A balance of unsafe care incidents and interactive cooperative care: A constructivist grounded theory study of safe care ecosystem for older inpatients.

AIMS: To explore older inpatients and their caregivers' care experience and how this relates to the gerontology care practice. BACKGROUND: Research interest in the conceptualization of safe care for older inpatients was growing, and these studies were predominantly reported from a single or healthcare perspective. There is a shortage of literature on how patients and their caregivers conceptualise safe care. DESIGN: Constructivist grounded theory. METHODS: Stage 1 included semi-structured interviews with inpatients. Stage 2 included semi-structured interviews with caregivers and six field notes. Purposive and theoretical sampling were used to recruit 61 participants across six healthcare institutions. Data analysis included initial coding, focused coding, and theoretical coding using constant comparative, field notes and memo writing. RESULTS: The substantive theory to emerge from the data was A balance of unsafe care incidents and interactive cooperative care. This core concept was informed by four categories: unsafe care incidents, interactive cooperative care, person-centred care, contextual conditions, and one care outcome. The relationships between these categories constituted a balance in which patient-centred care was the core, unsafe care incidents were the barriers, interactive cooperative care was the facilitator, and the result of the balance was the care outcome. The balance constituted a safe care ecosystem under the interaction of contextual conditions. CONCLUSIONS: Interactive cooperative care is vital in enabling care stakeholders to reduce unsafe care incidents, which facilitates them in achieving safe care and further constructing a healthy care ecosystem. RELEVANCE TO CLINICAL PRACTICE: This theory identifies barriers and facilitators encountered by care stakeholders to cope with everyday problems and guides them in developing personalised care plans to ensure patient safety.

Barriers and facilitators to feeling safe for inpatients: a model based on a qualitative meta-synthesis.

Objectives: To review and synthesize qualitative research exploring patients' safe experience and construct a model to present barriers and facilitators to feeling safe for inpatients. Design: A qualitative met-synthesis. Methods: We conducted a systematic electronic search of articles published in English with no date limitation across five databases (Ovid MEDLINE, EMBASE, Web of Science, CINAIL via EBSCO, and PsyINFO) in May 2023. Qualitative research focused on the safe experiences of inpatients was considered. Systematic searches yielded 8,132 studies, of which 16 articles were included. Two reviewers independently extracted and analyzed data. Qualitative meta-synthesis was performed through line-by-line coding of original texts, organizing codes into descriptive themes, and generating analytical themes. Results: We identified four themes and 11 sub-themes. Across the four themes, control included a barrier (Uncertainty) and two facilitators (Patient participation and safe care); responsible included three facilitators (Confidence in the profession, care for, and responsive); dignity included two barriers (Privacy and Neglect); stability included a barrier (Potential risk), and two facilitators (Harmonious and safe culture). We constructed a model to present the logical connection between these themes and related barriers and facilitators. Conclusion: Feeling safe for inpatients is a complex perception, including four themes: control, responsible, dignity, and stability. Surrounding four themes and related barriers and facilitators, we outline principles for creating a safe environment and present strategies for improving patients' hospitalization experience and ensuring patient safety. Clinical relevance: This review provides valuable insight into the clinical practice and health policy and helps medical staff to identify and overcome the potential barriers to implementing interventions in safe care. In addition, the model comprehensively describes the nature and dimensions of feeling safe, informing high-quality care service and related research. Systematic review registration: Identifier, CRD42023435489.

Construction and validation of safe care theory for older inpatients from the perspective of socio-ecological model: a study protocol.

INTRODUCTION: In an ageing society, older adults are the main users of healthcare services, and Chinese healthcare systems have been struggling to meet the care demand of older adults. Due to the illness, many older inpatients cannot finish daily activities independently and require healthcare from caregivers. Evaluating the care needs of older adults and exploring the factors affecting safe care at multiple levels are conducive to providing systematic care services for older inpatients. This study aims to examine which and how factors impact safe care for older inpatients and propose a safe care theory to provide directions on improving the safe care system in the hospital. METHODS AND ANALYSIS: A mixed-methods study with three interrelated research streams will be designed. (1) A safe care concept model: we will conduct a scoping review to extract the facilitators and barriers influencing the safe care of older inpatients and construct a concept model based on the socio-ecological model and the Yorkshire Contributory Factors Framework. (2) A safe care theory model: we will conduct a qualitative study with thematic analysis (aimed at older inpatients, caregivers and nurses) to define the concept connotations and propose a theory model. (3) A safe care theory: we will use the scales related to the theory model to test the concepts and statements. We will revise the theory model and derive a safe care theory based on the mixed-methods study results. This study will start in October 2023 and end in October 2025. ETHICS AND DISSEMINATION: This study was approved by the ethics committee (No. 20221598). All participants will be provided with consent forms prior to data collection. The study will be disseminated via peer-reviewed manuscripts and conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300067421.

A Nomogram for Predicting Unplanned Intraoperative Hypothermia in Patients With Colorectal Cancer Undergoing Laparoscopic Colorectal Procedures.

Unplanned intraoperative hypothermia is a complication that can lead to a variety of negative outcomes, such as cardiovascular events. We aimed to develop and validate an intraoperative hypothermia risk prediction nomogram for patients with colorectal cancer undergoing laparoscopic colorectal procedures. We conducted a prospective cohort study with 1,091 patients (ie, 765 in the training cohort, 326 in the validation cohort) from October 2020 to November 2021. We included six predictors in the nomogram model: body mass index, diabetes diagnosis, ambient temperature, ambient humidity, duration of surgery, and use of a forced-air warmer. The model performed well, and the area under the curve was 0.855. These results, together with an external validation value, mean that health care professionals can use the nomogram to calculate the intraoperative hypothermia risk for patients undergoing laparoscopic colorectal procedures and make clinical decisions based on the results.

Perceived stress and its impact on the health behavior of Chinese residents during the COVID-19 epidemic: An Internet-based cross-sectional survey.

Background and Aims: The novel coronavirus disease 2019 (COVID-19) causes severe respiratory illnesses, following exposure to air-borne droplets or direct contact, posing a great threat to human life. This study aimed to investigate perceived stress and its correlation with the health behaviors of Chinese residents during the COVID-19 epidemic. Methods: An Internet survey was conducted among 2449 residents in 20 provinces of China on residents' perceived stress, perception of COVID-19, and health behaviors. SAS 9.4 was used to analyze the relationship between health behaviors and perceived stress, and logistic regression was used to explore the factors influencing health risk stress. Results: The participants' perceived stress score was 22.25 ± 7.2 (total 56), and the incidence of health risk stress was 39.89% (977/2449). Females, students, and medical staff were at high risk. Health risk stress refers to a level of stress that is hazardous to health (score over 25). Perceived stress increased, while the frequency of health behaviors decreased. Age, perception of susceptibility to COVID-19, life-threatening level of COVID-19, perception of the importance of home isolation, and perception of the difference between a common cold and COVID-19 were positively related to the occurrence of health risk stress. Conclusions: A negative correlation was found between health behaviors and perceived stress. Therefore, it is of great significance to provide psychological interventions for those who are experiencing health risk stress and to promote their health behaviors.

Experience and support of Chinese healthcare professionals as second victims of patient safety incidents: A cross-sectional study.

PURPOSE: To describe the experience and support of Chinese healthcare professionals as second victims of PSIs. DESIGN AND METHODS: A cross-sectional study with anonymous online self-report questionnaires was adopted. A total of 1357 Chinese healthcare professionals participated in this study. The Chinese version of the Second Victim Experience and Support Tool (C-SVEST) was used to evaluate the experience of second victims and the quality of support resources. Descriptive and inferential statistics were employed to analyze the data. FINDINGS: This study showed that 350 participants (25.8%) had been involved in PSIs during their careers. The majority of respondents who had experienced PSIs agreed they suffered more from psychological distress, followed by professional self-efficacy distress, and physical distress. Besides, they regarded colleague support and management support as the most desirable support. Statistically significant differences were reported in some items. First, compared with medical staff without professional titles, staff with professional titles suffered more from psychological distress but gained more support from colleagues. PRACTICE IMPLICATIONS: The second victim phenomenon deserves further attention. The programs focusing on training qualified colleagues to provide emotional support should be developed, implemented, and evaluated. Moreover, it is necessary to build a better patient safety culture with nonpunitive responses and encourage the disclosure and reporting of PSIs.

Risk Prediction Models for Inadvertent Intraoperative Hypothermia: A Systematic Review.

PURPOSES: Inadvertent intraoperative hypothermia (core temperature <36°C) is a common surgical complication with several adverse events. Hypothermia prediction models can be a tool for providing the healthcare staff with information on the risk of inadvertent hypothermia. Our systematic review aimed to identify, demonstrate, and evaluate the available intraoperative hypothermia risk prediction models in surgical populations. DESIGN: This study is a systematic review of literature. METHODS: We systematically searched multiple databases (Ovid MEDLINE, Web of Science, Embase, and Cochrane Center Register of Controlled Trials). Two reviewers independently examined abstracts and the full text for eligibility. Data collection was guided by the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS checklist), and methodological quality and applicability were assessed by the Prediction model Risk Of Bias ASsessment Tool (PROBAST). FINDINGS: A total of 3,672 references were screened, of which eight articles were included in this study. All the models had a high risk of bias since most of them lacked model validation. Also, they failed to report the model performance and final model presentations, which restricted their clinical application. CONCLUSIONS: The researchers should present models in a more standard way and improve the existing models to increase their predictive values for clinical application.

Research on the factors that influence patients with colorectal cancer participating in the prevention and control of surgical site infection: Based on the extended theory of planned behaviour.

BACKGROUND: The most common and severe type of nosocomial infection in patients with colorectal cancer is surgical site infection (SSI). Patient-related factors are an important components of SSI. So it is necessary to participate in SSI prevention and control. It is important to identify the factors that influence patients' participation behaviour and to explore the mechanism of these effects. METHODS: A total of 580 patients with colorectal cancer completed relevant measures. Based on the extended theory of planned behaviour, a structural equation model was used to analyse the relationship among the influencing factors. RESULTS: The factors influencing participation of patients with colorectal cancer in SSI prevention and control were participation intention, participation ability, self-efficacy, participation attitude, perceived medical staff support, trust in physicians and social support. The direct effect coefficients of participation intention, participation ability and physician trust on SSI prevention and control behaviour were 0.67, 0.21 and 0.11, respectively. Self-efficacy, participation attitude, perceived medical staff support and social support indirectly affect participation behaviour through participation intention, and their effect values are 0.21, 0.11, 0.11 and 0.08, respectively. CONCLUSIONS: Based on the structural equation model developed in this study, targeted intervention measures should be implemented to mobilize the intention and enthusiasm of patients with colorectal cancer to participate in the prevention and control of SSI. PATIENT OR PUBLIC CONTRIBUTION: Patients or public contribute to spreading research findings, and promote broad participation in the implementation of policies or strategies.

Assessment and analysis of patient safety competency of Chinese nurses with associate degrees: A cross-sectional study.

Aim: To analyse the patient safety competency (PSC) of Chinese nurses with associate degrees (ADNs) and explore factors. Design: A cross-sectional study. Methods: A convenience sample of 451 ADNs working in 18 hospitals located in Chongqing city of China was investigated using the Patient Safety Competency Nurse Evaluation Scale (PSCNES). Descriptive and inferential statistics were used to analyse the data. Results: ADNs had a moderate level of PSC. In terms of the six dimensions of PSC, ADNs performed well in clinical practice and safety risk management, while they performed poorly in patient-centred care and patient safety culture. Statistically significant differences were reported in two items. Firstly, ADNs who have participated in patient safety training had a higher level in all dimensions of PSC than those who have not participated in related training. Secondly, ADNs without professional titles had a higher level of patient safety culture than those with professional titles.