Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses.

BACKGROUND: Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination-a common response after nurses suffer a patient safety event-may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources. OBJECTIVES: The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes. METHODS: A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables. RESULTS: There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses. DISCUSSION: The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences.

The Speaking Up Climate of Nurses for Patient Safety Concerns and Unprofessional Behaviors: The Effects of Teamwork and Safety Climate.

PURPOSE: This study aims to investigate the influence of teamwork and safety climate on nurses' speaking up for patient safety concerns and unprofessional behaviors. DESIGN: This study incorporates a cross-sectional research design. METHODS: The study included 217 surgical nurses employed in a Turkish university hospital. The research data were collected between April and June 2023 using the Teamwork Climate, Safety Climate Survey, Speaking Up Climate for Patient Safety, and Speaking Up Climate for Professionalism instruments. The relationships between these scales were assessed using Pearson correlation analysis. The Turkish validity and reliability of the Speaking Up Climate for Patient Safety and Speaking Up Climate for Professionalism scales were verified. The research model was tested using path analysis. FINDINGS: The mean age of the 217 surgical nurses was 25.88 ± 5.64 years. Teamwork climate showed a positive effect on safety climate and speaking up climate about patient safety concerns and unprofessional behaviors. Safety climate showed a positive association with nurses' speaking up climate about patient safety concerns and unprofessional behaviors. CONCLUSIONS: Teamwork climate and safety climate both positively affect the speaking up climate about patient safety concerns and unprofessional behaviors. Nurse managers who wish to promote a culture of speaking up about patient safety and unprofessional behaviors should prioritize improvements in the teamwork climate and safety climate.

Workplace bullying and its impact on the quality of healthcare and patient safety.

BACKGROUND: Workplace bullying (WPB) is a physical or emotional harm that may negatively affect healthcare services. The aim of this study was to determine to what extent healthcare practitioners in Saudi Arabia worry about WPB and whether it affects the quality of care and patient safety from their perception. METHODS: A cross-sectional study was conducted in 2018. An online survey was distributed among all practitioners at a multi-regional healthcare facility. A previously validated tool was sourced from an integrative literature review by Houck and Colbert. Responses to 15 themes were rated on a 5-point Likert scale, converted to percentage mean scores (PMS) and compared across participants' characteristics using bivariate and regression analyses. RESULTS: A total of 1074/1350 (79.5%) completed the questionnaire. The overall median [interquartile range] score of worrying about WPB was 81.7 [35.0]. Participants were mainly worried about the effect of WPB on their stress, work performance, and communication between staff members. A significant negative relationship developed between the quality of care and worrying about WPB, P < 0.001. More educated practitioners were 1.7 times more likely to be worried about WPB compared with their counter group, adj.P = 0.034. Junior practitioners were 1.6 times more likely to be worried about WPB, adj.P = 0.017. The group who has not been trained in handling WPB (1.7 times), and those who had been exposed to WPB (2.2 times) were both more likely to be worried about WPB compared with their counter groups, adj.P = 0.026 and adj.P < 0.001 respectively. CONCLUSIONS: Most healthcare practitioners worry about WPB, especially its negative impact on the quality of care and patient safety. A greater proportion of practitioners with higher levels of education and their less experienced counterparts were more worried about WPB. Previous exposure to a WPB incident amplifies the practitioners' worry, but being trained on how to counteract bullying incidents makes them less likely to be worried.

Healthcare professionals' perceptions of patient safety in European emergency departments: a comparative analysis of survey results.

Patient safety is a significant concern worldwide. The Emergency Departments (EDs) are vulnerable to adverse events. Europe, with its diverse healthcare systems, differs in patient safety. This study aimed to identify safety challenges through a comparative analysis of healthcare professionals' perceptions of patient safety in European EDs. In early 2023, a validated questionnaire was distributed to European ED professionals, meeting specific response rate criteria. The questionnaire included five safety domains and additional questions about infection control and team morale, with 36 ordinal scale questions. Responses ranged in five levels from "Never" to "Always," and the scores were summed to calculate the total safety score (TSS). The study examined the impact of per capita healthcare expenditure on safety perceptions using descriptive statistics, correlation assessments and SPSS 17 used for the analysis. The analysis of 1048 valid responses from 24 European countries revealed significant variability in safety perceptions. Teamwork scored highest, signifying effective collaboration. Common safety issues included overcrowding, patient flow management, understaffing, limited training and facilities for mental illnesses. TSS showed correlation with team morale and infection control, but no correlation with per capita healthcare expenditure. This comparative study underlines the disparities in patient safety perceptions across European EDs. Each country displayed unique safety concerns. Safety perceptions did not align with per capita healthcare expenditure, indicating that addressing ED safety needs multifaceted strategies. Policymakers can leverage these findings to inform strategic planning, encouraging targeted interventions to enhance patient safety at both the national and European levels.

Aquisição teórico-prática de tópicos relevantes à segurança do paciente: dilemas na formação de enfermeiros / Theoretical-practical acquisition of topics relevant to patient safety: dilemmas in the training of nurses / Adquisición teórico-práctico de tópicos relevantes sobre seguridad del paciente: dilemas en la formación de enfermeros

Objetivo: Investigar conteúdos relacionados à segurança do paciente, contemplados nos currículos de cursos de graduação em Enfermagem de duas Instituições de Ensino Superior brasileiras. Método: Estudo descritivo, tipo survey, realizado com 119 alunos de cursos de Enfermagem (Licenciatura e Bacharelado), no período de agosto a setembro de 2016. Os tópicos investigados foram baseados no Patient safety curriculum guide: multi-professional edition. De posse dos dados, realizaram-se análises univariadas e bivariadas. Resultados: Dos 46 conteúdos investigados no questionário, dois tiveram escores elevados de não obtenção em atividades teóricas e/ou práticas, que são: "Cultura de culpa" e "Infecção comunitária". Alunos da Licenciatura e Bacharelado referiram maior aquisição em aulas teóricas (p = 0,012), enquanto os do Bacharelado atribuíram de forma equivalente teoria e prática (p = 0,013). Conclusão: Os conteúdos estiveram contemplados, em sua maioria, na abordagem teórica e prática, ao menos uma vez no decorrer do curso. No entanto, quando se tratou de conteúdos ligados a aspectos socioculturais relacionados à segurança do paciente registraram-se escores menores.

Innovando en procesos asistenciales y seguridad del paciente mediante simulación clínica / Innovation in healthcare processes and patient safety using clinical simulation

Objetivo. En las organizaciones sanitarias muchas ideas excelentes no siempre se han llevado a la práctica o adoptado de modo generalizado. Dos elementos han condicionado este resultado: pensar que el cambio se consigue fundamentalmente acumulando conocimiento y creer que la difusión del mismo es el pilar de la transformación. Se describe y evalúa el programa de gestión del cambio del Servicio Cántabro de Salud basado en entrenamiento de equipos interprofesionales mediante simulación clínica. Material y métodos. El Comité de Coordinación y Desarrollo de Formación Continuada analizó las necesidades de aprendizaje propuestas por las unidades clínicas y las gerencias. Se seleccionaron aquellas competencias susceptibles de ser entrenadas mediante simulación. En las actividades se incluyó al equipo clínico completo de cada unidad. Para el diseño docente se utilizaron técnicas de aprendizaje experiencial basadas en simulación y debriefing. Los resultados se evaluaron siguiendo el modelo de Kirkpatrick. Resultados. Los objetivos de cambio incluyeron mejorar el rendimiento de los equipos clínicos en enfermedades con elevada prevalencia e índice de complicaciones; promover la reorganización de procesos asistenciales para hacerlos más eficientes manteniendo la seguridad, y facilitar la implementación de nuevas técnicas complejas con alto riesgo de complicaciones. Treinta unidades asistenciales realizaron 39programas de entrenamiento en los 3 hospitales de la red y atención primaria durante 2013-14. Participaron 1.559profesionales sanitarios incluyendo auxiliares, enfermeras y médicos. Conclusiones. La simulación clínica es un método para el entrenamiento de profesionales sanitarios que promueve y facilita el cambio en los equipos, y la reorganización asistencial (AU)

Objective. Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. Material and methods. The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. Results. Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. Conclusion. Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering (AU)

Resultados de la instauración provisional de un sistema voluntario y anónimo de notificación de incidentes en seguridad del paciente en el SAMU de Asturias / Results of provisional use of a system for voluntary anonymous reporting of incidents that threaten patient safety in the emergency medical services of Asturias

Objetivos: Conocer los incidentes y eventos adversos (EA) que se notificaron en el Servicio de Atención Médica Urgente (SAMU) de Asturias y caracterizarlos, evaluando sus consecuencias, el retraso asistencial provocado y su evitabilidad. Método: Estudio observacional y prospectivo en el que se analizaron las notificaciones realizadas por los profesionales sanitarios del SAMU Asturias, en un sistema de notificación diseñado por los investigadores. Resultados: Se obtuvo una tasa de notificación de 0,5% (IC 95%: 0,41-0,54). Un 74,7% supusieron daño al paciente. El 37,6% de los problemas estuvo relacionado con el centro coordinador de urgencias (CCU), 13,4% con el transporte, 10,8% con el vehículo y 8,8% con problemas de comunicación. Un 70% de los sucesos adversos (SA) notificados conllevó un retraso en la asistencia sanitaria. Un 55% de las notificaciones del CCU en las que hubo riesgo SAC (Severity Assessment Code) correspondió a problemas de recursos humanos y materiales. Los notificantes consideraron que un 88,1% eran evitables. Un 46,2% de los EA precisaron algún tipo de intervención para paliar sus efectos. Las medidas más propuestas por los profesionales para evitar los EA fueron aumento de recursos humanos y materiales (28,3%), elaboración de protocolos (14,5%) y cumplimiento de criterios de calidad (9,7%). Conclusiones: Fomentar la cultura de seguridad y la notificación de los profesionales sanitarios es de especial importancia en nuestro medio, por el número de EA graves, para así conocer los errores y establecer medidas para evitarlos. Los CCU son lugares sensibles para la aparición, detección y notificación de Incidentes (AU)

Objectives: To describe the reported incidents and adverse events in the emergency medical services of Asturias, Spain, and assess their consequences, delays caused, and preventability. Methods: Prospective, observational study of incidents reported by the staff of the emergency medical services of Asturias after implementation of a system devised by the researchers. Results: Incident reports were received for 0.48% (95% CI, 0.41%-0.54%) of the emergencies attended. Patient safety was compromised in 74.7% of the reported incidents. Problems arising in the emergency response coordination center (ERCC) accounted for 37.6% of the incidents, transport problems for 13.4%, vehicular problems for 10.8%, and communication problems for 8.8%. Seventy percent of the reported incidents caused delays in care; 55% of the reported incidents that put patients at risk (according to severity assessment code ratings) corresponded to problems related to human or material resources. A total of 88.1% of the incidents reported were considered avoidable. Some type of intervention was required to attenuate the effects of 46.2% of the adverse events reported. The measures that staff members most often proposed to prevent adverse events were to increase human and material resources (28.3%), establish protocols (14.5%), and comply with quality of care recommendations (9.7%). Conclusions: It is important to promote a culture of safety and incident reporting among health care staff in Asturias given the number of serious adverse events. Reporting is necessary for understanding the errors made and taking steps to prevent them. The ERCC is the point in the system where incidents are particularly likely to appear and be noticed and reported (AU)

Análisis de la cultura de seguridad en el ámbito de la identificación del paciente por el alumnado de enfermería egresado de la Universidad / Analysis of safety culture in the field of patient identification by the students of Nursing degree from the University

Objetivos: El proceso asistencial supone la existencia de problemas de seguridad que afectan a la calidad de vida y que se incrementan en la ancianidad. El objetivo de este trabajo es analizar la cultura de seguridad de los profesionales de enfermería. Metodología: Se planteó la elaboración de un estudio descriptivo de corte transversal mediante la administración de una encuesta a una muestra de los alumnos/as egresados/as de la facultad en los últimos tres cursos. El cuestionario constaba de 39 ítems de respuesta múltiple estructurado en aspectos profesionales, seguridad del paciente e identificación del paciente. Los datos fueron recopilados en una base de datos Excel y se realizó el análisis descriptivo con el paquete estadístico SPSS 19. Resultados: El 94,3% de los/as entrevistados mantenía contacto directo con los pacientes. El 77,1% consideró que en su servicio no había suficiente personal para afrontar la carga de trabajo. Los problemas más frecuentes relacionados con la seguridad del paciente son: la disponibilidad de la historia clínica cuando se precisa (48,6% de los casos), la inexistencia de informes de historias clínicas (36% de los casos) y, en ocasiones, el cambio de historia clínica de un paciente por la de otro (31,4% de los casos). Un 68,6% no notificó por escrito ningún incidente. Conclusiones: Los problemas más frecuentes relacionados con la seguridad son la falta de información en la historia clínica y los problemas de identificación que se agravan en la persona mayor. Existe una infranotificación de errores/incidentes, persistiendo prácticas que favorecen errores en la identificación

Objectives: The treatment process involves the existence of security issues that affect the quality of life and increase in old age. The aim of this paper is to analyze the safety culture of nursing professionals. Methodology: Developing a cross-sectional descriptive study was raised by administering a survey to a sample of students graduates of the Faculty in the last three years. The questionnaire consisted of 39 multiple-choice items divided into professional aspects, Patient Safety and Patient ID. Data were collected on an Excel database and descriptive analysis with SPSS 19 was performed. Results: 94.3% of the interviewees maintained direct contact with patients. 77.1% felt that not enough staff in their service to meet the workload. The most common problems related to patient safety are: the availability of medical records when required (48.6% of cases), the absence of reports of medical records (36% of cases) and sometimes the change history of a patient by another (31.4% of cases). 68.6% reported no written incident. Conclusions: The most common problems related to security are lack of information on the history and identification problems that are exacerbated in the elderly. There is underreporting of errors/incidents, practices favoring identification errors persist

Seguridad clínica en atención primaria. los errores médicos (II) / Clinical safety in primary care: medical errors (II)

El primer artículo de esta serie sobre seguridad clínica lo dedicamos a la epidemiología y a las políticas preventivas de tipo sistémico. En la presente revisión nos centraremos en los errores médicos con especial énfasis en los errores de tipo diagnóstico. Estos errores derivan de las características a veces elusivas de la propia enfermedad, las circunstancias en que el paciente presenta sus síntomas, y las características del propio profesional. Si consideráramos al clínico como una «máquina de diagnóstico» -paradigma del «médico-robot»-, nos sería más fácil admitir unas limitaciones cognitivas, y poner en marcha estrategias institucionales que humanizarían el trato que en ocasiones recibe. De manera más concreta examinaremos 3 estrategias de mejora del razonamiento clínico: reconocimiento de situaciones peligrosas, metacognición y supervisor interno(AU)

The first article of this series on Clinical Safety was dedicated to the epidemiology and systemic preventive policies. In the present review we focus on medical errors with special emphasis on diagnostic type errors. These errors sometimes arise from the elusive characteristics of the disease itself, the way in which the patients present their symptoms, and the characteristics of the professionals themselves. If we consider a general practitioner as a diagnostic machine, -paradigm of "physician as a robot"- it would be easier for us to accept some cognitive limitations and introduce institutional strategies that would humanise the treatment occasionally received. More specifically we will examine three strategies for improving clinical reasoning: recognising dangerous situations, metacognition, and an internal supervisor(AU)