Defining attributes of patient safety through a concept analysis.

AIM: The aim of this study was to report an analysis of the concept of patient safety. BACKGROUND: Despite recent increase in the number of work being done to clarify the concept and standardize measurement of patient safety, there are still huge variations in how the term is conceptualized and how to measure patient safety data across various healthcare settings and in research. DESIGN: Concept analysis. DATA SOURCES: A literature search was conducted through PubMed and Cumulative Index to Nursing and Allied Health Literature, Plus using the terms 'patient safety' in the title and 'concept analysis,' 'attributes' or 'definition' in the title and or abstract. All English language literature published between 2002-2014 were considered for the review. METHODS: Walker and Avant's method guided this analysis. RESULTS: The defining attributes of patient safety include prevention of medical errors and avoidable adverse events, protection of patients from harm or injury and collaborative efforts by individual healthcare providers and a strong, well-integrated healthcare system. The application of Collaborative Alliance of Nursing Outcomes indicators as empirical referents would facilitate the measurement of patient safety. CONCLUSION: With the knowledge gained from this analysis, nurses may improve patient surveillance efforts that identify potential hazards before they become adverse events and have a stronger voice in health policy decision-making that influence implementation efforts aimed at promoting patient safety, worldwide. Further studies are needed on development of a conceptual model and framework that can aid with collection and measurement of standardized patient safety data.

Assessing the professional development needs of experienced nurse executive leaders.

OBJECTIVE: The objective of this study was to identify the professional development topics that senior nurse leaders believe are important to their advancement and success. BACKGROUND: Senior/experienced nurse leaders at the executive level are able to influence the work environment of nurses and institutional and health policy. Their development needs are likely to reflect this and other contemporary healthcare issues and may be different from middle and frontline managers. A systematic way of assessing professional development needs for these nurse leaders is needed. METHODS: A descriptive study using an online survey was distributed to a convenience sample of nurse leaders who were members of the Association of California Nurse Leaders (ACNL) or have participated in an ACNL program. RESULTS: Visionary leadership, leading complexity, and effective teams were the highest ranked leadership topics. Leading change, advancing health: The future of nursing, healthy work environments, and healthcare reform were also highly ranked topics. CONCLUSIONS: Executive-level nurse leaders are important to nurse retention, effective work environments, and leading change. Regular assessment and attention to the distinct professional development needs of executive-level nurse leaders are a valuable human capital investment.

Healthy work environments and staff nurse retention: the relationship between communication, collaboration, and leadership in the pediatric intensive care unit.

BACKGROUND: A healthy work environment can improve patient outcomes and registered nurse (RN) turnover. Creating cultures of retention and fostering healthy work environments are 2 major challenges facing nurse leaders today. SPECIFIC AIMS: Examine the effects of the healthy work environment (communication, collaboration, and leadership) on RN turnover from data collected from a research study. METHODS: Descriptive, cross-sectional, correlational design. Pediatric critical care RNs from 10 pediatric intensive care units (PICU) completed the Practice Environment Scale of the Nursing Work Index Revised and a subscale of the Intensive Care Unit Nurse-Physician Communication Questionnaire. These staff nurses were asked whether they intend to leave their current job in the next 6 months. Statistical analysis included correlations, multiple linear regression, t tests (2-tailed), and 1-way analysis of variance. RESULTS: A total of 415 RNs completed the survey. There was a statistically significant relationship between leadership and the intent to leave (P < .05). There was also an inverse relationship between years of experience and intent to leave. None of the communication variables between RNs and among RNs and MDs or collaboration were significantly associated with PICU nurses' intention to leave. CONCLUSION: Effective leadership in the PICU is important to PICU RNs and significantly influences their decisions about staying in their current job.

Rapid response teams: qualitative analysis of their effectiveness.

BACKGROUND: Multidisciplinary rapid response teams focus on patients' emergent needs and manage critical situations to prevent avoidable deaths. Although research has focused primarily on outcomes, studies of the actual team effectiveness within the teams from multiple perspectives have been limited. OBJECTIVE: To describe effectiveness of rapid response teams in a large teaching hospital in California that had been using such teams for 5 years. METHODS: The grounded-theory method was used to discover if substantive theory might emerge from interview and/or observational data. Purposeful sampling was used to conduct in-person semistructured interviews with 17 key informants. Convenience sampling was used for the 9 observed events that involved a rapid response team. Analysis involved use of a concept or indicator model to generate empirical results from the data. Data were coded, compared, and contrasted, and, when appropriate, relationships between concepts were formed. Results Dimensions of effective team performance included the concepts of organizational culture, team structure, expertise, communication, and teamwork. CONCLUSIONS: Professionals involved reported that rapid response teams functioned well in managing patients at risk or in crisis; however, unique challenges were identified. Teams were loosely coupled because of the inconsistency of team members from day to day. Team members had little opportunity to develop relationships or team skills. The need for team training may be greater than that among teams that work together regularly under less time pressure to perform. Communication between team members and managing a crisis were critical aspects of an effective response team.

Development of a tool to assess risk for falls in women in hospital obstetric units.

Because women hospitalized in obstetric units are typically young and healthy, they might be overlooked when health care providers assess for risk for falls. Recent literature has identified pregnant and postpartum women as being prone to falls, with hospitalization compounding their risk. A review of current practices among perinatal units for assessing risk for falls revealed that existing fall risk tools, which were created for geriatric and/or medical surgical patients, are used. Without any focused prevention efforts, hospitalized obstetric patients are vulnerable to a preventable event. The Obstetric Fall Risk Assessment System™ is intended to improve safety among hospitalized women on obstetric units, using an assessment tool and scoring system to determine fall risk.

Nurse-physician teamwork in the emergency department: impact on perceptions of job environment, autonomy, and control over practice.

BACKGROUND: Teamwork is essential to safety. Few studies focus on teamwork between nurses and physicians in emergency departments (EDs). OBJECTIVE: The aim of this study was to examine differences between staff in the interventional group EDs (IGEDs) and control group EDs (CGEDs) on perception of job environment, autonomy, and control over practice. METHODOLOGY: This was a comparative cross-sectional study of the impact of teamwork on perceptions of job environment, autonomy, and control over practice by registered nurses and physicians (MDs) in EDs. RESULTS: Staff in the IGEDs showed significant differences compared with staff who worked in the CGEDs on staff perception of job environment, autonomy, and control over practice. CONCLUSION: Active teamwork practice was associated with increased perceptions of a positive job environment, autonomy, and control over practice of both nurses and physicians.

An educational intervention to increase "speaking-up" behaviors in nurses and improve patient safety.

"Speaking up" is a critical component in improving patient safety. Studies indicate, though, that most registered nurses prefer using behaviors of avoidance or accommodation in conflict situations. The purpose of this quasi-experimental study was to determine whether an educational intervention using scenarios, personal reflection, and peer support in small groups could improve speaking-up behaviors in registered nurses. Results showed a significant difference in speaking-up behaviors and scores in the intervention group (P < .001).

Improving patient safety to reduce preventable deaths: the case of a California safety net hospital.

Preventable deaths occur when signs and symptoms of risk and decline are not detected yet are present many hours prior to a deteriorating course. Rapid responses teams (RRTs), also referred to as medical emergency teams (METs) were introduced to improve patient safety by preventing code arrests and death. This research using a case study methodology describes a nurse-led RRT, developed at a large, safety net, teaching hospital in California. Safety-net hospitals are challenged to deliver care and meet the complex needs of vulnerable patient populations. This hospital is a mission driven organization that is focused on the patient and the needs of underserved populations. To respond to the call for reform for patient safety and reduce adverse events, the organization adopted RRTs, early recognition rounds by RRT registered nurses (RNs) and the use of trigger alerts by nursing assistants (NAs) to expand the surveillance and identification of patients most at risk of clinical deterioration. Collaboration with interns and residents (house staff) facilitated their involvement and response to RRT calls. Using quality data from 2005 to 2010, findings from this patient safety innovation address RRT utilization, frequency of non-ICU code arrests, hospital mortality, and post-arrest survival outcomes.

Surgical teams: role perspectives and role dynamics in the operating room.

Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal relations and begins to be established when the room is being set up for the surgical case, and evolves as the surgical procedure progresses. The leadership and supervisory competencies of the circulating RNs establish the initial work environment. Both influenced the degree of cooperation and support that was observed, which had an effect on the interactions and relationships between other members of the surgical team. As the surgery unfolds, the surgeon's behaviours and interpersonal relations modify this environment and ultimately influence the degree of team work, team satisfaction and team performance.

How RNs rescue patients: a qualitative study of RNs' perceived involvement in rapid response teams.

BACKGROUND: Patients are admitted to hospitals everyday with clinical conditions that can change dynamically resulting in adverse outcomes. The rapid response team (RRT) intervention is a formalised resource to respond to the nurse's concerns about such patients before code arrest occurs. Registered nurses (RNs) are in a position to recognise critical changes and to rescue patients at the most opportune moments, but little is known about how RNs rescue patients using these increasingly popular teams. Our aims were to investigate how RNs rescue patients in hospitals where RRTs are in place. METHODS: Fifty participants involved with RRTs participated in semistructured individual interviews in six California hospitals. Data were analysed using coding and constant comparison methods. RESULTS: Overall, RNs view RRTs as a helpful and effective safety intervention. RRT RNs and bedside RNs support one another in a synergistic way to prevent adverse patient events during the rescuing process. However, traditional hierarchies and relationships with physicians and supervisors impede some components of RN decision-making during rescuing. CONCLUSIONS: RNs find the RRT supportive when their patient is at risk or care needs are changing. They benefit from a formalised mechanism that enables immediate access to resources. RRT RNs in this study applied their expertise with critically ill patients to rescue medical and surgical patients. The RRT RN and bedside RNs' interaction influenced the rescuing process. Their role synergy was a value-added contribution to preventing adverse events and to improving patient safety by RNs.

Assessing the performance of surgical teams.

BACKGROUND: High-performing and high-reliability teams are an important component of service delivery. With a focused emphasis on safety in acute care hospitals, understanding the nature of surgical teams and team performance is an essential component to achieving high-quality surgical care. More information is needed about the challenges to effective team functioning in the operating room, the influence of working conditions, and the environmental context on surgical team performance. PURPOSE: The purpose of this study is to describe the nature of surgical teams and how they perform in the operating room to contribute to a broader knowledge about high-performing and high-reliability teams in health care settings. METHODOLOGY/APPROACH: We conducted a qualitative study involving direct observation and semistructured interviews. Field observations of 10 high-complexity surgeries and face-to-face interviews with 26 members of surgical teams were completed at one university medical center. A conceptual framework derived from the literature was developed to guide the selection of surgeries and surgical teams to be observed. Data were transcribed and analyzed to identify the factors and different conditions that influence the performance of these surgical teams. FINDINGS: The type of coordination and the degree of independent and interdependent coordination vary among the seven observed stages of the surgical process. Most of the surgical teams were ad hoc teams and as such, further challenged by consistently frequent "hand-offs" for break relief. Additional role demands influence the situational dynamics which can alter the adaptive capacity of the team. PRACTICE IMPLICATIONS: The surgical event evokes a changing degree of coordination and adaptation to complexity and uncertainty. In such environments, relational coordination through leadership can contribute to a successful surgical result, improvement of the overall process, including error reduction, and enhanced knowledge creation and dissemination, particularly germane in research university teaching hospitals.

Nurse executive transformational leadership and organizational commitment.

OBJECTIVE: To investigate the relationship between nurse executive leadership and organizational commitment among nurses in acute care hospitals. BACKGROUND: A key challenge for organizations is to maximize the contributions of all workers by cultivating their commitment. Nurse leaders are in a position to influence organizational commitment among nurses. METHODS: The theoretical constructs underlying this study are the transformational leadership theory and the Etzioni's organizational theory. A cross-sectional, field survey of nurse executives, nurse managers, and staff nurses was conducted to assess nurse executive transformational and transactional leadership and their relationship to organizational commitment. Hypotheses were tested using correlational analysis, and univariate statistics were used to describe the sample. RESULTS: An inverse relationship between nurse executive transformational and transactional leadership and alienative (highly negative) organizational commitment was statistically significant. A positive association was demonstrated between nurse executive leadership and nurse manager leadership. CONCLUSIONS: This study supports the effect of nurse executive leadership on nurse manager leadership and on organizational commitment among nurses despite role distance. To the extent that transformational leadership is present, alienative organizational commitment is reduced. This relationship shows the importance of nurse executive leadership in organizational involvement among nurses in the dynamic context of contemporary hospital settings.