A safety culture assessment by mixed methods at a public maternity and infant hospital in China.

OBJECTIVE: To assess safety culture at a public maternity hospital in Shanghai, China, using a sequential mixed methods approach. The study was part of a bigger study looking at the application of the mixed methods approach to assess safety culture in health care in different organizations and countries. METHODOLOGY: A mixed methods approach was utilized by first distributing the Safety Attitudes Questionnaire measuring six safety culture dimensions and five independent items to all hospital staff (n=1482) working in 18 departments at a single hospital. Afterward, semistructured interviews were conducted using convenience sampling, where 48 hospital staff from nine departments at the same hospital were individually interviewed. RESULTS: The survey received a response rate of 96%. The survey findings show significant differences between the hospital departments in almost all safety culture dimensions and independent items. Similarly, the interview findings revealed that there were different, competing priorities between departments perceived to result in a reduced quality of collaboration and bottlenecks in care delivery. Another major finding was that staff who worked more hours per week would perceive working conditions significantly more negatively. Issues related to working conditions were also the most common concerns discussed in the interviews, especially the issue on high workload. High workload was also reflected in the fact that 91.45% of survey respondents reported that they worked 40 hours or longer per week. Finally, interview findings complemented survey findings, thus providing a more complete and accurate picture of safety culture. CONCLUSION: Hospital leaders need to prioritize interventions focused on improving the quality of cross-department collaboration and reducing workload. A mixed methods assessment of safety culture provides more meaningful, targeted results, enabling leaders to prioritize and tailor improvement efforts to increase the impact of an intervention.

An Audit of Diabetes-Dependent Quality of Life (ADDQOL) in Older Patients with Diabetes Mellitus Type 2 in Slovenia.

OBJECTIVE: This article reports a study to measure diabetes-dependent quality of life (QOL) in older Slovenian patients with diabetes mellitus type 2 (DMT2). METHODS: A cross-sectional study of older (age ≥ 65 years) patients with DMT2 at outpatient diabetic centers was conducted in all regions in Slovenia. The Audit of Diabetes-Dependent Quality of Life questionnaire was carried out between January and May 2012. Statistical analysis was performed by using IBM SPSS Statistics software, version 18.0. RESULTS: After exclusion of noneligible respondents, a total of 285 respondents were included in the analysis, which represented a 57% response rate. Lower QOL was significantly connected to a heart attack episode (odds ratio 2.42; 95% confidence interval 1.06-5.20) and to the perception of not having diabetes under control (odds ratio 0.36; 95% confidence interval 0.18-0.69). Eleven (3.9%) patients reported no impact of DMT2 on their QOL at all, while in the remaining respondents, particular reference was put to the effects on freedom to eat, dependency on others, and family life. There was no significant difference between the older people living in urban and rural areas. CONCLUSIONS: The findings of the present study highlight the impact of DMT2 on QOL. DMT2 imposes a personal burden on individuals. Information on the QOL of older patients with diabetes is important to Slovenian policymakers and family physicians to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QOL of patients with diabetes.

Principles of risk management in community nursing.

Risk is present in all aspects of practice. The changing nature of primary care means that community nurses will increasingly be expected to adopt roles that have traditionally been undertaken by other professionals and which may be associated with higher levels of risk. Although these developments offer opportunities to enhance patient care, nurses must also be aware of the implications for their own accountability. One way to embrace this accountability, and to meet the demands of clinical governance, is to engage in risk management. By adopting the principles of risk management nurses can act proactively to ensure they provide a high quality service that meets patient needs.

Making the most of teams in the mentorship of students.

Community nurses are rightly expected to act as mentors. This role offers students valuable opportunities to gain insight into community care and contributes to the development of future services and the professional growth of individual mentors. There can be tension, however between the demand of nurses' clinical roles and the need to support students. This article identifies ways in which teams can get the most out of mentoring, focusing on the importance of strong clinical leadership and the need for nurses to "own" the mentorship role and to work with other stakeholders. Finally, examples of initiatives from one inner-London trust are offered to demonstrate robust ways of enabling practice-based education.

Caring for people with learning disability using care management.

Current Government health policy is moving towards the delivery of services for clients with a learning disability through mainstream primary care services. At present there are difficulties in providing health services that meet the needs of clients. These include lack of resources (financial, physical and human), time and expertise. Yet clients with learning disabilities often have some of the most complex physical and mental health needs and they have a right to expect access to services that are responsive and sensitive to their requirements. In light of the current policy and stated difficulties, all service providers and stakeholders need to work together to review how services are provided and to negotiate shared resources. This article suggests adopting a care management approach, where clients are supported by different providers with a lead practitioner taking responsibility for assessment, planning and review in partnership with the client and his/her carers.

Empowering practitioners: an unrealistic expectation of nurse education?

BACKGROUND: Empowerment has become an increasingly popular theme in nurse education. This is evident from the growing number of courses that claim to enable nurses to become empowered. However, this is taking place in an environment with little critical debate about the assumptions and implications for educators and students. Consequently there is a risk of creating hegemony and regimes of truth. AIM: This paper sets out to review critically existing discourses on empowerment and to suggest a more reflexive and realistic view. THEMES: The origins of empowerment are established, together with its relationship to professional education. There is a review of the nature of power and autonomy, followed by an examination of the effects of expectations of empowering practice on educators and students. The lack of reflexivity in notions of empowerment is discussed. Consideration is given to the possibility of rehabilitating empowerment by offering an alternative conception that is realistic and reflexive. CONCLUSIONS: Conclusions are drawn to suggest that although much of the writing on empowerment in education is insufficiently self-critical and consequently is open to censure, ideas of empowerment should not be rejected completely: they may serve to stimulate educators (and their students as future practitioners) to connect with and challenge society.

Meeting demand for clinical placements in one community trust.

The effective management of learning in clinical practice is assuming growing significance for all health-care organizations. This is due to various professional and political imperatives that underscore the need to produce increasing numbers of practitioners who are sufficiently skilled to be deemed 'fit for practice', and must also be prepared to use their skills in different ways in a 'modernized' NHS. This article explores some of the ways in which one community trust has responded to this challenge, a challenge compounded by the need for extended final year medical student primary and community care placements. It also attempts to illustrate the extent to which we have recognized the importance of adopting an interprofessional approach to learning in and about practice.