Daily work variability in falls prevention of hospitalized patients: nursing team's perception.

BACKGROUND: The identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The World Health Organization. These safety incidents allowed the visualization of a vast panorama, ranging from preventable incidents to adverse events with catastrophic outcomes. In this scenario, the issue of fall(s) is inserted, which, despite being a preventable event, can lead to several consequences for the patient, family, and the healthcare system, being the second cause of death by accidental injury worldwide, this study aims to identify the variability inherent in the daily work in fall prevention, the strategies used by professionals to deal with it and the opportunities for improvement of the management of work-as-imagined. METHOD: A mixed method approach was conducted, through process modeling and semi-structured interviews. The study was conducted in a public university hospital in southern Brazil. Study steps: modeling of the prescribed work, identification of falls, modeling of the daily work, and reflections on the gap between work-as-done and work-as-imagined. Medical records, management reports, notification records, protocols, and care procedures were consulted for modeling the work process, and semi-structured interviews were conducted with 21 Nursing professionals. The study was conducted between March 2019 and December 2020. RESULTS: From July 2018 to July 2019, 447 falls occurred, 2.7% with moderate to severe injury. The variability occurred in the orientation of the companion and the assurance of the accompanied patient's de-ambulation. The professionals identified individual strategies to prevent falls, the importance of multi-professional work, learning with the work team, and the colleague's expertise, as well as suggesting improvements in the physical environment. CONCLUSION: This study addressed the need for fall prevention in the hospital setting as one of the main adverse events that affect patients. Identifying the variability inherent to the work allows professionals to identify opportunities for improvement, understand the risks to which patients are subjected, and develop the perception of fall risk as a way to reduce the gap between work-as-imagined and work-as-done.

Evaluation of patient safety culture in a private general hospital: a case study in Brazil.

PURPOSE: The purpose is to assess the patient safety culture perceived by healthcare and administrative staff in a Brazilian hospital and examine whether education and experience are related to positive perceptions. DESIGN/METHODOLOGY/APPROACH: A descriptive-analytical case study was carried out at Ernesto Dornelles Hospital, a private Brazilian institution. The Brazilian version of the Hospital Survey on Patient Safety Culture was used to assess the perceptions of 618 participants, of whom 315 worked in healthcare assistance and 303 in administrative services. The main outcome was the percentage of positive responses, and the independent variables included the type of work, schooling and length of experience. FINDINGS: None of the twelve dimensions was strengthened. The percentage of positive responses was the highest for "Hospital management support for patient safety" (67.5%), and the lowest was for "Nonpunitive response to error" (29%). The healthcare staff had a slightly higher average than the administrative staff. The percentage of positive responses from professionals with undergraduate or graduate degrees was higher for the eight dimensions of safety culture. The length of hospital experience was not associated with any dimensions. ORIGINALITY/VALUE: This study explored the influence of education and professional experience on the perception of patient safety in healthcare and administrative staff from a private institution. These approaches allow to know with greater depth and clarity factors that are related to the patient safety culture and, thus, have more consistent evidence to support interventions in specific needs.

Patient safety nucleus: the pathway in a general hospital. / Núcleo de segurança do paciente: o caminho das pedras em um hospital geral.

OBJECTIVE: To describe the experience of implementing the patient safety nucleus and the strategies developed to ensure safer care. METHOD: Experience report on the implementation of the nucleus and strategies for patient safety in a hospital in the south of Brazil, from 2009 to 2017. RESULTS: The concern with patient safety was made official in 2009 with the creation of a specific service for risk management and in 2015 it was named the patient safety nucleus. Eight strategies were implemented in order to disseminate the patient safety policy. CONCLUSION: An improvement was observed in the processes related to patient safety in the institution. Top management support and leadership engagement were key to this journey.

Care transition strategies in Latin American countries: an integrative review.

OBJECTIVE: To identify and analyze available literature on care transition strategies in Latin American countries. METHODS: Integrative literature review that included studies indexed in PubMed, LILACS, Web of Science Core Collection, CINAHL, SCOPUS databases, and the Scientific Electronic Library Online (SciELO), published in Portuguese, Spanish or English, between 2010 and 2017. RESULTS: Eleven articles were selected and the strategies were grouped into components of care transition: discharge planning, advanced care planning, patient education and promotion of self-management, medication safety, complete communication of information, and outpatient follow-up. These strategies were carried out by multidisciplinary team members, in which nurses play a leading role in promoting safe care transitions. CONCLUSIONS: Care transition activities are generally initiated very close to patient discharge, this differs from recommendations of care transition programs and models, which suggest implementing care transition strategies from the time of admission until discharge.

Association between workload of the nursing staff and patient safety outcomes.

OBJECTIVE To describe the workload of the nursing team and relate it with patient safety outcomes in clinical and surgical inpatient units of a university hospital. METHOD Cross-sectional study, carried out from October 2013 to September 2015. The factor under study was the workload, expressed as the ratio between the mean number of patients and the number of nursing professionals in 24 hours and in the day shifts. RESULTS The sample consisted of 157,481 patients, 502 nursing professionals and 264 observations of safety outcomes. The ratios of patients per nurse and per nursing technician in day shifts indicate a mean estimate of 14-15 and 5-6 patients per professional, respectively. There was a significant association between the workloads in the inpatient units and average length of stay, urinary infection related to invasive procedure and the satisfaction of patients with nursing care. CONCLUSION The increase in the workload of the nursing team had an impact on quality of care and safety for patients. An adequate staffing promotes a safer care environment.

The medication process, workload and patient safety in inpatient units. / Processos de medicação, carga de trabalho e a segurança do paciente em unidades de internação.

Objective To conduct a survey of critical points in the medication process, its repercussions on the demands made on the nursing team and risks related to patient safety. Method This was a qualitative descriptive study that adopted an ecological-restorative approach. The data were collected through focus groups and photographs. Participants consisted of nurses and nursing technicians. Results Three categories emerged from the thematic analysis: challenges related to the process of prescribing and dispensing medication; medication administration with relation to work shift organization; and the use of new technologies to reduce medication errors. The results indicated that the medication process plays a central role in organizing nursing care, being that these professionals represent the last barrier for detecting medication prescription and administration errors. Conclusion By identifying vulnerabilities in the medication administration phase, the use of technology can help ensure patient safety.

[Educational strategies to improve adherence to patient identification]. / Estratégias educativas para melhorar a adesão à identificação do paciente.

OBJECTIVE: The aim of this study was to analyze the impact of educational actions on the results of an adherence indicator while checking patient identification wristbands before high-risk care. METHODS: This is a descriptive and exploratory study that was conducted in a large university hospital between January 2013 and December 2014, where 6,201 patients were interviewed. Data were analyzed by descriptive statistics. RESULTS: The analysis and monitoring of the adherence indicator in patient identification wristbands showed a tendency to increased percentage along the study period, from 42.9% to 57.8% between January and April 2013,and from 81.38% to 94.37% between September and December 2014. CONCLUSIONS: Teaching strategies based on staff awareness improved the professionals' adherence to checking patient ID wristbands. In addition, this result can contribute to strengthening the safety culture within the institution.

Challenges of safety culture in Surgical Center: mixed methods study.

OBJECTIVE: to analyze the safety attitudes of health and support areas professionals working in Surgical Center. METHOD: sequential explanatory mixed methods study. The quantitative stage covered 172 health and support professionals in eight Surgical Centers of a hospital complex. The Safety Attitudes Questionnaire/Surgical Center was applied. In the subsequent qualitative stage, 16 professionals participated in the Focus Group. Photographic methods were used from the perspective of ecological and restorative thinking, and data analysis occurred in an integrated manner, through connection. RESULTS: the general score, by group of Surgical Centers, based on the domains of the Safety Attitudes Questionnaire/Surgical Center, reveals a favorable perception of the safety climate, with emphasis on the domains Stress Perception, Communication in the Surgical Environment, Safety Climate and Perception of Professional Performance. The overall analysis of the domain Communication and Collaboration between Teams appears positive and is corroborated by data from the qualitative stage, which highlights the importance of interaction and communication between healthcare teams as fundamental for daily work. CONCLUSION: the perception of safety attitudes among health and support professionals was positive. The perception of the nursing team stands out as closer or more favorable to attitudes consistent with the safety culture.

Burnout and network centrality as proxies for assessing the human cost of resilient performance.

The extra effort of healthcare professionals to provide care is a manifestation of resilient performance (RP), usually going unnoticed due to successful outcomes. However, it is not clear how the human cost of RP can be assessed. This study addresses this gap by investigating the relationships between proxies of RP and its human cost. The proposed approach was tested in a 29-bed intensive care unit (ICU). The centrality of each professional in the advice-seeking social network was considered as the proxy of their contribution to system resilience. A resilience score was calculated for each professional as the product of three network centrality metrics (in-degree, closeness, and betweenness) and two non-network attributes, namely their availability and reliability. Professionals' burnout was the proxy of the human cost of RP, assessed through the Maslach Burnout Inventory, composed of 22 items divided into a triad of emotional exhaustion, depersonalization, and personal accomplishment. Both questionnaires, for social network analysis and burnout, included socio-demographic questions and were answered by 99.0% of the professionals. Results indicated a weak correlation between emotional exhaustion and the resilience score (p = 0.008). This score was also weakly correlated with working overtime (p = 0.005). Overall, findings provided initial evidence that RP as measured in our study matters to burnout, and that the two proxies are exemplars of applying a more general reasoning that might be valid for other proxies.

Coping strategies for COVID-19 primary care: a mixed method study. / Estratégias de enfrentamento da COVID-19 na atenção primária: estudo de método misto.

This article aims to analyse the COVID-19 coping strategies adopted by municipal health managers in two regions. A mixed method study of the sequential explanatory type was carried out with municipal health managers and primary care coordinators. The quantitative stage was developed with the application of an instrument to 42 managers to identify coping actions and associations with demographic and epidemiological data of COVID-19 in the municipalities. The results aimed at the definition of 15 participants and the collection of data in the qualitative stage, enabling approximation of the meta inferences of the study. Of the actions implemented, there were immediate actions to monitor cases, organize new care flows and encourage the population to adopt nonpharmacological measures. Regional articulation was the device that allowed for expansion and municipal autonomy for testing, reducing contamination and deaths among citizens. Municipal coping strategies that focused on the surveillance of cases and expansion of testing showed positive outcomes in terms of the number of infections and deaths from COVID-19.

O objetivo deste artigo é analisar as estratégias de enfrentamento da COVID-19 adotadas por gestores municipais de saúde em duas regiões. Estudo de método misto do tipo explanatório sequencial, realizado com gestores municipais de saúde e coordenadores da atenção primária. A etapa quantitativa foi desenvolvida com a aplicação de instrumento a 42 gestores, para identificação de ações de enfrentamento e associação com dados demográficos e epidemiológicos da COVID-19 nos municípios. Os resultados direcionaram à definição de 15 participantes e à coleta de dados na etapa qualitativa, possibilitando aproximação das metainferências do estudo. Das ações implantadas, foram unânimes as ações de monitoramento dos casos, organização de novos fluxos de atendimento e estímulo à adoção de medidas não farmacológicas pela população. A articulação regional foi o dispositivo que permitiu ampliação e autonomia municipal para a testagem, com redução de contaminação e óbitos nos munícipes. As estratégias municipais de enfrentamento que tiveram foco na vigilância dos casos e na ampliação da testagem apresentaram desfechos positivos no que se refere a número de óbitos por COVID-19.

Comparison of patient classification systems for dimensioning nursing staff.

OBJECTIVE: To compare nursing staff workload and dimensioning measured by two patient classification systems. METHOD: Cross-sectional study, developed in a clinical inpatient unit of a large hospital in southern Brazil, between June and August 2022. Included patients (n = 260) were assessed through two different patient classification systems. The dimensioning calculation provided by the standard and descriptive statistics were applied. RESULTS: Of the total number of patients, 1,248 classifications were performed with each of the classification systems. One of the instruments showed a concentration of demand for minimal care (54.5%) and the other for intermediate care (63.4%). The anticipation of required nursing hours was discrepant (235.58 and 298.16 hours), as well as the projected nursing staff, which was of 53 and 67 workers, respectively. CONCLUSION: Measurement of workload and dimensioning were different when using two patient classification systems in the same sample. Additional accuracy studies shall be carried out.

Nursing performance in COVID-19 and non-COVID-19 units: Implications for occupational health.

OBJECTIVE: to analyze the implications of the pandemic on the Nursing team's occupational health according to its performance in COVID-19 and non-COVID-19 units. METHOD: a multicenter and mixed-methods study, with a sequential explanatory strategy. A total of 845 professionals took part in the first stage, answering an electronic form which contained sociodemographic and work-related variables, as well as about the pandemic and their health, in addition to the Self-Reporting Questionnaire. 19 professionals were interviewed in the second stage. The quantitative data were submitted to statistical analysis and the qualitative ones to thematic content analysis, with integration by connection. RESULTS: the pandemic exerted impacts on the professionals' health, both in the COVID-19 and non-COVID-19 areas. However, composition of the teams presented different characteristics between the areas, as well as the risk perceptions and the work demands. CONCLUSION: the professionals working in areas COVID-19 and non-COVID-19 areas are equally affected, although with different work exposure regarding the requirements at work in the COVID-19 units and the fear of contamination in non-COVID-19 units.

Experience of the patient regarding their safety in the hospital environment.

OBJECTIVES: to analyze the factors that can impact patients' experience concerning safety-related measures in the hospital setting. METHODS: this qualitative, descriptive, and exploratory study was conducted with patients and their family members at a hospital in southern Brazil. Semi-structured interviews were carried out using the Critical Incident Technique between January and February 2022. The collected data underwent content analysis with the assistance of IRaMuTeQ software. RESULTS: five patients, four family members, and three patient-family units participated in the study. The following categories emerged: "Patientprofessional interaction as a component of safe care," "Recognition of safety protocols in the patient's experience," and "Safe care and the challenges in hospital care." CONCLUSIONS: patient-professional interaction, communication, awareness of safety protocols, and the availability of the nursing team are factors that influence patients' experience regarding the safety of their care during hospitalization.

[The notion of task in focus groups]. / A noção de tarefa nos grupos focais.

The aim of this paper is to revisit the concept of task in light of Pichon-Riviére's referential and to discuss its application in research with focus groups. Focus groups are understood as a research technique which proposes to investigate a topic in depth, allowing the construction of new ideas and answers on the subject in focus. The presuppositions of operative groups were used to support the research practice with focus groups. In these, the notion of task has a key strategic position from which it seeks to intervene in society through dialogue and collective construction, unlike simple data collecting

[The social representations of the process of choosing leaders in the perspective of the nursing team]. / Representações sociais do processo de escolha de chefias na perspectiva da equipe de enfermagem.

This exploratory-descriptive, qualitative study was performed with the objective to analyze the social representation of the process of choosing leaders among nursing workers of a university hospital. The information was obtained through free word association and open interviews. For the purposes of this study, thematic content analysis was performed, guided by the Social Representations Theory. Through this focus the following category emerged: division of the nursing team - the input and output of the process of choosing leaders. The category consists of a crystallization of the social representation of the subject, anchored in elements related to leadership, impartiality, change, knowledge, trust and humanization. The idea of leadership is highlighted as inducing a movement in the division of the team as it is associated with the process of choosing leaders for an environment of communication, suitable for integrating the team and recognizing potential leaders.

Nurses' conceptions regarding patient safety during surgical positioning.

OBJECTIVE: To know the conceptions regarding patient safety during their surgical positioning from the perspective of nurses in a Surgical Center. METHOD: Qualitative descriptive exploratory study, with seven nurses from private hospital in southern Brazil in August 2018. Data generation using the Focus Group technique, with content analysis by Bardin. RESULTS: From the data analysis, six categories emerged: "patient safety", "surgical patient risks", "nurses in the operating room", "training", "involvement of the interprofessional" team and application of the risk assessment scale. The development of injuries resulting from positioning was identified as the greatest risk for the surgical patient, highlighting the presence of the nurse in the operating room as essential for the prevention of this risk, through patient assessment and staff training. FINAL CONSIDERATIONS: Nurses identified risk to patient safety in relation to surgical positioning and considered they presence in the operating room to be indispensable.

Beyond patient classification: the "hidden" face of nursing workload.

This is a theoretical-reflective essay, which aimed to reflect on the centralization of Patient Classification Systems in workload and hospital nursing staff sizing. The reflexive interpretations were guided by two axes: Patient Classification Systems : constitution and utilities; and "Hidden" nursing activities in workload measurement. The first evidences the importance and the role of these instruments in workload identification and in hospital nursing staff sizing, exemplifying several possibilities to be used by nurses. On the other hand, with the second axis, it is clear that there are many nursing activities that are not sensitive to the application (even if systematic) of these means of patient assessment. Therefore, nursing workload measurement may be underestimated. It was inferred that the complexity of practice environments requires a macro and micro institutional look at the nursing workload measurement, especially when considered for workforce planning/sizing purposes.

Patient safety culture in central sterile supply departments: nurses' perceptions.

OBJECTIVE: To know the perceptions of nurses with experience in Central Sterile Supply Departments about the safety culture. METHODS: A qualitative study developed with 12 nurses from hospitals in the South and Southeast Brazilian regions, with data collected in March 2021 through online interviews. Bardin's content analysis was performed with the support of the IRaMuTeQ software. RESULTS: The interpretations were classified considering the following aspects: indirect care provided by Central Sterile Supply Departments (27.16%), low visibility of Central Sterile Supply Departments for patient safety (26.92%), difficulty in internal communication (30.69%) and difficulties learning from errors and fair culture (15.23%). CONCLUSIONS: The perceptions about the safety culture are related to the quality control of processes and to infection prevention; however, there were perceptions about its low recognition and devaluation. The communication, learning from errors and fair culture subcultures proved to be weak.

Modeling of adult patient falls and the repercussions to Nursing as a second victim. / Modelagem de quedas de pacientes adultos e as repercussões à Enfermagem como segunda vítima.

OBJECTIVE: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. METHOD: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. RESULTS: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories "The complexity of care to prevent falls" and "Feelings of the second victim" emerged. CONCLUSION: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

Multiprofessional round with checklist: association with the improvement in patient safety in intensive care.

OBJECTIVE: To verify the association between a multiprofessional round with the use of checklists and patient safety practices by health professionals in an intensive care unit. METHOD: Mixed-method study, delineated by the sequential explanatory approach, conducted in a hospital in southern Brazil. Quantitative data were analyzed using Poisson regression, and qualitative data, using content analysis. The integrated analysis was performed through the explained/connected combination. RESULTS: In the post-implementation period of the rounds with systematic use of the checklist, there was a significant improvement in the prophylaxis of venous thromboembolism, light sedation, reduction in the days of use of mechanical ventilation, central venous catheter and indwelling urinary catheter. CONCLUSION: The multiprofessional round with the systematic use of checklist, associated with the improvement in patient safety practices, was considered as a strategy that ensures better care in intensive care and favors job satisfaction.