Nurses' practice environments, error interception practices, and inpatient medication errors.

PURPOSE: Medication errors remain a threat to patient safety. Therefore, the purpose of this study was to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses' error interception practices, and rates of nonintercepted medication errors in acute care hospitals. DESIGN: This study, using a nonexperimental design, was conducted in a sample of 82 medical-surgical units recruited from 14 U.S. acute care hospitals. Registered nurses (RNs) on the 82 units were surveyed, producing a sample of 686 staff nurses. METHODS: Data collected for the 8-month study period included the number of medication errors per 1,000 patient days and the number of RN hours per patient day. Nurse survey data included the Practice Environment Scale of the Nursing Work Index as a measure of environmental characteristics; a metric of nurses' interception practices was developed for the study. All survey measures were aggregated to the unit level prior to analysis with hierarchical linear modeling. FINDINGS: A supportive practice environment was positively associated with error interception practices among nurses in the sample of medical-surgical units. Importantly, nurses' interception practices were inversely associated with medication error rates. CONCLUSIONS: A supportive practice environment enhances nurses' error interception practices. These interception practices play a role in reducing medication errors. CLINICAL RELEVANCE: When supported by their practice environments, nurses employ practices that can assist in interrupting medication errors before they reach the patients.

Nurses' clinical reasoning: processes and practices of medication safety.

In this article, we describe the depth of knowledge and skill nurses used in making decisions regarding the safe processes and practices of medication administration. Using grounded theory, we identified the essence of medication safety by nurses as the theme of clinical reasoning. Nurses used two medication safety processes within the clinical reasoning theme-maintaining medication safety and managing the environment-together with six categories of patient-focused medication safety practices in the first process and four categories of environmental-focused safety practices within the second process. These processes and practices present an emerging model of safe medication administration developed from the narratives of 50 medical-surgical nurses. This model provides researchers with the basis for the development of systemic policies for safer medication administration for patients. Health care professional educators might also find the results useful in developing curricula focused on patient safety as the foundation of quality care.

Effects of nursing practice environments on quality outcomes in nursing homes.

The objective of this study was to determine whether nurse staffing levels and modifiable characteristics of the nursing practice environment are associated with important quality indicators represented by the percentage of residents with pressure ulcers and numbers of deficiency citations in nursing homes. A cross-sectional design linked nurse survey data, aggregated to the facility level, with Nursing Home Compare, a publicly available federal database containing nursing home-level measures of quality. The facility sample consisted of 63 Medicare- and Medicaid-certified nursing homes in New Jersey, and the nurse survey sample comprised 340 registered nurses providing direct resident care. Characteristics of the practice environment were measured using the Practice Environment Scale of the Nursing Work Index, included in the nurse survey. The total number of deficiency citations, the percentage of residents with pressure ulcers, nurse staffing levels, and facility characteristics were extracted from the Nursing Home Compare database. Results indicated that a supportive practice environment was inversely associated with the percentage of residents with pressure ulcers and fully mediated the effect of profit status on this important outcome. The nursing practice environment and facility size explained 25% of the variance in quality deficiencies. There were no associations between staffing levels and quality indicators. Findings indicate that administrative initiatives to create environments that support nursing practice may hold promise for improving quality indicators in nursing homes.

Strategic state-level nursing workforce initiatives: taking the long view.

This article reviews long-range, strategic nursing workforce initiatives developing in 5 states. It also summarizes progress in establishing a national network of state nursing centers for sharing workforce data, and new education, workplace, and policy initiatives being undertaken by and on behalf of the nursing profession.

Reconstructing a meaning of pain: older Korean American women's experiences with the pain of osteoarthritis.

The purpose of this grounded theory study was to gain a deeper understanding of older Korean American women's experiences of chronic osteoarthritic pain. The data included a set of 3 interviews with 7 women over age 60, field notes, observations, memos, and the literature about the chronic pain of osteoarthritis. Through constant comparative analysis and coding typical of grounded theory, a five-stage process emerged inductively from the data. The core variable, Reconstructing a Meaning of Pain, included the concepts of the process in the grounded theory through which the women learned to manage and tolerate the pain. During this process, the women came to perceive their pain as a component of aging rather than as a symptom of disease.