Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study.

OBJECTIVES: Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture in a Danish psychiatric department before and after a leadership intervention. METHODS: A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders. RESULTS: In total, 358 and 325 staff members participated before and after the intervention, respectively. 19 of the staff members were clinical area level leaders. In both surveys, the response rate was >75%. The proportion of frontline staff with positive attitudes improved by ≥5% for 5 of the 7 patient safety culture dimensions over time. 6 patient safety culture dimensions became more positive (increase in mean) (p<0.05). Frontline staff became more positive on all dimensions except stress recognition (p<0.05). For the leaders, the opposite was the case (p<0.05). Staff leaving the department after the first measurement had rated job satisfaction lower than the staff staying on (p<0.05). CONCLUSIONS: The improvements documented in the patient safety culture are remarkable, and imply that strengthening the leadership can act as a significant catalyst for patient safety culture improvement. Further studies using a longitudinal study design are recommended to investigate the mechanism behind leadership's influence on patient safety culture, sustainability of improvements over time, and the association of change in the patient safety culture measures with change in psychiatric patient safety outcomes.

Coping with clean intermittent catherization--experiences from a patient perspective.

BACKGROUND: Poor bladder emptying is a well-known phenomenon in urology which increases the risk of urinary tract infection. Thus, it is important to insure effective bladder emptying for the patient. This may be performed by emptying the bladder intermittently by means of a disposable catheter. The method is called clean intermittent catheterization (CIC). The purpose of CIC is, apart from the scientific reasons, to give patients the opportunity to live the life they did prior to experiencing problems with bladder emptying. In our view, a large number of patients do not cope with their new life with CIC in spite of learning programmes and written guidance. AIM: The aim of this study was to develop knowledge about how patients experience having to empty their bladder by using a disposable catheter for the rest of their lives. Knowledge nurses could be used to improve the quality of the procedure for CIC training. Furthermore this study also helps in investigating the strategies used by the patients used to master CIC in order to improve the organization of training in the future. METHOD: The research design was qualitative and took a phenomenological hermeneutic approach. The data were based on interviews with eight patients using CIC. RESULTS AND CONCLUSION: The results suggested that need to perform CIC for the rest of one's life resulted in a traumatic crisis which could be experienced to be more or less stressful. Situations were mastered employing strategies which could either be problem- or emotion-focused. These strategies aimed, respectively, at solving the problem or at reducing the unpleasant feelings connected with the situation.

A prospective study on whether a tension-free urethropexy procedure affects the residual urine and flow up to 4 years after the operation.

BACKGROUND: Sling procedures performed for urinary stress incontinence can be complicated by urinary retention and flow problems. The aim of this study was to evaluate the flow and the residual urine before and after a tension-free vaginal urethropexy procedure performed for stress urinary incontinence. METHODS: A total of 72 women were included in the study. For voiding phase assessment, patients had spontaneous flow and residual urine measurements performed before the operation and 3 months and 1, 2, 3, and 4 years after the operation. RESULTS: The patients experienced an increase in residual urine 3 months postoperatively, but returned toward preoperative values in the following 4 years. A statistically significant decrease in maximum flow, average flow, and corrected maximum flow was observed 3 months after the operation, which was unchanged in time and thus did not increase over the years. CONCLUSION: The tension-free urethropexy operation had an influence on flow which did not deteriorate over the years. Whether this change in flow will have any influence on the detrusor function or create voiding problems in years to come is unknown.