and garbage collection [21 (8.4%)] were reported. Exposures mainly occurred in the inpatient wards [75 (30.1%)] and operating theaters [56 (22.6%)]. Among the exposed HCP, 130 (52.2%) had been fully vaccinated against hepatitis B virus (HBV). Conclusion: Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete.

How Do the Vietnamese Lose Face? Understanding the Concept of Face through Self-Reported, Face Loss Incidents

In Western universal theory, face has been considered as an individual possession, a fundamental motivation for politeness and driven by the concern for autonomy as well as the desire to be free from imposition. However, research on face and politeness in a number of East Asian countries has provided evidence that such a way of conceptualizing face may not be valid to these cultures and languages. Given the scarcity of research on the concept of face in Vietnamese, this paper explores face in Vietnamese by means of self-reported incidents where a sense of face loss (mất mặt or mất thể diện) was felt. Scenarios reconstructed from collected authentic incidents were used to examine whether different participants responded in the same way to situations perceived as potentially causing loss of face. The findings have confirmed that face in Vietnamese is both an individual and collective possession and a subjective value, conditionally dependent on social evaluation.

Female alcohol consumption, motivations for aggression and aggressive incidents in licensed premises

Research into the relationship between alcohol and aggression has previously focused on men. However, in recent years there has been an increase in binge drinking and violent crime among women, behaviours which have been labelled ‘ladette’ culture in the UK. The current study advances the literature in this area by investigating the relationship between alcohol consumption and aggressive behaviour of females in licensed premises, including the type of aggression and motivations for aggressive incidents. Ninety-three female university students completed the Student Alcohol Questionnaire (SAQ; Engs, 2002), the Aggression Questionnaire (Buss & Perry, 1992) and a questionnaire developed to measure self-reported aggressive incidents. Females who had been involved in an aggressive incident reported spending more time on average in licensed premises per week and higher levels of aggression as well as consuming significantly more alcohol on the day of the incident than females who had not been involved in an aggressive incident. Contrary to expectations, however, those who had been involved in an aggressive incident did not report drinking more beer (a male-orientated drink) than those who had not. Verbally aggressive incidents were reported more than physically aggressive incidents, and aggression was commonly motivated by an emotional reaction or to address a grievance. The finding that average alcohol consumption per week was significantly associated with female aggression in licensed premises highlights the importance of developing interventions to reduce alcohol consumption among young females.

Determinants of High Pesticide Exposure Events in the Agricultural Health Cohort Study from Enrollment (1993-1997) through Phase II (1999-2003)

We conducted an analysis of the determinants of high pesticide exposure events (HPEEs), which are defined as self-reported incidents of high exposure to pesticides, fertilizers, or other chemicals in the Agricultural Health Study, a cohort of private applicators and their spouses residing in North Carolina or Iowa, and commercial applicators residing in Iowa. We examined the risk of HPEEs occurring between enrollment (phase 1: 1993-1997) and follow-up (phase II: 1999-2003) among participants who completed the phase II questionnaire (n=43,149) by calculating hazard rate ratios and 95% confidence intervals using Cox proportional-hazard regression. During the followup period, 1,582 HPEEs were reported (3.8%). HPEE risk was significantly higher among Iowa residents, younger participants, those with a hearing deficit, a risk-taking personality, and an HPEE prior to enrollment. Among private applicators (n=30,102), larger farm size, higher frequency and duration of pesticide use, spraying pesticides with open cab windows, using a tractor cab without a charcoal filter, repairing spray equipment, wearing work clothing more than two days without changing, not removing work boots before entering the home, and storing pesticides in the home were associated with significantly higher HPEE risk. Among commercial applicators (n=2326), higher frequency of pesticide use was associated with a significantly higher HPEE risk. Among spouses (n=10,721), higher frequency of pesticide use, using an application vehicle with a cab, and storing pesticides in the home were associated with a significantly higher HPEE risk. Our findings indicate that HPEEs were associated with several modifiable pesticide handling procedures that can be targeted in safety training and education.

The Application of Aronson's Taxonomy to Medication Errors in Nursing

Medication administration is a frequent nursing activity that is prone to error. In this study of 318 self-reported medication incidents (including near misses), very few resulted in patient harm-7% required intervention or prolonged hospitalization or caused temporary harm. Aronson's classification system provided an excellent framework for analysis of the incidents with a close connection between the type of error and the change strategy to minimize medication incidents. Taking a behavioral approach to medication error classification has provided helpful strategies for nurses such as nurse-call cards on patient lockers when patients are absent and checking of medication sign-off by outgoing and incoming staff at handover.

Preliminary Empirical Assessment of Offshore Production Platforms in the Gulf of Mexico

This paper reports on a preliminary analysis of performance indicators on 3,020 platforms operating in the Gulf of Mexico between 1996 and 2010. Statistical analysis reveals that company-reported incidents (such as blowouts, fires, injuries, and pollution) increase with water depth, controlling for platform characteristics such as age, quantity of oil and gas produced, and number of producing wells. In addition to company-reported incidents, we examine government inspections and the type of enforcement action (warning, component shut-in, facility shut-in, or civil penalty review) following an inspection. Fewer incidents of noncompliance are detected during inspections on deep-water platforms compared with shallow-water platforms; however, the magnitude of the effect of depth on noncompliance is not large. We provide a preliminary analysis of the effect of prior findings of noncompliance, suggesting that noncompliance is persistent. We also find significant variability in both self-reported incidents and noncompliance across leaseholders.

An Examination of Moderators of Perceived Stress and Illness Behavior

The purpose of this study was to examine multiple psychosocial factors (social support, negative affect, coping skills, and perceived health status) as moderators of perceived stress on illness behavior. College students recruited from undergraduate psychology courses completed measures in an on-line survey. Hierarchical multiple regression analyses indicated that commonly investigated psychosocial factors such as affectivity, coping, and social support moderated the relationship between perceived stress and one illness behavior (report of illness without visits to the doctor). However, other moderator variables less investigated, such as perceived health status had a significant effect on both illness behaviors (self-reported incidents of illness with and without visits to the doctor). Our findings highlight the role of behavioral health in primary care and the importance of educating individuals on the relationship between psychosocial factors and health.

Classifying nursing errors in clinical management within an Australian hospital

Although many classification systems relating to patient safety exist, no taxonomy was identified that classified nursing errors in clinical management. To develop a classification system for nursing errors relating to clinical management (NECM taxonomy) and to describe contributing factors and patient consequences. We analysed 241 (11%) self-reported incidents relating to clinical management in nursing in a metropolitan hospital. Descriptive analysis of numeric data and content analysis of text data were undertaken to derive the NECM taxonomy, contributing factors and consequences for patients. Clinical management incidents represented 1.63 incidents per 1000 occupied bed days. The four themes of the NECM taxonomy were nursing care process (67%), communication (22%), administrative process (5%), and knowledge and skill (6%). Half of the incidents did not cause any patient harm. Contributing factors (n=111) included the following: patient clinical, social conditions and behaviours (27%); resources (22%); environment and workload (18%); other health professionals (15%); communication (13%); and nurse's knowledge and experience (5%). The NECM taxonomy provides direction to clinicians and managers on areas in clinical management that are most vulnerable to error, and therefore, priorities for system change management. Any nurses who wish to classify nursing errors relating to clinical management could use these types of errors. This study informs further research into risk management behaviour, and self-assessment tools for clinicians. Globally, nurses need to continue to monitor and act upon patient safety issues.

Moderate and severe adverse events associated with apheresis donations: incidences and risk factors

The goal of this observational retrospective study was to evaluate various donor and procedural variables as potential risk factors for different types of moderate to severe adverse events (AEs) during apheresis collections. Data on all apheresis collections performed on Trima Accel (TA; CaridianBCT) instruments over a 28-month period were extracted from a donor database (Vista Information System, CaridianBCT) and reviewed along with AE reports from the same period. Donor and procedural variables were compared among uneventful procedures and those that resulted in various types of moderate to severe AEs, including presyncopal or syncopal (PS) episodes, citrate reactions (CR), reactions with both components (PS + CR), and self-reported incidents of significant venipuncture-related vascular injuries (VIs). A total of 59 moderate to severe AEs occurred among 15,763 procedures (0.37%), including 19 PS, 4 CR, 17 PS + CR, 12 VI, and 7 miscellaneous reactions. Greater blood loss and lower net fluid balance were associated with PS; female sex, older age, and smaller total blood volume (TBV) were associated with CR; and development of VI may be associated with female sex and smaller TBV. Younger age was not a risk factor for AEs. Apheresis collections performed by TA instruments are safe with a low incidence of significant AEs. Various types of AEs have different predisposing factors. Apheresis may be a safer option for donors with risk factors for PS reactions associated with whole blood collections, such as younger age, female sex, and small TBV.

Predicting accidental falls in people with multiple sclerosis — a longitudinal study

Objective: To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests. Design: A longitudinal, multi-centred cohort study with prospectively collected falls. Procedures: Self-reported incidents during the three months following a standardized test procedure. Subjects: Seventy-six people with multiple sclerosis and an Expanded Disability Status Scale score between 3.5 and 6.0. Main outcome measures: Berg Balance Scale, Timed Up and Go cognitive, Four Square Step Test (FSST) and 12-item Multiple Sclerosis Walking Scale. Results: Forty-eight people (63%) registered 270 falls. Most falls occurred indoors during activities of daily life. We found a correlation of rs=0.57 between near falls and falls, and of rs = 0.82 between registered and retrospectively recalled falls. Fallers and non-fallers differed significantly regarding Expanded Disability Status Score (odds ratio (OR) 1.99, 95% confidence interval (CI) 1.22; 3.40), spasticity (OR 1.14, CI 1.02; 1.31), proprioception (OR 2.50, CI 1.36; 5.12) and use of walking aids (OR 2.27, CI 1.23; 4.37). Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5—15.6 times depending on severity. The odds of falling were doubled for each degree of increased Expanded Disability Status Score and more than doubled for each degree of increased spasticity. The Berg Balance Scale, use of walking aids and Timed Up and Go cognitive best identified fallers (73—94%) and proprioception, Expanded Disability Status Score, 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers (75—93%). Conclusions: In clinical practice, looking at the use of walking aids, investigating proprioception and spasticity, rating Expanded Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers.

Which aspects of safety culture predict incident reporting behavior in neonatal intensive care units? A multilevel analysis*

Safety culture assessments are increasingly used to evaluate patient-safety programs. However, it is not clear which aspects of safety culture are most relevant in understanding incident reporting behavior, and ultimately improving patient safety. The objective of this study was to examine which aspects of safety culture predict incident reporting behavior in the neonatal intensive care unit (NICU), before and after implementation of a voluntary, nonpunitive incident reporting system. Survey study based on a translated, validated version of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. This survey incorporates two outcome measures, 11 dimensions of patient-safety culture as well as demographic data. Eight tertiary care NICUs and one surgical pediatric ICU. All unit personnel. Implementation of a specialty-based, voluntary, nonpunitive incident reporting system. The survey was conducted before (t = 0) and after (t = 1 yr) the intervention. number of self-reported incidents in the past 12 months. Overall response rate was 80% (n = 700) at t = 0 and 76% (n = 670) at t = 1 yr. Based on a multivariate multilevel regression prediction model, the number of self-reported incidents increased after the intervention and was positively associated with a nonpunitive response to error and negatively associated with overall perceptions of safety and hospital management support for patient safety. A nonpunitive approach to error, hospital management support for patient safety, and overall perceptions of safety predict incident reporting behavior in the NICU. The relation between these aspects of safety culture and patient outcome requires further scrutiny and therefore remains an important issue to address in future research.

The Effect of School Choice on Participants: Evidence from Randomized Lotteries

School choice has become an increasingly prominent strategy for enhancing academic achievement. To evaluate the impact on participants, we exploit randomized lotteries that determine high school admission in the Chicago Public Schools. Compared to those students who lose lotteries, students who win attend high schools that are better in a number of dimensions, including peer achievement and attainment levels. Nonetheless, we find little evidence that winning a lottery provides any systematic benefit across a wide variety of traditional academic measures. Lottery winners do, however, experience improvements on a subset of nontraditional outcome measures, such as self-reported disciplinary incidents and arrest rates.

School size and youth violence

This paper investigates the relationship between school size and youth violence. Our analysis suggests that any potential education gain that arises through larger scale may be achieved only at the cost of increasing level of student frustration, alienation, and violence. Recent studies that used school-centered data to show the relationship may provide biased results. The main goal of this paper is to retest this hypothesis on an individual micro-database of youths. Self-reported incidents of violence are used to see if school size has had an independent effect on youth violence after controlling for other demographic and school characteristics.

Self-reported incidents, accidents, and use of protective gear among small-scale forestry workers in Sweden

Self-reported data were collected from 156 self-employed small-scale forestry workers regarding their work, including use of safety gear and number and type of incidents and accidents. About 40% of the respondents reported that during the previous 24 months they had some kind of work-related accident where an injury occurred, and/or experienced in incident, a close call that could have resulted in an injury. Of those injured or involved in an accident, 50% reported that at the time of the accident or incident they were not fully using their safety gear. Sixty-seven percent of the accident victims reported seeking medical attention for their injuries. No significant relationships were found between production level, age, use of safety gear or sensation seeking tendencies and the reports of accidents and incidents. Accidents and incidents were most likely to occur during felling, thinning and transportation activities and were usually caused by unforeseen interactions with falling trees/branches or equipment. Compared to earlier surveys of Swedish small-scale forestry workers, consistent use of all required safety gear was down by 10% to 50%. Protective pants and gloves were the items least likely to be used while ear, eye and foot protection were most likely to be used. The results indicate that better planning during felling processes may be the key to reducing the number of accidents for this population.

Adverse events in acute care: an integrative literature review.

An integrative literature review was conducted to investigate studies on adverse events reported in medical, health services, and nursing literature. The review was guided by the method proposed by Jackson (1980) and Ganong (1987). Three questions shaped the review: (a) What terms are used to denote adverse events? (b) What purposes drive adverse events research? and (c) What data sources are used to study adverse events? Adverse events was the dominant term, the study of adverse events as an outcome variable was the prevailing research purpose, and monitoring or screening the patient clinical record and self-reported incidents by health care professionals were the main data sources. Future research is recommended to conceptualize and study adverse events.

The Impact of Faculty-Student Interactions on Teaching Behavior: An Investigation of Perceived Student Encounter Orientation, Interactive Confidence, and Interactive Practice

Previous research has examined satisfactory and unsatisfactory faculty-student interactions from only the student's viewpoint. In this research, the authors used a national sample of marketing professors' self-reported satisfactory and dissatisfactory critical incidents with students. Their findings support previous incident classification schemes. They identified five specific behavior outcomes resulting from critical interactions with students: method and material changes; requirements clarification; reinforcing actions; student praise; and greater authoritativeness. The authors also introduce three constructs—student encounter orientation, instructor interaction confidence, and instructor interaction practice—and discuss the relationship of constructs to incident classifications, the (dis)satisfactory nature of an interaction, and behavioral responses.

Strict U.S. Alcohol Laws Reduce Teen Drinking, Study Suggests

Strict U.S. Alcohol Laws Reduce Teen Drinking, Study Suggests

Patterns of Anti-Gay Violence

This nonexperimental, descriptive study investigates anti-gay victimizations and reporting practices to the police. In this analysis of 241 self-reported incidents, the results partly support previous research on victimization. Differences were also found between gender identities and offense, reporting to police, and injury. Race appeared also to be a factor in offense and reporting to police.

Stress, Conflict, Elder Abuse and Neglect in German Nursing Homes: A Pilot Study Among Professional Caregivers

ABSTRACT A questionnaire survey on elder abuse and neglect in residential settings was conducted among a convenience sample of 80 people working in German nursing homes. Data on nursing staff's experiences of stress and conflict at their workplaces, self-reported incidents of abuse and neglect of nursing home residents, incidents observed as witnesses and subjective theories about causes and motives underlying violence in nursing homes are reported. Whereas 59% report physical or verbal aggression by residents during the previous 2 months, 79% indicate having abused or neglected a resident at least once during that period; 66% witnessed victimizations of residents by colleagues. Different types of neglect and verbal/psychological abuse are most common. Subtypes of elder abuse and neglect show differential correlation patterns with measures of work stress. Subjects attribute abuse and neglect not only to staff shortage and work overload but also to a number of factors in the offender's personality on the one hand and at the political and social level on the other. From a motivational point of view, abuse and neglect are regarded as instrumental acts to reduce workload and as effects of pent-up aggression and inner tensions.

Reducing harmful alcohol-related behaviors: effective regulatory methods.

This article examines the effects of tort liability, criminal law, administrative regulation, price and availability of alcohol, and personal and state characteristics on the decisions to engage in heavy episodic drinking and to drink and drive. Individual behavior data from the Behavioral Risk Factor Surveys (1984-95) were used in a logit analysis of the probability that a respondent engaged in heavy episodic drinking (n = 86,273), drinking and driving (n = 87,087) and drinking and driving if also a heavy episodic drinker (n = 22,261). Imposing tort liability on bars reduced self-reported incidents of drunk driving among all drinkers (p = .043) but did not reduce the probability of heavy episodic drinking or drinking and driving among heavy drinkers. In this first national study of the impact of social host liability, we found that such liability lowered the self-reported probability of heavy episodic drinking (p = .0004) and drinking and driving among all drinkers (p = .0005). Although several criminal and administrative regulations were also effective in reducing heavy episodic drinking and drunk driving, the imposition of tort liability represents a useful addition to the arsenal of alcohol-control policies.