A Communication Training Program to Encourage Speaking-Up Behavior in Surgical Oncology.

Patient safety in the OR depends on effective communication. We developed and tested a communication training program for surgical oncology staff members to increase communication about patient safety concerns. In phase one, 34 staff members participated in focus groups to identify and rank factors that affect speaking-up behavior. We compiled ranked items into thematic categories that included role relations and hierarchy, staff rapport, perceived competence, perceived efficacy of speaking up, staff personality, fear of retaliation, institutional regulations, and time pressure. We then developed a communication training program that 42 participants completed during phase two. Participants offered favorable ratings of the usefulness and perceived effect of the training. Participants reported significant improvement in communicating patient safety concerns (t40 = -2.76, P = .009, d = 0.48). Findings offer insight into communication challenges experienced by surgical oncology staff members and suggest that our training demonstrates the potential to improve team communication.

Analysis and prioritization of near-miss adverse events in a radiology department.

OBJECTIVE: The purpose of this study is to describe a method for the evaluation and prioritization of near-miss events in a radiology department. MATERIALS AND METHODS: Sixty-two consecutive near-miss events occurring between 2007 and 2009 were retrospectively evaluated, classified by error type, and scored for five elements associated with risk. The worst outcome potentially associated with each event was predicted by consensus and scored on a standardized 5-point complications grading scale. Scores were then assigned for event frequency, method of detection, barrier number, and quality. The product of individual scores, ranging from 1 to 180, was termed the hazard score. Events were analyzed by error type, element scores, and hazard score. RESULTS: Electronic order entry errors were the most common error type, and 90% of these errors originated outside the radiology department. More than half (65%) of the events were assigned maximal severity scores, and 68% of the errors had been encountered three or more times previously. Twenty-five events (40%) were detected by good fortune rather than by plan. No barrier to the projected worst outcome was identified in nearly half (47%) of cases. In most instances (73%), strong barriers were absent. Nine events (15%) had maximal hazard scores of 180, whereas 21 events (34%) had hazard scores of 30 or less. CONCLUSION: This method was constructed from standardized definitions of outcome severity, the ability of current systems to detect or mitigate an adverse event or outcome, and event frequency and offers a tool for systematic evaluation and stratification of near-miss adverse events.

The perceived value of certification by certified perioperative nurses.

We conducted this study to determine the perceived value of certification in perioperative nursing. Following development and pilot-testing, we mailed the 18-item Likert-type instrument, the Perceived Value of Certification Tool (PVCT), to a sample of 2750 perioperative nurses who had earned the CNOR or CRNFA credential or both. A total of 1398 surveys were returned (50.8% response rate). Factor analysis extracted three factors, accounting for 61% of the variance: personal value, recognition by others, and professional practice. Internal consistency reliability testing (Cronbach's alpha) identified a standardized alpha of.924. Over 90% of respondents agreed or strongly agreed with statements about the value of certification related to feelings of personal accomplishment and satisfaction, validating specialized knowledge, indicating professional growth, attainment of a practice standard, personal challenge, and professional commitment, challenge, and credibility. These results are consistent with previously published literature on specialty certification in nursing.

Stories from the operating room: moral dilemmas for nurses.

This article explores stories related by perioperative nurses when asked to describe ethical judgements and subsequent actions that affected patient outcomes. A total of 214 patient care situations were analysed for moral actions taken and moral outcomes achieved in the perioperative arena. Content analysis of the patient care situations revealed a wide variety of ethical issues. Concerns about informed consent and quality of care were the most frequently identified issues. Respondents reported that 7% of patients underwent unwanted procedures and that positive moral outcomes were achieved in 65% of situations. It is of concern that, despite the fact that more than two-thirds (69%) of the respondents reported undergoing ethics education, only 27% could relate a story of an ethical situation.

Morality in perioperative nurses.

This study examined nurses' moral motivation, character, and action using a Model of Morality for Perioperative Nurses. Influences on moral actions and selected outcomes for surgical patients and perioperative nurses were examined. Results indicate that motivation and character are related directly to the moral actions of perioperative nurses (R = .13 to .31, P < .001). Fourteen percent of the variance in action was explained by motivation, character, self-perceived level of practice, and ethics education. Results suggest that current models do not describe the moral behavior of perioperative nurses adequately. Future research should examine constructs that explain the moral actions of nurses in the perioperative setting.