Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study.

AIM: To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints. BACKGROUND: Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship. DESIGN: A qualitative study design with a hermeneutical approach was developed. METHODS: A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research. RESULTS: Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint. CONCLUSIONS: Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints. RELEVANCE FOR CLINICAL PRACTICE: Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.

Clinical Holding in Pediatric Venipuncture: Caring by Empowering the Caregiver.

The use of restraint in the child-adolescent population is highly controversial due to the consequences it can have for patients and their families, although it is sometimes necessary to employ restraint to perform techniques safely and effectively. Clinical Holding is committed to the involvement of parents during venipuncture in the context of family-centred care. This study assesses levels of distress and pain in children undergoing this procedure, as well as satisfaction in parents and nurses. Parents assist in the restraint of children and provide accompaniment during venipuncture. Levels of distress and pain were not particularly elevated. Satisfaction levels among parents and nurses were high. A positive correlation was found between anticipatory and real distress (r = 0.737, p = 0.000), and between real distress and real pain (r = 0.368, p = 0.035). A negative correlation was observed between real pain and parent satisfaction (r = -0.497, p = 0.003). Parental participation during venipuncture contributed to better management of distress and pain. In the future, it would be advisable to incorporate the other pharmacological and non-pharmacological measures recommended by Clinical Holding to ensure care of the highest quality and safety.

[Attitudes towards patient safety culture in a hospital setting and related variables]. / Actitudes frente a la cultura de seguridad del paciente en el ámbito hospitalario y variables correlacionadas.

OBJECTIVE: To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables. METHODS: The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative. RESULTS: 59% (n=123) of respondents rated safety between 7 and 8. 53% (n=103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was "teamwork in the unit/service" and the opportunity for improvement was "staffing". A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff. CONCLUSIONS: This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies.

Cultura de seguridad del paciente en diferentes ámbitos asistenciales: fortalezas y oportunidades de mejora / Patient safety culture in different healthcare settings: strengths and improvement opportunities

Objetivo: identificar fortalezas y oportunidades de mejora respecto a la cultura de seguridad (CdS) del paciente de profesionales sanitarios en diferentes niveles asistenciales y analizar su asociación con factores sociales y profesionales. Método: estudio descriptivo transversal realizado en el Parc Sanitari Sant Joan de Déu de Sant Boi de Llobregat (Barcelona, España). Se incluyeron profesionales asistenciales excluyendo a los que llevaran <1 año trabajando o estudiantes (N= 1.976). Se administró la versión española del cuestionario Hospital Survey on Patient Safety Culture. Se consideraron fortalezas un ≥ 75% de respuestas positivas y oportunidades de mejora ≥ 50% de respuestas negativas. Se realizó un análisis descriptivo, un análisis bivariante mediante Chi cuadrado, U de Mann-Whitney y Kruskal-Wallis considerando significancia estadística a valores p< 0,05. Resultados: participaron 205 profesionales (10,4%) de los cuales el 56,1% fue mujer, el 25,4% enfermero/a, el 54,6% trabajaba en Salud Mental, el 76,1% tenía turno diurno y el 71,7% llevaba > 5 años trabajando. La dimensión “Trabajo en equipo dentro de las unidades/servicios” fue la única de las 12 analizadas que resultó una fortaleza (75,31% respuestas positivas). No se identificaron oportunidades de mejora, pero la “Dotación de personal” fue la dimensión peor valorada (44,26% respuestas negativas). Los auxiliares de Enfermería mostraron mayor CdS, igual que los del turno nocturno, los que llevaban > 5 años trabajando y los de ámbito hospitalario. El ámbito con menos CdS fue el de Salud Mental. Conclusiones: el trabajo en equipo es un pilar fundamental en la CdS. Es imprescindible diseñar estrategias que generen un impacto positivo en la seguridad del paciente, como reforzar la dotación de personal.(AU)

Objective: to identify the strengths and improvement opportunities regarding Safety Culture (SC) for patients by healthcare professionals in different settings of care, and to analyse their association with social and professional factors. Method: a descriptive cross-sectional study conducted at the Parc Sanitari Sant Joan de Déu in Sant Boi de Llobregat, (Barcelona, Spain). The study included healthcare professionals; students or those who had been working for <1 year were excluded (N= 1,976). The Spanish version of the Hospital Survey on Patient Safety Culture questionnaire was administered. Strengths were considered at ≥ 75% of positive answers, and improvement opportunities at ≥ 50% of negative answers. Descriptive analysis was conducted, and bivariate analysis through Square Chi, Mann-Whitney’s U and Kruskal-Wallis; statistical significance was considered at p< 0.05 values. Results: the study involved 205 professionals (10.4%); 56.1% were female, 25.4% were nurses, 54.6% worked in Mental Health, 76.1% worked in the day shift, and 71.7% had been working for > 5 years. The dimension “teamwork within the units/ departments” was the only one out of the 12 analysed which represented a strength (75.31% of positive answers). No improvement opportunities were identified, but “staffing” was the dimension with the worst rating (44.26% of negative answers). Nursing assistants showed higher SC, as well as those in the night shift, those who had been working >5 years and those in the hospital setting. The setting with the lowest SC was Mental Health. Conclusions: teamwork is a key element in SC. It is essential to design strategies that will generate a positive impact on patient safety, such as reinforcing the staff.(AU)

Actitudes frente a la cultura de seguridad del paciente en el ámbito hospitalario y variables correlacionadas / Attitudes towards patient safety culture in a hospital setting and related variables

Objetivo: Describir las actitudes frente a la cultura de la seguridad en trabajadores de un hospital y la influencia de variables sociodemográficas y profesionales. Métodos: En una muestra de profesionales y auxiliares de enfermería se administró el cuestionario Hospital Survey on Patient Safety Culture. Se consideró como fortaleza más del 75% de respuestas positivas y como oportunidad de mejora más del 50% de respuestas negativas. Resultados: El 59% (n=123) calificó la seguridad entre 7 y 8. El 53% (n=103) no realizó ninguna declaración de incidente en el último año. Como fortaleza se identificó «trabajo en equipo en la unidad/servicio», y como oportunidad de mejora, «dotación de personal». Se obtuvo una cultura de seguridad más positiva en los servicios ambulatorios, en profesionales de enfermería y en contratación a jornada parcial. Conclusiones: El estudio ha permitido medir la cultura de la seguridad, hecho que facilitará su seguimiento y orientará las estrategias de mejora trabajando los puntos débiles y reforzando los potenciales (AU)

Objective: To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables. Methods: The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative. Results: 59% (n=123) of respondents rated safety between 7 and 8. 53% (n=103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was ‘teamwork in the unit/service’ and the opportunity for improvement was ‘staffing’. A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff. Conclusions: This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies (AU)

El liderazgo enfermero: para la consolidación de la cultura del paciente en el ámbito hospitalario / Nursing leadership to consolidate a culture of patient safety in the hospital setting

Objetivos: Describir el concepto, origen, medida y estrategias organizacionales para fomentar la cultura de seguridad del paciente. Justificar el liderazgo enfermero en el marco de la seguridad del paciente en el ámbito clínico. Método: Análisis conceptual a partir de la revisión crítica de la literatura sobre el tema. Resultados: Las cuatro líneas estratégicas para la realización de un plan de calidad y seguridad son la creación de un comité de seguridad del paciente, la implementación de un sistema de declaración y gestión de los incidentes, la información y formación a los profesionales y, por último, el empoderamiento del paciente. La medición de la cultura de seguridad permite analizar los puntos fuertes y los de mejora a nivel institucional. Según varios estudios, la dotación de personal y el soporte de la dirección destacan como aspectos con mayor margen de mejora para un aumento de la cultura de seguridad. Conclusiones: Tras enmarcar la importancia y a su vez la dificultad de garantizar la seguridad del paciente en las organizaciones sanitarias y el compromiso de las enfermeras, se concluye la necesidad de la implicación de todas las disciplinas asistenciales y no asistenciales, de los políticos, de los gestores y de los propios pacientes para poder lograr unos hospitales más seguros en la atención a todos los ciudadanos

Aims: To describe the concept, background, measures and organizational strategies to promote a culture of patient safety; to justify nursing leadership in the context of patient safety in the clinical setting. Method: A conceptual analysis based on critical review of literature on the subject. Results: The four strategic lines required to carry out a safety and quality plan are the creation of a patient-safety committee, implementation of an incident reporting and management system, provision of information and training for professionals and, finally, patient empowerment. Assessment of the safety culture allows analysis of strengths along with facets that can be improved at an institutional level. According to various studies, staffing and management support stand out as aspects with the greatest margin for improvement in enhancing the safety culture. Conclusions: Subsequent to framing the importance, and consequent difficulty, of ensuring patient safety in health organisations and the commitment of nurses, it can be concluded that here is a need for all care disciplines to be involved, non-caregivers, politicians, managers and the patients themselves, to achieve safer hospitals for the care of all citizens