Safety attitudes and working climate after organizational change in a major emergency department in Sweden.

BACKGROUND: Medically complex patients present challenges to the health care system, particularly in the emergency department (ED) setting. Specifically, teamwork is thought to affect staff safety climate, which in turn impacts patient safety. AIM: This study aimed to evaluate the effect of organizational changes to interprofessional team assessment processes on staff perception of teamwork and safety attitudes in the ED. METHODS: This prospective observational study used cross-sectional design and measured ED staff perception of patient safety related domains at two time-points (before and after an organizational intervention), using the Safety Attitude Questionnaire. RESULTS: Statistically significant changes were seen among the overall sample (n = 112 at time point one and n = 121 at time point two) for the safety climate, working conditions, and stress recognition domains. Nurses and doctors showed different baseline attitudes and different responses to the intervention between the two time points. CONCLUSION: The results reflect improved positive attitudes overall though there were differences in responses between the nursing and medical professions. The findings highlight opportunities to improve attitudes among ED team members through defined organizational change and learning from one another. Organizational change can affect staff perceptions of the safety climate and interprofessional teamwork, which may improve the ED working environment.

Monitoring the impact of cow's milk allergy on children and their families with the FLIP questionnaire--a six-month follow-up study.

BACKGROUND: Many children with cow's milk allergy (CMA) develop tolerance, but, challenges in daily life may remain. Using the Food hypersensitivity famiLy ImPact questionnaire (FLIP), we sought to monitor changes in the impact of CMA over time. METHODS: Families of children with CMA, who participated in the validation of the FLIP, were re-approached 6 months later for follow-up. Change in reported difficulties was assessed by paired sample t-test and mixed models, stratifying by outgrown vs. persistent CMA. RESULTS: Impact on families with children who had outgrown CMA (n = 20) decreased in the FLIP's total score (p = 0.0001) and in two subscales; Health and Emotions (p = 0.0001) and Everyday Life (p = 0.0001). In contrast, no significant improvements were registered in nutritional concerns. Impact on the group with persistent CMA (n = 57) was unchanged at follow-up except for more impact on Everyday Life (p = 0.001). In the final analysis comparing longitudinal changes in the groups, the strongest differences were observed for the subscales Health & Emotions and Everyday Life; for the Nutrition subscale, the between-group changes also differed, but to lesser extent. CONCLUSIONS: We have documented the varying impact of CMA on parents and children over time. Families who were still affected continued to experience impact in daily life. Despite development of tolerance, families who were no longer affected revealed continuing nutritional concerns. Follow-ups should be offered even after outgrown CMA to encourage progression to unrestricted diet, to prevent eating disorders and to promote healthy growth.

Developing an assessment tool for intended learning outcomes in clinical practice for nursing students.

This report describes the development of a new criterion based reference tool to assess nursing knowledge and competence in clinical practice. Nursing education has changed from educating a profession, based on tested experience, to being based on a scientific approach and research based knowledge. Assessment should be capable of measuring whether intended learning outcomes have been reached or not, and if the aims of a course have been fulfilled in order to ensure safe and competent nursing care. The intended learning outcomes from a first year course syllabus were integrated and formed into a three-graded criterion-referenced assessment tool, Assessment of Clinical Education, (AClEd). The AClEd is to be seen as a template, and may be tailor-made in accordance to the objectives, level and criteria of a specific course. The tool showed validity in assessing nursing skills not only the nursing student's ability to perform a task but also, most importantly, the quality of nursing care.