Scoping review of patients' attitudes about their role and behaviours to ensure safe care at the direct care level.

BACKGROUND: To improve harm prevention, patient engagement in safety at the direct care level is advocated. For patient safety to most effectively include patients, it is critical to reflect on existing evidence, to better position future research with implications for education and practice. METHODS: As part of a multi-phase study, which included a qualitative descriptive study (Duhn & Medves, 2018), a scoping review about patient engagement in safety was conducted. The objective was to review papers about patients' attitudes and behaviours concerning their involvement in ensuring their safe care. The databases searched included MEDLINE, CINAHL and EMBASE (year ending 2019). RESULTS: This review included 35 papers about "Patient Attitudes" and 125 papers about "Patient Behaviours"-indicative of growing global interest in this field. Several patterns emerged from the review, including that most investigators have focused on a particular dimension of harm prevention, such as asking about provider handwashing, and there is less known about patients' opinions about their role in safety generally and how to actualize it in a way that is right for them. While patients may indicate favourable attitudes toward safety involvement generally, intention to act or actual behaviours may be quite different. CONCLUSION: This review, given its multi-focus across the continuum of care, is the first of its kind based on existing literature. It provides an important international "mapping" of the initiatives that are underway to engage patients in different elements of safety and their viewpoints, and identifies the gaps that remain.

A 5-facet framework to describe patient engagement in patient safety.

BACKGROUND: Health care remains unacceptably error prone. Recently, efforts to address this problem have included the patient and their family as partners with providers in harm prevention. Policymakers and clinicians have created patient safety strategies to encourage patient engagement, yet they have typically not included patient perspectives in their development or been comprehensively evaluated. We do not have a good understanding of "if" and "how" patients want involvement in patient safety during clinical interactions. OBJECTIVE: The objective of this study was to gain insight into patients' perspectives about their knowledge, comfort level and behaviours in promoting their safety while receiving health care in hospital. METHODS: The study design was a descriptive, exploratory qualitative approach to inductively examine how adult patients in a community hospital describe health-care safety and see their role in preventing error. RESULTS: The findings, which included participation of 30 patients and four family members, indicate that although there are shared themes that influence a patient's engagement in safety, beliefs about involvement and actions taken are varied. Five conceptual themes emerged from their narratives: Personal Capacity, Experiential Knowledge, Personal Character, Relationships and Meaning of Safety. DISCUSSION: These results will be used to develop and test a pragmatic, accessible tool to enable providers a way to collaborate with patients for determining their personal level and type of safety involvement. CONCLUSION: The most ethical and responsible approach to health-care safety is to consider every potential way for improvement. This study provides fundamental insights into the complexity of patient engagement in safety.

Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study.

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.

No. 282-Rural Maternity Care.

OBJECTIVE: To provide an overview of current information on issues in maternity care relevant to rural populations . EVIDENCE: Medline was searched for articles published in English from 1995 to 2012 about rural maternity care . Relevant publications and position papers from appropriate organizations were also reviewed . OUTCOMES: This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities .

Perspectives on Patient Safety Among Practical Nursing Students.

Background Practical nursing students are students enrolled in a two-year college practical nursing diploma program. They are responsible for providing safe patient care to the patients they care for. Assessing students' perceptions of their own patient safety competencies can help educators identify gaps in their knowledge and skills and identify, at a curricula level, the concepts and information required to improve the quality of their care. Purpose To explore practical nursing students' confidence in what they are learning about patient safety within their nursing education. Methods This cross-sectional descriptive study used a modified version of the Health Professional Education in Patient Safety Survey. Results Overall, students expressed the greatest confidence in their abilities to provide care in Clinical Safety topics. More than 75% of the students' feared punishment when making an error and 88% have difficulty questioning other healthcare providers. Less than 30% of students stated that a system-level focus on errors was taught to them in their education programs. Conclusions More investigation is needed to understand what practical nursing students' fear about the provision of safe care. Additional focus on systems aspects of hazard identification and the prevention of errors needs to be present in nursing education programs.

Accessing best practice resources using mobile technology in an undergraduate nursing program: a feasibility study.

Mobile technology presents new opportunities for nursing education and ultimately the provision of nursing care. The aim of this study was to explore the utility of mobile technology in undergraduate nursing education. In this evaluation study, undergraduate nursing students were provided with iPod Touch devices containing best practice guidelines. Computer self-efficacy was assessed, and the Theory of Planned Behavior was used to identify potential predictors of the use of mobile technology. Questionnaires were completed at baseline (n = 33) and postimplementation (n = 23). Feedback on feasibility issues was recorded throughout the study period. Students generally found the devices useful, and few technical problems were identified; however, lack of skill in using the devices and lack of support from staff in the clinical setting were commonly identified issues. Self-efficacy scores were high throughout the study. Attitudes, perceptions of the desirability of use, perceived personal control over use, and intentions of using the device were lower postimplementation than at baseline. Attitude toward the technology predicted intention to use the device after graduation. Mobile technology may promote evidence-informed practice; however, supporting students' acquisition of related skills may optimize use. Successful integration of mobile technology into practice requires attention to factors that affect student attitudes.

Preliminary adaptation of the systems thinking for everyday work cue card set in a US healthcare system: a pragmatic and participatory co-design approach.

INTRODUCTION: Healthcare is a highly complex adaptive system, requiring a systems approach to understand its behaviour better. We adapt the Systems Thinking for Everyday Work (STEW) cue cards, initially introduced as a systems approach tool in the UK, in a US healthcare system as part of a study investigating the feasibility of a systems thinking approach for front-line workers. METHODS: The original STEW cards were adapted using consensus-building methods with front-line staff and safety leaders. RESULTS: Each card was examined for relevance, applicability, language and aesthetics (colour, style, visual cues and size). Two sets of cards were created due to the recognition that systems thinking was relatively new in healthcare and that the successful use of the principles on the cards would need initial facilitation to ensure their effective application. Six principles were agreed on and are presented in the cards: Your System outlines the need to agree that problems belong to a system and that the system must be defined. Viewpoints ensure that multiple voices are heard within the discussion. Work Condition highlights the resources, constraints and barriers that exist in the system and contribute to the system's functions. Interactions ask participants to understand how parts of the system interact to perform the work. Performance guides users to understand how work can be performed daily. Finally, Understanding seeks to promote a just cultural environment of appreciating that people do what makes sense to them. The two final sets of cards were scored using a content validity survey, with a final score of 1. CONCLUSIONS: The cards provide an easy-to-use guide to help users understand the system being studied, learn from problems encountered and understand the everyday work involved in providing excellent care. The cards offer a practical 'systems approach' for use within complex healthcare systems.

Characteristics promoting behaviour change: physician experience with a coalition-led quality improvement initiative to reduce excessive laboratory test ordering.

BACKGROUND: Attempts have been made to reduce excessive laboratory test ordering; however, the problem persists and barriers to physician involvement in quality improvement (QI) remain. We sought to understand physician participation experience following a laboratory test overuse initiative supported by a QI coalition. METHODS: As part of a larger mixed-methods study, structured virtual interviews were conducted with 12 physicians. The Theoretical Domains Framework (TDF) and the Behavioural Change Wheel (BCW) were used to identify characteristics that influence physician behaviour change for QI leadership and participation and appropriate blood urea nitrogen (BUN) test ordering. A content analysis of physicians' statements to the TDF was performed, resulting in overarching themes; relevant TDF domains were mapped to the intervention functions of the BCW. RESULTS: Nine overarching themes emerged from the data. Eight of 14 TDF domains influence QI leadership and participation, and 10 influence appropriate BUN-test ordering behaviours. The characteristics participants described that promoted a change in their QI participation, leadership and appropriate BUN-test ordering were: QI education with hands-on training; physician peer mentorship/support; personnel assistance (QI and analytics) and communication from a trusted/credible physician leader who shares data and insights about the physician role in the initiative, clinical best practice and past project success. Other elements included: a simply designed initiative requiring minimal effort and no clinical workflow disruptions; revised order forms/panels and limiting test-order frequency when laboratory tests are normal. Additionally, various future intervention strategies were identified. For their initial initiative participation, physicians acknowledged coalition leader or member credibility was more important than awareness of the coalition. CONCLUSIONS: Based on physicians' described perceptions and experiences, coalition characteristics that influenced their QI leadership and participation, and appropriate BUN-test ordering behaviours were revealed; these characteristics aligned to several TDF domains. The findings suggest that these behaviours are multidimensional, requiring a multistrategy approach to change behaviour.

Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study.

BACKGROUND: A coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study's purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering. METHODS: Using sequential explanatory mixed methods, intervention components were grouped as person focused or system focused. Quantitative phase/analyses included: monthly total and average of the BUN test for six hospitals (medicine programme and two EDs) were compared pre initiative and post initiative; a cost avoidance calculation and an interrupted time series analysis were performed (participants were divided into two groups: high (>50%) and low (<50%) BUN test reduction based on these findings). Qualitative phase/analyses included: structured virtual interviews with 12 physicians/participants; a content analysis aligned to the Theoretical Domains Framework and the Behaviour Change Wheel. Quotes from participants representing high and low groups were integrated into a joint display. RESULTS: Monthly BUN test ordering was significantly reduced in 5 of 6 participating hospital medicine programmes and in both EDs (33% to 76%), resulting in monthly cost avoidance (CAN$900-CAN$7285). Physicians had similar perceptions of the coalition's characteristics enabling their QI involvement and the factors influencing BUN test reduction. CONCLUSIONS: To enable physician confidence to lead and participate, the coalition used the following: a simply designed QI initiative, partnership with a coalition physician leader and/or member; credibility and mentorship; support personnel; QI education and hands-on training; minimal physician effort; and no clinical workflow disruption. Implementing person-focused and system-focused intervention components, and communication from a trusted local physician-who shared data, physician QI initiative role/contribution and responsibility, best practices, and past project successes-were factors influencing appropriate BUN test ordering.

Rural maternity care.

OBJECTIVE: To provide an overview of current information on issues in maternity care relevant to rural populations. EVIDENCE: Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. OUTCOMES: This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in rural settings. Remuneration models should facilitate interprofessional collaboration. 9. Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care. 10. Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported. 11. Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery. 12. All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met. 13. Quality improvement and outcome monitoring should be integral to all maternity care systems. 14. Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.

Interprofessional jargon: how is it exclusionary? Cultural determinants of language use in health care practice.

Language can impact significantly on the ways in which health care professionals relate and provide clinical services, as well as the way in which patients conceptualize their role in the healthcare encounter. The aim of this project was to explore the barriers and challenges to developing a collaborative approach in health care. A hermeneutic research approach was used with a convenience sample of international key informants representing 6 disciplines. A total of 10 individual, semi-structured interviews were conducted. Findings emphasized the need to be more inclusive by avoiding the use of exclusionary jargon so that all members of the health care team, including patients and families, can adopt a collaborative practice orientation.

Development and pilot testing of the collaborative practice assessment tool.

Collaborative practice is receiving increased attention as a model of healthcare delivery that positively influences the effectiveness and efficiency of patient care while improving the work environment of healthcare providers. The collaborative practice assessment tool (CPAT) was developed from the literature to enable interprofessional teams to assess their collaborative practice. The CPAT survey included 56 items across nine domains including: mission and goals; relationships; leadership; role responsibilities and autonomy; communication; decision-making and conflict management; community linkages and coordination; perceived effectiveness and patient involvement; in addition to three open-ended questions. The tool was developed for use in a variety of settings involving a diversity of healthcare providers with the aim of helping teams to identify professional development needs and corresponding educational interventions. The results of two pilot tests indicated that the CPAT is a valid and reliable tool for assessing levels of collaborative practice within teams. This article describes the development of the tool, the pilot testing and validation process, as well as limitations of the tool.

Measures of movement and mobility used in clinical practice and research: a scoping review.

OBJECTIVE: The first objective of this scoping review was to identify all the tools designed to measure movement or mobility in adults. The second objective was to compare the tools to the conceptual definitions of movement and mobility by mapping them to the International Classification of Functioning, Disability and Health (ICF). INTRODUCTION: The concepts of movement and mobility are distinct concepts that are often conflated, and the differences are important to patient care. Movement is a change in the place or position of a part of the body or of the whole body. Mobility is derived from movement and is defined as the ability to move with ease. Researchers and clinicians, including nurses, physiotherapists, and occupational therapists who work with adults and in rehabilitation, need to be confident that they are measuring the outcome of interest. INCLUSION CRITERIA: This scoping review considered studies that included participants who are adults, aged 19 and older, with any level of ability or disability. The concepts of interest were tools that measured movement or mobility relative to the human body. Studies were considered regardless of country of origin, health care setting, or sociocultural setting. METHODS: CINAHL, Health and Psychosocial Instruments, MEDLINE, and Embase were searched in June 2018 and OpenGrey, Dissertation Abstracts International, and Google Scholar were searched in November 2018. The searches were limited to articles in English, and the date range was from the inception of the database to the current date. Data were extracted from the studies using a custom data extraction tool. Once tools were identified for analysis, they were coded using the table format developed by Cieza and colleagues. RESULTS: There were 702 unique tools identified, with 651 of them available to be coded for the ICF. There were 385 ICF codes used when coding the tools. From these codes, the percentage of codes of the defining attributes of movement and mobility that were covered could be calculated, as well as the percentage of tool items that were linked to the antecedents, consequences, or defining attributes of movement or mobility. CONCLUSIONS: Although there are many tools that measure only movement or mobility, there are many that measure a mixture of the defining attributes as well as the antecedents and consequences. The tool name alone should not be considered a guarantee of the concept measured, and tool selection should be done with a critical eye. This study provides a starting point from which clinicians and researchers can find tools that measure the concepts of movement and mobility of interest and importance to their patient population.

Absorptive capacity in the adoption of innovations in health care: a scoping review protocol.

OBJECTIVE: To explore how absorptive capacity has been conceptualized and measured in studies of innovation adoption in health care organizations. INTRODUCTION: Current literature highlights the need to incorporate knowledge translation processes at the organizational and system level to enhance the adoption of new knowledge into practice. Absorptive capacity is a set of routines and processes characterized by knowledge acquisition, assimilation, transformation, and application. Absorptive capacity, a key concept in organizational learning theory, is thought to be critical to the adoption of new knowledge and innovations in organizations. INCLUSION CRITERIA: This scoping review will include primary studies (ie, experimental, quasi-experimental, observational, and qualitative study designs) and gray literature that broadly focus on the adoption of innovations at the organizational level in health care, and frame innovation adoption as processes that rely on organizational learning and absorptive or learning capacity. METHODS: Data sources will include comprehensive searches of electronic databases (eg, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus), gray literature, and reference scanning of relevant studies. Study abstracts and full texts will be screened for eligibility by two reviewers, independently. Data extraction of relevant studies will also be done independently by two reviewers. All discrepancies will be addressed through further discussion or adjudicated by a third reviewer. Synthesis of the extracted data will focus on descriptive frequencies, counts, and thematic analysis and the results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR).

Building Research Capacity in Nursing Academia in 2020: Is the Road Less Perilous?

BACKGROUND: Building research capacity in nursing academic units continues to be a challenge. There are a number of external contextual factors and internal factors that influence individual faculty as well as the collective to engage successfully in research. PURPOSE: The overall aim of this opinion article is to provide an overview of the current external and internal, processes and structures, relevant to capacity of nursing faculty to engage in research. METHODS: To inform the external context, we reviewed national research funding trends for nursing. To inform the internal context, we provided an exemplar of the internal processes and structures designed to support research capacity building within our academic unit. RESULTS: Canadian Institutes of Health Research funding trends for research grants led by nurse principal applicants increased between 2010 and 2013, followed by a steady decline. In 2017 to 2018, there were only 24 research grants led by nurse principal applicants. These external challenges coupled with the traditional internal barriers, such as the imbalance between teaching and research time, threaten research capacity for nursing academics. CONCLUSION: Organizational strategies to promote research capacity within academic nursing units are a necessary requirement to move forward.

Core competencies: the next generation. Comparison of a common framework for multiple professions.

This report demonstrates the application of a competency model to the regulated and unregulated professions of medical radiation technology, social work, pharmacy, and psychology. The competency model is based on the CanMEDS framework and was originally applied to the professions of medicine, occupational therapy, physical therapy, and nursing in an earlier work. The framework identifies the core competencies common to learners in health care, which are professional (and health advocate), expert, scholar, manager, communicator, and collaborator. In this report, these core competencies are applied to four additional disciplines in an effort to make the cultural shift from discipline-based silos to a common language for ascertaining the skills, knowledge, and attitudes needed to function in interprofessional teams.

Simulation in interprofessional education for patient-centred collaborative care.

AIM: This paper is a report of preliminary evaluations of an interprofessional education through simulation project by focusing on learner and teacher reactions to the pilot modules. BACKGROUND: Approaches to interprofessional education vary widely. Studies indicate, however, that active, experiential learning facilitate it. Patient simulators require learners to incorporate knowing, being and doing in action. A theoretically based competency framework was developed to guide interprofessional education using simulation. The framework includes a typology of shared, complementary and profession-specific competencies. Each competency type is associated with an intraprofessional, multiprofessional, or interprofessional teaching modality and with the professional composition of learner groups. METHOD: The project is guided by an action research approach in which ongoing evaluation generates knowledge to modify and further develop it. Preliminary evaluations of the first pilot module, cardiac resuscitation rounds, among 101 nursing students, 42 medical students and 70 junior medical residents were conducted in 2005-2007 using a questionnaire with rating scales and open-ended questions. Another 20 medical students, 7 junior residents and 45 nursing students completed a questionnaire based on the Interdisciplinary Education Perception scale. FINDINGS: Simulation-based learning provided students with interprofessional activities they saw as relevant for their future as practitioners. They embraced both the interprofessional and simulation components enthusiastically. Attitudinal scores and responses were consistently positive among both medical and nursing students. CONCLUSION: Interprofessional education through simulation offers a promising approach to preparing future healthcare professionals for the collaborative models of healthcare delivery being developed internationally.

A new inter-professional course preparing learners for life in rural communities.

The 'Professionals in Rural Practice' course was developed with the aim of preparing students enrolled in professional programs in Canada to become better equipped for the possible eventuality of professional work in a rural setting. To match the reality of living and working in a rural community, which by nature is interprofessional, the course designers were an interprofessional teaching team. In order to promote group cohesiveness the course included the participation of an interprofessional group of students and instructors from the disciplines of medicine, nursing, occupational therapy, physical therapy, teacher education, and theology. The format of the course included three-hour classes over an eight-week period and a two-day field experience in a rural community. The course utilized various experiential and interactive teaching and learning methods, along with a variety of assessment methods. Data were collected from student participants over two iterations of the course using a mixed methods approach. Results demonstrate that students value the interprofessional and experiential approach to learning and viewed this course as indispensable for gaining knowledge of other professions and preparation for rural practice. The data reveal important organizational and pedagogical considerations specific to interprofessional education, community based action research, and the unique interprofessional nature of training for life and work in a rural community. This study also indicates the potential value of further longitudinal study of participants in this course. Key words: Canada, community based action research, education, interdisciplinary, interprofessional.

Effectiveness of universal hyperbilirubinemia screening on newborn health: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to assess the effectiveness of the universal hyperbilirubinemia screening program on common newborn health outcomes.Specifically, the review will assess: the incidence of severe hyperbilirubinemia/kernicterus/exchange transfusion, rate of readmission due to jaundice, length of hospital stay on birth admission, rate and utilization of phototherapy during birth hospitalization, and jaundice related emergency visits.