Two-part Instrument Research Articles

The effects of mentorship and educational videos on nursing students’ physical examination skills: a clinical audit

BackgroundPoor competence in clinical examination skills among nurses has been reported in practice, and there is a strong consensus that physical examination (PE) education must be improved. However, deficiencies cannot be resolved by theoretical training alone, and new training approaches are required to enable nursing students to perform PE accurately. This study aimed to determine and compare the effect of two new educational methods (mentorship and educational video methods) on the physical examination skills of Iranian nursing students.MethodsThis study was a clinical audit with three group pretest posttest design. Eligible nursing students were recruited through the census method and assigned to three groups (mentorship, educational videos, and control group) using permuted block randomization. Students were taught PE skills in three vital systems through three approaches (mentors, educational videos, and routine educational methods). Data were collected using a two-part instrument consisting of a demographic information questionnaire and a 32-item checklist for assessing the students’ skills in examining the respiratory system (10 items), cardiovascular system (13 items), and 12 cranial nerves (9 items). Data were analyzed using SPSS software version 16 and descriptive and analytical statistical tests.ResultsAt baseline, students in all groups scored less than half of the possible scores in all three systems, and the mean scores of the three groups were not statistically different (P > 0.05). After the intervention, the mean scores of students in the mentorship group increased significantly in all three systems (P < 0.001), whereas the mean scores of students in the educational video group and the control group did not change significantly (P > 0.05). Furthermore, after the intervention, the mean scores of the educational video group and the control group did not significantly differ in any of the three systems (P > 0.05). The ANCOVA showed that with posttest score as the covariate, PE skills in all three systems improved one week after the intervention in the mentor group compared to the control group and the educational video group. However, PE skills in all three systems did not improve one week after the intervention in the educational video group compared to the control group.ConclusionsThe mentorship method is more effective than the educational video and routine methods for teaching PE skills to nursing students. Nursing schools can use the mentor method in training nursing students, and it is recommended to revise the PE lesson unit in the nursing curriculum and exchange it from a purely theoretical-based unit to a mixture of theoretical and clinical-based training. Educational videos alone cannot improve nursing students’ PE skills; thus, if educational videos are used to teach clinical skills, it is necessary to hold hands-on sessions to provide feedback to students and correct their mistakes.

Understanding Variation in Health Care Quality Experiences of Three Stakeholders: Patients and Kin, Professionals, and Hospitals

Summary As quality of care increasingly becomes a strategic topic for hospitals, understanding variation between stakeholders’ experiences is essential. A framework can be used by managers, researchers, and policy makers to account for these variations and set priorities to ensure an environment of trust among all stakeholders — including patients and kin. To measure perceptions of quality from a multidimensional view, researchers at the Leuven Institute for Healthcare Policy established four objectives. The first was to explore whether patients and kin (collectively), and professionals experience quality as a multidimensional concept. The second was to examine the between-stakeholder variation across health care quality experiences of patients/kin and professionals. The third was to examine between-hospital variation in health care quality experiences among the 19 hospitals studied. The fourth was to set quality priorities for hospital management and policy makers based on multistakeholder and multicenter data. To collect information, researchers used the Flanders Quality Model (FlaQuM)-Quickscan tool, which is a two-part instrument that measures quality from a multidimensional view. It includes a series of statements on health care quality for patients and kin (part 1) and a corresponding series of statements on health care quality for professionals (part 2), each consisting of 15 quality domains and three global ratings; all respondents were required to address both parts 1 and 2. To explore whether quality is experienced as a multidimensional concept, intraindividual variation was examined by analyzing stakeholders’ differences between minimum and maximum scores on the instrument domains. Between-stakeholder variation was examined by evaluating differences in mean scores of the two stakeholder groups on the quality domains using unpaired t-tests. Between-hospital variation was examined by evaluating differences in hospitals’ mean scores on the quality domains using one-way analysis of variance (ANOVA). In total, 14,977 respondents (6,590 patients/kin and 8,387 professionals) completed the FlaQuM-Quickscan during the study period between May 2021 and June 2022. Respondents used a Likert scale, where 0 is full disagreement with the statement and 10 is full agreement. Analyses revealed important intraindividual variation in experiences of respondents across quality domains. Researchers also observed that patients/kin scored all domains (in parts 1 and 2) significantly higher than professionals, except for the Equity domain in part 2. Significant between-hospital variation in the mean scores was observed for all domains. Of note, by combining the correlation of the overall quality scores with the quality domains, the difference in mean scores on domains, and the variation between hospitals’ mean scores, priorities can be identified. Overall, researchers found that patients/kin and professionals do experience quality as a multidimensional concept. The multidimensional priorities identified based on the FlaQuM-Quickscan results indicate the need for future multifaceted quality strategies at the meso and macro levels that can have an impact at the patient care level. Hospital management and policy makers need to support the integration between executive/management-level and frontline-level initiatives.

Hearing and Functioning in Everyday Life Questionnaire: Development and Validation of an ICF-Based Instrument.

Self-assessment instruments are commonly used in audiological rehabilitation. However, several studies highlight the lack of multidimensionality in existing outcome measures, with the consequence that they only partially capture aspects of functioning in everyday life for people living with hearing loss. This study aimed to develop and investigate the content validity of a self-assessment instrument based on the validated Brief International Classification of Functioning, Disability, and Health Core Set for Hearing Loss. The design was a two-part instrument development study. The first part focused on the item-generation process of the instrument, named the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) during an experts' workshop. The second part focused on international content validation of the instrument using group interviews. Strategic sampling was used and 30 adults with hearing loss from India, South Africa, and the United States participated in the group interviews. The expert's workshop resulted in the first version of the HFEQ containing 30 items. The results from group interviews show that the content of the HFEQ was considered to be valid concerning its relevance, comprehensiveness, and comprehensibility. A majority (73%) of the HFEQ items were perceived by the participants as relevant and easy to comprehend. For the remaining 27% of the items, the content was perceived to be relevant in all countries, but some terms and expressions were reported to require rewording or clearer examples. These modifications will be made in the next step of the development process. Content validation of the HFEQ demonstrates promising results, with participants perceiving the content as relevant and comprehensible. Further psychometric validation is required to investigate other psychometric properties, such as construct validity and reliability. The HFEQ has the potential to become a valuable new instrument for assessing everyday functioning in people with hearing loss in audiological rehabilitation and in research.

VALIDATION OF THE INTERNATIONAL 7-ITEM FALLS EFFICACY SCALE IN PORTUGUESE COMMUNITY-DWELLING OLDER ADULTS

ABSTRACT Objective to determine the psychometric properties of the international 7-item Falls Efficacy Scale. Method a psychometric study. Convenience sample consisting of 170 older adults living in the Madeira Autonomous Region, Portugal. A two-part instrument was used (sociodemographic characterization and the Falls Efficacy Scale-International-Portugal). The starting point was the translation and transcultural adaptation already carried out for the Falls Efficacy Scale - International (16 items). Construct validity (factorial analysis and discriminant validity) and the reliability (Cronbach's α) of the 7-item scale were evaluated. Previous authorization was obtained from the Ethics Commission and from the people involved. Results in the exploratory factorial analysis, the International 7-item Falls Efficacy Scale presents an explained variance of 65.8%. The Spearman's correlation between the score obtained based on the 7 items and the score obtained based on the 16 items is significant and very strong (r=0.987, p&lt;0.0001). Internal consistency was 0.958. Conclusion the validity and reliability study of the International 7-item Falls Efficacy Scale revealed that it is an adequate scale for the evaluation of the fear of falling in the community-dwelling older adults.

Does educational-supportive program affect anxiety in women with endometrial cancer? Result from a randomized clinical trials.

Following a diagnosis of cancer, distress is a common reaction. For Iranian women with endometrial cancer, treatment and survivorship can result in disabling symptoms of depression, anxiety, social, and spiritual crises. The aim of this study was to determine whether a combination of education and support intervention as a comprehensive program focusing on education, coping, and support had better short- and long-term effects on anxiety of these patients. The current randomized clinical trial was performed on a sample of 140 women with endometrial cancer. A two-part instrument was used - a demographic information form and "Beck's Anxiety" questionnaire. The intervention was an educational-supportive program in 3 weekly sessions in experimental group (N = 70), whereas control group (N = 70) received routine care. Descriptive statistics, Chi-square test, t-tests, and repeated measure analysis of variance were used to analyze data. P value less than 0.05 was considered as statistically significant. The total scores of anxiety (mean± standard deviation) was significantly lower in the experimental group immediately after intervention (8.46 ± 5.17, P < 0.001), 1 month (7.78 ± 4.59, P < 0.001) and 2 months (7.55 ± 4.55, P < 0.001) after intervention to compare with before intervention (16.82 ± 10.19). In this study, this program could decrease the anxiety in women with endometrial cancer.

Una mirada de las estrategias de enseñanza del inglés como lengua extranjera desplegadas por profesores practicantes chilenos

El estudio tuvo como objetivo explorar y describir las prácticas de enseñanza de los futuros profesores de inglés como lengua extranjera respecto de las habilidades de gestión del aula, implementación de planificaciones de clases, estrategias de enseñanza y provisión de retroalimentación. Se observaron 160 clases en diferentes regiones del país. El estudio siguió un diseño cuantitativo no experimental. Para obtener información demográfica y detectar las prácticas en el aula se diseñó un instrumento compuesto de dos partes con una escala de observación Likert. Después de la recopilación de datos, se calcularon estadísticos descriptivos, one-way ANOVA y pruebas post hoc de Tukey HSD. Los resultados indican que, aunque los puntajes tienden a ser relativamente similares y estables en todo el país, existen algunas diferencias estadísticamente significativas teniendo en cuenta la relación entre el género y la gestión del aula, la dependencia escolar, el desempeño de los practicantes y la entrega de retroalimentación. Los autores reconocen la necesidad de estudios adicionales que puedan explicar una correlación entre estos resultados y las elecciones de los practicantes a través de un enfoque cualitativo.

Who says aging is lonely? A phenomenology of Filipino older adults’ experiences of happiness when joining international group tours

ABSTRACTAcross the literature, travelling has been viewed as a recurring activity for older adults and is driven by a multitude of purposes and reasons. Previous studies have probed touristic activities of older adults however, little is known about their emotional experiences specifically their sense of happiness when joining international group tours, hence this phenomenological study. A qualitative approach was utilized to gather data from a group of 15 purposively selected participants aged 60 years and above. A two-part instrument consisting of a robotfoto and a semi-structured interview was used in this study. Through vertical and horizontal analyses of the field text, this study afforded the development of The Spiraling Model of Aging Filipino Tourists’ Happiness. This model describes aging tourists’ happiness while travelling as a product of Shared Moments, Shared Culture, Shared Memories, and Shared Transcendence. Summarily, findings of this study may provide significant insights to service providers such as hotels, airlines and travel agencies across the globe in developing innovative marketing strategies that cater to this promising age group. Empirically, this study may stimulate further exploration in the field of Cognitive Psychology aimed at adding large-scale data regarding the study of emotions specifically older adults’ happiness when joining international group tours.

The Effect of Education Based on BASNEF Model on Lifestyle in Patients with Hypertension

Background: Hypertension is a major health problem in all communities that is closely associated with lifestyle. Different educational models have been used to improve the lifestyle in these patients. However, inconsistent results have been reported. Objectives: This study aimed to investigate the effect of education based on the BASNEF model on lifestyle in patients with essential hypertension. Methods: This single-blind randomized controlled clinical trial was conducted in 2015 on 80 patients with essential hypertension. The intervention group received five sessions of training based on the BASNEF model, while the control group received routine care. A two-part instrument was used in this study. The first part included a demographic questionnaire and the second part comprised the life style questionnaire (LSQ). The LSQ was responded in two times, i.e. before and one month after the intervention. Descriptive statistics, independent sample t-test, and analysis of covariance were used to analyze the data. Results: The mean score of lifestyle in the intervention group was 121.80 at the start of the study that changed to 149.60 (with an increase of 27.8) after the intervention (P < 0/001). However, the mean score of lifestyle did not significantly change in the control group (126.55 vs. 122.78). The greatest improvements were observed in the areas of nutrition and weight management, sports and fitness, physical health, disease prevention, and mental health, in sequence. Conclusions: Using a training program based on the BASNEF model was effective in improving the lifestyle in patients with hypertension. Thus, this model of behavior modification can be used as an inexpensive and applicable method in modification of lifestyle and behavior change in patients with hypertension.

Comparing the Effect of Concept Mapping and Conventional Methods on Nursing Students’ Practical Skill Score

Background:Development of practical skills in the field of nursing education has remained a serious and considerable challenge in nursing education. Moreover, newly graduated nurses may have weak practical skills, which can be a threat to patients’ safety.Objectives:The present study was conducted to compare the effect of concept mapping and conventional methods on nursing students’ practical skills.Patients and Methods:This quasi-experimental study was conducted on 70 nursing students randomly assigned into two groups of 35 people. The intervention group was taught through concept mapping method, while the control group was taught using conventional method. A two-part instrument was used including a demographic information form and a checklist for direct observation of procedural skills. Descriptive statistics, chi-square, independent samples t-tests and paired t-test were used to analyze data.Results:Before education, no significant differences were observed between the two groups in the three skills of cleaning (P = 0.251), injection (P = 0.185) and sterilizing (P = 0.568). The students mean scores were significantly increased after the education and the difference between pre and post intervention of students mean scores were significant in the both groups (P < 0.001). However, after education, in all three skills the mean scores of the intervention group were significantly higher than the control group (P < 0.001).Conclusions:Concept mapping was superior to conventional skill teaching methods. It is suggested to use concept mapping in teaching practical courses such as fundamentals of nursing.

Internet Addiction and its Predictors in Guilan Medical Sciences Students, 2012

Internet is one of the technologies of the modern era that is being extensively used around the world. It is believed that excessive Internet use can be pathological and addictive. Though, academic use of the Internet is primarily intended for learning and research, students are one of the groups at risk of Internet addiction. Due to the expanding use of Internet among the university students, this study was conducted to examine the Internet addiction and its predictors among Guilan University of Medical Sciences students. A cross-sectional study was conducted on 583 students during the first semester of 2012. A two-stage stratified random sampling was conducted and a two-part instrument was used for data collection. The first part of the instrument was consisted of questions about demographic characteristics and the second part was the Young's Internet addiction inventory. Chi-square, Kruskal-Wallis testes, Spearman correlation coefficient and ranked logistic regression were used for data analysis. About 5.7% of the students were moderately dependent to the Internet, while 44.1% were at risk for Internet addiction. Significant relationships were observed between the Internet addiction with age (P < 0.001), gender (P < 0.001), marital status (P < 0.001), major (P = 0.016), Grade point average (P = 0.017), semester of studying (P = 0.009) and student residence place (P = 0.014). However, no significant relationship was observed between the internet addiction score and level of discipline, parental job status and education level or the students' accommodation. About half of the participants in this study were at risk of Internet addiction. This finding can be a warning sign for the authorities in universities to pay more attention to this issue. A wide range of education along with empowering programs may be needed to inform the university students about the advantages and disadvantages of internet and the correct manner of using it.

This Too Shall Pass

Considering the paucity of studies dealing with the holistic aspect of the cancer experience, this grounded theory study seeks to conceptualize the process of cancer survivorship among Filipinos. Twenty-seven Filipino cancer survivors were purposively selected, and a two-part instrument, specifically robotfoto and focus group interviews, was used to gather data. The Glaserian method of grounded theory analysis was used, and extended texts were analyzed inductively via a dendrogram. Member checking and correspondence were observed to validate the surfacing stages, leading to the conceptualization of a theoretical model termed as the Ribbon of Cancer Survivorship. The said model describes the trifling (living before), transfusing (accepting the reality), transforming (being strong), and transcending (living beyond) phases of cancer survivorship. Ten interesting substages were also identified, namely: tainting, desolating, disrupting, and embracing for the transfusing phase; tormenting, distressing, awakening, and transfiguring for the transforming phase, and trembling and enlivening for the transcending phase. The resulting theoretical model has clearly and successfully described the entire process of cancer survivorship among Filipinos. It is hoped that the model be used as a reference for future studies about cancer survivorship and as a guide for nurses in providing a more empathetic care among cancer patients.

Reliability and Validity of the McDonald Play Inventory

This study examined the ability of a two-part self-report instrument, the McDonald Play Inventory, to reliably and validly measure the play activities and play styles of 7- to 11-yr-old children and to discriminate between the play of neurotypical children and children with known learning and developmental disabilities. A total of 124 children ages 7-11 recruited from a sample of convenience and a subsample of 17 parents participated in this study. Reliability estimates yielded moderate correlations for internal consistency, total test intercorrelations, and test-retest reliability. Validity estimates were established for content and construct validity. The results suggest that a self-report instrument yields reliable and valid measures of a child's perceived play performance and discriminates between the play of children with and without disabilities.

Information Overload or Information Under Siege: Filipino Faculty Extendees' Concept, Motivation and Expectations

Previous studies have quantified the extent of usage, knowledge, and relationship of people's behavior in regard to food supplements—particularly in developed countries such as the United States. Despite the prevalence of supplements use and the issues surrounding its use, there has been little or no study of supplement use in a developing country like the Philippines. This study aimed to explore, qualitatively, the concept, motivations, and expectations of a select group of Filipino elderly relative to their use of commercialized food supplements (CFS). Five faculty extendees from a private university in the Philippines were selected in this phenomenological study. A two-part research instrument consisting of a robotfoto and a face-to-face interview guide with semistructured questions was used. Extended texts were subjected to phenomenological reduction via repertory grid analysis. Conceptual clusters that emerged were subjected to the member checking procedure for purposes of ensuring data trustworthiness. Through constant comparison of the concepts, expectations, and motivations of the respondents of the study relative to their use of CFSs, a clear-cut taxonomy of users was identified: (a) the idealist-experimentalist and (b) the realist-pragmatist. The emerged typologies in this study create a picture that can help healthcare providers understand the dynamics of patient behavior toward CFS use. Implications of the study to health education are also documented in this paper.

The development of a new cardiac auscultation test: How do screening and diagnostic skills differ?

Background: Newly qualified doctors are expected to be able to conduct a cardiac auscultation unassisted, but studies show conflicting results regarding cardiac auscultation skills.Methods: A two-part test instrument was designed containing innovative recordings of heart sounds from patients with common cardiac murmurs as well as healthy controls. A total number of 109 participants were tested, representing four levels of clinical experience. The content validity of the test instrument was studied by a postal questionnaire to 114 clinical teachers at the University Hospital of Aarhus, Denmark.Results: A significant correlation was found between level of experience and the ability to diagnose the conditions from which the murmurs originated (r = 0.45, P < 0.0001). No correlation was found between level of experience and the ability to identify persons with cardiac murmurs from healthy controls. All groups showed a tendency to interpret healthy heart sounds as cardiac murmurs.Conclusions: Diagnostic ability was found to correlate positively with clinical experience, whereas the ability to distinguish cardiac murmurs from normal heart sounds seems independent of clinical experience.

Sertraline Improves Executive Function in Patients With Vascular Cognitive Impairment

The authors reviewed 35 open-label sertraline trials for executive impairment in ischemic cerebrovascular disease. Outcomes included clock-drawing, the Executive Interview (EXIT25), the Geriatric Depression Scale, and the Mini-Mental State Examination. Clinically "meaningful" improvement was defined as a >3.0 EXIT25 point decline from baseline. "Remission" was defined as the achievement of an EXIT25 score <15/50. Only EXIT25 scores improved significantly. Twenty patients (57.1%) experienced a clinically meaningful improvement in executive control function. Twelve (34.3%) achieved remission. Our findings suggest that sertraline may have both statistical and clinically meaningful effects on executive control function in ischemic cerebrovascular disease. The authors discuss the implications for future clinical trials.

The Success and Struggles of Filipino Geriatric Nurses in Nursing Homes

Geriatric nursing is a physically and emotionally demanding job in healthcare. It is a neglected field despite the growing population of the elderly, and the experiences of geriatric nurses are one of the unrecognized aspects of this field. This qualitative study purports to explore the successes and struggles of the lived experiences of a select group of Filipino geriatric nurses working in nursing homes. A total of five registered nurses selected from Philippine geriatric homes were the subjects of this qualitative study. Data were gathered from a two-part instrument: namely, a researcher-made robotfoto and a semistructured interview. Through the use of a repertory grid involving both cool and warm analyses, field texts were phenomenologically reduced in order to establish distinct conceptual clusters. Summarily, two roles were found to be the defining elements of Filipino geriatric care nurses' sense of success and fulfillment. These include the instrumental and developmental, which describe the nurses' appreciation of their unique place in the lives of their elderly patients and, at the same time, their experiences of personal and professional growth and expansion as nurses. In regard to their struggles, the contextual conditions in the workplace typify the roadblocks of their efficient and effective delivery of quality healthcare services.

How Many Sides Does a Coin Have? A Phenomenology of Filipino Nurses' Motivation and Attitudes Toward Geriatric Care

Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the “lebenswelt” that describe the motivation and attitudes of a selected group of Filipino nurses toward geriatric care. A total of six registered nurses who had experienced taking care of elderly patients voluntarily participated as respondents of this study. A two-part instrument developed by the researchers was made to elicit necessary data and information. The first part comprised of the robotfoto intended to establish the baseline characteristics of nurses under study. The second part consisted of a semistructured individual in-depth interview using “aide memoire” to probe into the motivation and attitudes of the nurse respondents. Field texts were phenomenologically reduced via repertory grid. Two distinct and interesting themes, namely Geriatric Service Motivation Typology and the Yin-Yang of Geriatric Attitudes emerged. The first theme includes the Single Loop and Double Loop type of motivation The former involves a transactional and unidirectional process, while the latter constitutes a two-way relational and transformational process. The second theme consists of a harmonious combination of the two sides of the nurses' attitudes toward geriatric care. Through this study, the human side of nursing is seen and captured, thus increasing the awareness and knowledge of nurses, improving provision of optimum geriatric care, and inspiring nurses to pursue geriatric nursing with a yearning to serve the elderly with and from the heart.

Conflitos éticos na revelação de informações - parte II

This a qualitative study, developed with the objective of describing and analyzing nurses moral judgments in a situation involving ethical conflicts regarding the omission of information, by identifying the argumentative foundations in their way of reflecting and formulating such judgments. The study was undertaken in the city of Maringá, Paraná State, Brazil, with 28 nurses working as faculty, as well as in hospital and ambulatory assistance. Data was collected between October 1998 and February 1999 through focused open interviews, making use of a two-part instrument: the characterization of subjects, and the presentation of a case describing a situation of ethical dilemmas regarding the practice of nursing assistance as for the patient’s right to information. The case was accompanied by questions that approached the theme to be judged, as well as by requests for support to the given answers. In order to interpret the results, thematic analysis was employed, which originated three categories: the process of free and knowledgeable consent, the professional’s attitude in face of the information, and the team’s responsibility to free and knowledgeable consent. It was concluded that nurses base their justifications more on normative and deontological ethics.

279: Quality of life surveys: Are responders different from non-responders?

Purpose: The purpose of this study was to describe male and female LT patients’ symptoms before and up to 6 months after LT. Methods and Materials: Subjects completed self-administered instruments before and at 1, 3, and 6 months after transplant. The Transplant Symptom Inventory, a 67-item, two-part instrument, measures symptom frequency and symptom distress on a 5-point likert scale. Rank order and change over time were analyzed with RIDIT analysis and Mantell-Hanzel chi-square. Significance was set at p 0.05). Results: The sample consisted of 163 LT patients, the majority were white (96 females and 67 males. Before LT, both genders ranked shortness of breath (SOB) with activity as the most distressing and most frequently occurring symptom Six months after LT, both genders reported a significant decrease in the frequency of SOB with activity, the frequency and distress for SOB at rest, and a significant decrease in frequency of fatigue, chest tightness, and feelings of lack of control. Females also reported a significant decrease in the frequency of heart palpitations, tiring easily and feelings of helplessness. In contrast, male LT recipients reported a significant decrease in the distress associated with SOB with activity, tiring easily, feeling afraid and feeling sad. Males also reported significant decreases in the frequency of sleepiness, fever, and feeling depressed, helpless and irritable. Negative symptoms reported by females included a significant increase in the frequency of tremors. Negative symptoms reported by males included a significant increase in distress due to the frequent occurrence of tremors, nausea, vomiting, and stomach pain. Conclusions: At six months post LT, both genders reported significantly less SOB and fatigue and a significant decrease in the occurrence of feeling helpless. Male recipients reported more positive improvements as well as more negative symptoms than females. These findings underscore the importance of assessing changes in symptoms over time and to realize that gender differences exist.

Do EMS Personnel Identify, Report, andDisclose Medical Errors?

Objective. To evaluate self-reports of prehospital providers' error frequency, disclosure, andreporting in their actual practice andin hypothetical scenarios. Methods. The authors surveyed a convenience sample of prehospital providers attending a statewide emergency medical services conference using a two-part instrument. Part 1 evaluated respondent demographics andactual practice patterns. Part 2 used hypothetic scenarios to assess error identification, disclosure, andreporting patterns. Descriptive statistics andFisher's exact tests were used to characterize demographics andpractice patterns. For hypothetical scenarios, the authors calculated mean responses with 95% confidence intervals (CIs) to assess error identification, anticipated disclosure, andreporting patterns. Results. The response rate was 88% (372/425). Analysis was limited to 283 (75% of 372) respondents who were emergency medical technicians andhad complete data. In the previous year, 157 (55%) providers identified no errors in practice, 100 (35%) reported one or two errors, and26 (9%) identified more than two errors. In approximately half of cases, identified errors were reported to the receiving provider, or supervisor. In hypothetical cases, severe errors were identified 93% (95% CI 92–94) of the time, but the ability of providers to identify mild errors significantly varied. In all scenarios, respondents were much more likely to report errors to the receiving hospital, their supervisor, andtheir medical director than to patients. Conclusions. Prehospital providers demonstrate the capacity to identify, report, and, to a lesser extent, disclose errors in hypothetical scenarios but may not apply these skills uniformly in their own practices. Enhancing error management skills in prehospital clinical practice will require focused education andtraining.