The association between patient safety culture and adverse events - a scoping review.

BACKGROUND: Adverse events (AEs) affect 10% of in-hospital patients, causing increased costs, injuries, disability and mortality. Patient safety culture (PSC) is an indicator of quality in healthcare services and is thus perceived as a proxy for the quality of care. Previous studies show variation in the association between PSC scores and AE rates. The main objective of this scoping review is to summarise the evidence on the association between PSC scores and AE rates in healthcare services. In addition, map the characteristics and the applied research methodology in the included studies, and study the strengths and limitations of the evidence. METHODS: We applied a scoping review methodology to answer the broad research questions of this study, following the PRISMA-ScR checklist. A systematic search in seven databases was conducted in January 2022. The records were screened independently against eligibility criteria using Rayyan software, and the extracted data were collated in a charting form. Descriptive representations and tables display the systematic mapping of the literature. RESULTS: We included 34 out of 1,743 screened articles. The mapping demonstrated a statistical association in 76% of the studies, where increased PSC scores were associated with reduced AE rates. Most of the studies had a multicentre design and were conducted in-hospital in high-income countries. The methodological approaches to measuring the association varied, including missing reports on the tools` validation and participants, different medical specialties, and work unit level of measurements. In addition, the review identified a lack of eligible studies for meta-analysis and synthesis and demonstrated a need for an in-depth understanding of the association, including context complexity. CONCLUSIONS: We found that the vast majority of studies report reduced AE rates when PSC scores increase. This review demonstrates a lack of studies from primary care and low- and- middle-income countries. There is a discrepancy in utilised concepts and methodology, hence there is a need for a broader understanding of the concepts and the contextual factors, and more uniform methodology. Longitudinal prospective studies with higher quality can enhance efforts to improve patient safety.

Cues and clues predicting presence of symptoms of depression in stroke survivors.

AIMS AND OBJECTIVES: To investigate to what extent self-reported cues about lack of treatment or concerns about inadequate health care from stroke survivors were associated with symptoms of depression. BACKGROUND: Stroke survivors are prone to depression, and thus, any easily available cues which may inform healthcare workers about patients' mental well-being are potentially important. This study investigates whether two such cues - Cue 1 the subjectively reported lack of access to rehabilitation, and more generally, Cue 2 an expressed concern that their healthcare needs may not be adequately met - may be clinically relevant to be on the outlook for. DESIGN: A cross-sectional survey of stroke survivors three months after discharge from a stroke unit. METHODS: Analysis of data on stroke survivors collected at three months after discharge from a hospital's stroke unit, by means of a mailed questionnaire. Descriptive statistics for the sample population were computed, and a binary logistic model fitted to estimate the impact of subjectively perceived lack of rehabilitation and subjectively reported low confidence in the healthcare system on symptoms of depression as measured by the Hospital Anxiety and Depression Scale. RESULTS: The percentage of patients reporting the presence of symptoms of depression three months postdischarge (22·6%) was consistent with the main body of literature on this subject. Both cues investigated had a significant (p < 0·05) and elevated odds ratio-Cue 1 odds ratio = 4·7 (1·3-18·4) and Cue 2 odds ratio = 2·8 (1·2-6·4), respectively - for showing symptoms of depression in our population. CONCLUSION: Healthcare workers who come in contact with stroke survivors who report having missed out on rehabilitation or express concern that their care needs may not be adequately met by their access to health care should ensure that the patients' mental well-being is being duly monitored and should consider further investigation for depression. RELEVANCE TO CLINICAL PRACTICE: Healthcare workers who come into contact with stroke survivors should pay attention to patients' remonstrance of access to rehabilitation, or concerns about adequacy of received care, as these might constitute cues for the presence of symptoms of depression.

'Both assistant and specialist': Nurse Anaesthetists' experiences of being relocated during the COVID-19 pandemic: A qualitative study.

AIM: The aim of the study was to explore the experiences of nurse anaesthetists being relocated during the COVID-19 pandemic. DESIGN: The study has a qualitative design. METHODS: A total of 12 nurse anaesthetists from four different hospitals were included. Data were collected using individual semi-structured interviews and then analysed using content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS: The 12 respondents, of whom three were men, were between 46 and 64 years old and had 7 to 30 years of experience as NAs. Two themes emerged in the analysis: (1) 'Diverse experiences' with the sub-themes 'Preparedness' and 'Insecurity' and (2) 'Both assistant and specialist' with the sub-themes 'Exhausting' and 'Meaningful'. CONCLUSION: This study shows that the NAs competencies made them prepared to handle many of the situations. They also experienced situations where they were uncomfortable being pressured to take responsibility. They were regarded as a uniform group without considering their prior experiences. Mapping the personnel's former experiences is required to utilize best possible matching of personnel to assignments and create less stress and insecurity among them.

Does the cancer patient's disease stage matter? A comparative study of caregivers' mental health and health related quality of life.

OBJECTIVE: Cancer affects both patients and their caregivers. Caregiver burden may change during different stages of the patients' cancer trajectory. Limited research has focused on the impact of being a caregiver, assessed by the caregiver's mental health and quality of life (QOL) during the curative and the palliative phases of the patient's disease. The aim of this study is to compare caregivers of cancer patients during the curative and a palliative phases with respect to their mental health and health-related QOL. METHOD: This descriptive, cross-sectional study combines data from two studies. The first group consists of caregivers of patients with cancer in the late palliative phase and the second group consists of caregivers of outpatients with cancer who suffer from pain and/or use analgesics. Data were collected by means of standardized measures and analyzed with descriptive statistics. RESULTS: Based on this material, no significant differences in mental health and health- related QOL were revealed for caregivers of cancer patients in the palliative and the curative phases, respectively. Neither education level in the caregivers, nor the patients' functional status influenced caregivers' mental health or QOL. Younger caregivers seem to have better physical QOL. SIGNIFICANCE OF RESULTS: Being caregivers of cancer patients seems to have a similar pattern of impact on caregivers' mental health and quality of life regardless of the patient's disease stage. We share some reflections about the way in which the cancer stage is divided and the appropriateness of such selection for measuring caregivers' mental health and QOL. Additionally, we discuss the use of generic instruments for measuring specific contexts and particular samples.

Educating for Excellence: A Cohort Study on Assessing Student Nurse Anesthetist Non-Technical Skills in Clinical Practice.

Non-technical skills play an integral role in providing safe and excellent anesthesia. Currently there is little standardization in the assessment of non-technical skills in clinical practice, although various instruments exist. The aim of this study was to explore the use of the Nurse Anaesthetists' Non-Technical Skills-Norway (NANTS-no) structured assessment instrument in developing and assessing non-technical skills in clinical practice. This cohort study had a longitudinal design. Twenty student nurse anesthetists' nontechnical skills were assessed by their mentors (N=31) and clinical supervisors (N=7) at three time-points over a 12-month period, after providing anesthesia to a patient. A 5-point rating scale was used for both the experts' assessments and students' self-assessments. Development of non-technical skills over time was estimated using linear mixed-effect models. The students demonstrated a significant overall development of non-technical skills (P<.001), achieving an expert assessment of 4.5 at the end of their education. The students significantly underestimated their clinical performance compared with the experts' assessments (P<.001). The structured behavioral assessment instrument appears to be reliable for assessing student nurse anesthetists' non-technical skills in clinical practice. This study may have implications for systematic assessment of non-technical skills in Norway and other countries.

"The Worst Is the Worry": Importance of Preoperative Preparation of Preschool Children.

Children often experience a high level of anxiety before anesthesia, which may lead to poor cooperation during anesthesia induction and negative consequences for the postoperative period. The aim of this study was to obtain knowledge that may improve practice in preparing preschoolers for anesthesia and surgery by analyzing nurse anesthetists' preoperative experiences with children. A focus group interview with nurse anesthetists was conducted. The interview was recorded and transcribed verbatim, and results were analyzed using qualitative text analysis. Three main themes were identified to relieve preschoolers' anxiety: "Making the unknown and scary harmless," "Using oneself," and "Having a lap to sit on." Findings indicate that explanation and preparation through play, as well as experiences of participation and coping, can safeguard children who are feeling anxious. The professional and personal qualities of a Certified Registered Nurse Anesthetist (CRNA) are important when managing pediatric patients' anxiety. It is essential that CRNAs have the ability to adapt the induction of anesthesia to suit the child individually (and parents). The parents constitute an important collaborator for CRNAs. Young children need explanations and knowledge about what is happening and what to expect. CRNAs should focus on codetermination and participation for preschool children undergoing anesthesia.

Students' top 10 priorities of research uncertainties on students' sleep: a pragmatic James Lind Alliance approach.

OBJECTIVES: Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. DESIGN: The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: 'as a student, which question(s) do you consider to be important with regards to sleep?'. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. SETTING: A higher education institution in Norway. PARTICIPANTS: 555 students. RESULTS: The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. CONCLUSIONS: We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.

Cancer patients' barriers to pain management and psychometric properties of the Norwegian version of the Barriers Questionnaire II.

The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. The purpose of this study was to evaluate the psychometric properties of the BQ-II in a sample of Norwegian cancer patients. The BQ-II was translated into Norwegian and pilot tested with eight oncology outpatients. Then, a convenience sample of 321 cancer patients from two different sites was recruited to maximize the number of questionnaires available for the psychometric analyses. Patients were included if they: were >18 years of age; had a diagnosis of cancer; and self-reported pain and/or use of analgesics. Construct validity of the Norwegian version of the BQ II (NBQ-II) was evaluated using an exploratory factor analysis. A seven-factor solution was found that was more consistent with the original version of the BQ. Construct validity of the NBQ-II was demonstrated through positive correlations between most of the subscale and total scores on the NBQ-II and pain intensity and pain interference scores. Finally, Cronbach's α coefficients of ≥0.7 for six of the seven subscales and 0.89 for the total scale demonstrated acceptable levels of internal consistency. In conclusion, the NBQ-II demonstrated adequate psychometric properties. However, further revision and testing of the questionnaire should be performed to confirm the factor structure that was identified in this study.

Association between self-perceived pain sensitivity and pain intensity after cardiac surgery.

BACKGROUND AND PURPOSE: Cardiac surgical pain remains a clinical challenge affecting about 40% of individuals in the first six months post-cardiac surgery, and continues up to two years after surgery for about 15-20%. Self-perceived sensitivity to pain may help to identify individuals at risk for persistent cardiac surgical pain to optimize health care responses. The purpose of this study was to assess the relationship between self-perceived pain sensitivity assessed by the Pain Sensitivity Questionnaire (PSQ) and postoperative worst pain intensity up to 12 months after cardiac surgery. Sex differences in baseline characteristics and the PSQ scores were also assessed. METHODS: This study was performed among 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013. A secondary data-analysis was utilized to explore the relationship between preoperative PSQ scores and worst pain intensity rated preoperatively, across postoperative Days 1-4, at 2 weeks, and at 1, 3, 6, and 12 months post-surgery. Linear mixed model analyses were performed to estimate changes in pain intensity during 1-year follow-up. RESULTS: The mean (±standard deviation) PSQ-total score was 3.3±1.4, with similar scores in men and women. The PSQ-total score was significantly associated with higher worst pain intensity ratings adjusted for participant characteristics (p=0.001). CONCLUSION: Use of the PSQ before surgery may predict cardiac surgical pain intensity. However, previous evidence is limited and not consistent, and more research is needed to substantiate our results.

A review of self-rated generic quality of life instruments used among older patients receiving home care nursing.

In the last two decades, quality of life and health-related quality of life have become commonly used outcome measures in the large number of studies evaluating healthcare and home care nursing. The objective of this systematic search and review was to evaluate studies that include self-rated generic quality of life instrument used among elderly patients receiving home care nursing. Searches were conducted in Medline, Embase, PsycINFO and Cinahl for articles published between January 2005 and June 2016, with 17 studies in eight countries meeting the inclusion criteria and assessed for quality. Overall, the review shows great variations in the included studies regarding characteristics of the participants and place of origin, the generic quality of life instruments applied and their dimensions. In this review, we raise the question of whether the generic questionnaires used to measure quality of life do in fact measure what is essential for quality of life in elderly users of home care nursing. The psychological and physical dimensions of quality of life were assessed in almost all included studies, while older-specific dimensions like autonomy, control and sensation were less frequently assessed. There is reason to believe that generic quality of life instruments frequently do not capture the dimensions that are most important for elderly people with health problems in need of home care nursing.