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1.
Hum Factors ; : 18720820906041, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32119581

RESUMO

OBJECTIVE: We examine whether surgical teams can handle changes in task requirements better when their formal leader and strategic core role holder-that is, the main surgeon-is central to team coordination. BACKGROUND: Evidence regarding the benefits of shared leadership for managing complex tasks is divided. We tested whether a strategic core role holder's centrality in team coordination helps teams to handle different types of task complexity. METHOD: We observed coordination as specific leadership behavior in 30 surgical teams during real-life operations. To assess the strategic core role holder's coordination centrality, we conducted social network analyses. Task complexity (i.e., surgical difficulty and unexpected events) and surgical goal attainment were rated in a questionnaire. RESULTS: In the critical operation phase, surgical difficulty impaired goal attainment when the strategic core role holder's coordination centrality was low, while this effect was nonsignificant when his/her coordination centrality was high. Unexpected events had a negative effect on surgical goal attainment. However, coordination centrality of the strategic core role holder could not help manage unexpected events. CONCLUSION: The results indicate that shared leadership is not beneficial when teams face surgical difficulty during the critical operation phase. In this situation, team coordination should rather be centralized around the strategic core role holder. Contrarily, when unexpected events occur, centralizing team coordination around a single leader does not seem to be beneficial for goal attainment. APPLICATION: Leaders and team members should be aware of the importance of distributing leadership differently when it comes to managing different types of task complexity.

2.
BMJ Open ; 10(2): e034863, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32060162

RESUMO

OBJECTIVE: To study the psychometric properties of the Georgian version of the Safety Attitudes Questionnaire short version. DESIGN: Cross-sectional study. SETTING: Three Georgian hospitals. PARTICIPANTS: Personnel of participating hospitals (n=305 responses, estimated response rate 30%). INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: Psychometric properties (model fit, internal consistency, construct validity, convergent and discriminant validity) of the instrument, factor structure derived from the data. RESULTS: The Georgian version of Safety Attitudes Questionnaire demonstrated acceptable construct validity and internal consistency (Cronbach's alpha 0.61-0.91). Three factors, Teamwork Climate, Safety Climate and Working Conditions, had limited convergent and discriminant validity. Confirmatory factor analysis with the original six-factor model resulted in limited model fit (χ2/df=2.14, root mean square error of approximation (RMSEA)=0.06, goodness of fit index (GFI)=0.83, CFI=0.88, TLI=0.86). Exploratory factor analysis resulted in a modified four-factor model with satisfactory model fit (χ2/df=2.09, RMSEA=0.06, GFI=0.88, CFI=0.93, TLI=0.91). CONCLUSIONS: The Georgian version of the Safety Attitudes Questionnaire (short version) demonstrated acceptable psychometric properties, with acceptable to good internal consistency and construct validity. While the whole model had limited fit to the data, a modified factor model resulted in good model fit. Our findings suggest the dimension Working Conditions has questionable psychometric properties and should be interpreted with caution. Other two correlated dimensions Teamwork Climate and Safety Climate share considerable variance and may be merged. Overall, the instrument can provide valuable information relevant for advancement of patient safety culture in Georgian hospitals.

3.
BMC Health Serv Res ; 20(1): 53, 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31969150

RESUMO

In the original publication of this article [1], the authors missed that reverse coding was necessary for the item "Do you work separate from your colleagues?" before calculating the scale 'social relations'. So they corrected the analysis accordingly. The results with the revised scale show that there are no longer any significant differences between nurses and physicians with regard to this scale.

4.
J Patient Saf ; 16(1): 90-97, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29166297

RESUMO

OBJECTIVES: Both patient satisfaction and hospital safety culture have been recognized as key characteristics of healthcare quality and patient safety. Thus, both characteristics are measured widely to support quality and safety improvement efforts. However, because safety culture surveys focus exclusively on the perspective of hospital staff, the complimentary information to be gained from patients' perceptions of safety culture has received little research attention so far. We aimed to develop a measure explicitly focusing on patients' perceptions of safety culture in the hospital setting and perform an initial evaluation of its measurement properties. METHODS: We employed a multistep development approach including (a) literature review of survey instruments for patient experience and safety culture and (b) item categorization and selection. We evaluated the measurement properties of the final item set focusing on factor structure, internal consistency, item difficulty, and discrimination. Data were collected from June to December 2015 via an online patient survey conducted routinely by a health insurer. RESULTS: Overall, 112,814 insured persons participated in the online survey (response rate = 19.7%). The final 11-item set formed a single scale that was named Patients' Perceptions of Safety Culture scale. Its measurement properties were deemed satisfactory based on this initial evaluation. CONCLUSIONS: The Patients' Perceptions of Safety Culture scale contributes to both a more comprehensive view of patients' experience of healthcare and a more balanced approach to safety culture measurement in healthcare. It contributes to an increased recognition of patients' views on safety-relevant aspects of their care that provide important inputs to patient safety improvement.

5.
BMJ Open ; 9(11): e034609, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31740477

RESUMO

OBJECTIVE: The medication process requires clear and transparent documentation in patient records. Incomplete or incorrect medication documentation may contribute to inappropriate clinical decision-making and adverse events. To comprehensively assess the quality of in-hospital medication documentation, we developed a retrospective chart review (RCR) instrument. We report on the development process, the feasibility of the instrument and describe our application of the instrument to a sample of patient records. DESIGN: Cross-sectional study using an RCR instrument to evaluate paper-based, non-standardised prescription and medication administration charts (MediDocQ). SETTING: Two German university hospitals. PARTICIPANTS: Records from 1361 patients admitted between April and July 2015 were evaluated. METHODS: The MediDocQ development process comprised six consecutive stages: focused literature review, web-based search, initial patient record screening, review by project advisory board, focus groups with professionals and pilot testing. The final 54-item RCR instrument covers three key components of medication documentation: (1) completeness of documented information (including prescription, medication administration and pro re nata (PRN) medication), (2) quality of transcriptions and (3) compliance with chart structure, legibility, handling of deletions and chart corrections. Descriptive statistics are presented as mean values, SD, median and interquartile ranges for individual items. RESULTS: Overall, 33 out of 54 items resulted in mean values above 0.75, indicating high-quality medication documentation. Documentation quality was particularly compromised for verbal and PRN orders (which involve more steps than standard orders) and when documentation was not completed at the same time as medication administration. CONCLUSIONS: MediDocQ is a patient safety instrument that can be used to evaluate the quality of medication documentation and identify components of the process where intervention is required. In our setting, standardisation of medication documentation, particularly regarding medication administration and PRN medication is a priority.

6.
Front Neurol ; 10: 969, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31572288

RESUMO

Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2-3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period. Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the "door-to-needle" time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire. Interventions: We are applying a multi-level intervention in cooperation with three "STREAM multipliers" from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2-3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings. Clinical Trial Registration: STREAM is a registered trial at https://clinicaltrials.gov/ct2/show/NCT03228251.

7.
BMJ Open ; 9(9): e028280, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31515415

RESUMO

OBJECTIVES: To investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship. DESIGN: Systematic review and meta-analysis. DATA SOURCE: PubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email. ELIGIBILITY CRITERIA: Studies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting. DATA EXTRACTION AND SYNTHESIS: Moderator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation was r =0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance. CONCLUSION: Teamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.

8.
BMJ Open ; 9(9): e026896, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31488465

RESUMO

OBJECTIVE: To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC). DESIGN: Literature review and an analysis framework to review studies. SETTING: Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East. DATA SOURCES: A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review. PRIMARY AND SECONDARY OUTCOME MEASURES: Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC). RESULTS: Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions 'staffing', 'communication openness', 'non-punitive response to error', 'organisational learning' and 'overall perceptions of safety' resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument. CONCLUSIONS: While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.

9.
BMC Health Serv Res ; 19(1): 547, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382968

RESUMO

BACKGROUND: Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria's, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers. METHODS: We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany. RESULTS: Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours. CONCLUSION: These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.


Assuntos
Higiene das Mãos/normas , Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos de Enfermagem/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/normas , Infecção Hospitalar/enfermagem , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Feminino , Alemanha , Desinfecção das Mãos/normas , Higiene das Mãos/métodos , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Enfermeiras Administradoras/normas , Casas de Saúde/normas , Inquéritos e Questionários , Adulto Jovem
10.
BMJ Open ; 9(7): e030972, 2019 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-31362971

RESUMO

OBJECTIVES: To study the psychometric properties of the Georgian version of the Hospital Survey on Patient Safety Culture (HSPSC-GE). DESIGN: Cross-sectional study. SETTING: Three Georgian hospitals. PARTICIPANTS: Staff of participating hospitals (n=579 responses, response rate 41.6%). PRIMARY AND SECONDARY OUTCOME MEASURES: Psychometric properties (Model fit, internal consistency, construct validity) of the instrument, factor structure derived from the data. RESULTS: HSPSC-GE demonstrated acceptable construct validity but highly limited internal consistency (Cronbach's alpha 0.35-0.87). Confirmatory factor analysis with the original 12-factor model resulted in poor model fit (root mean square error of approximation (RMSEA)=0.06; standardised root mean square residuals (SRMR)=0.08; comparative fit index (CFI)=0.74; goodness of fit index (GFI)=0.81; Tucker-Lewis Index (TLI)=0.70). Accounting for reversed item bias resulted in improved fit indices. Exploratory factor analysis resulted in an alternative five-factor model including only 19 items, but with satisfactory model fit (RMSEA=0.07; SRMR=0.07; CFI=0.90; GFI=0.89; TLI=0.88). CONCLUSIONS: The HSPSC-GE as a whole demonstrated poor psychometric properties. However, a number of dimensions demonstrated acceptable internal consistency and reliability. Our results indicated presence of reversed item bias, which may be inherent to the original instrument design of the HSPSC and should be taken into account while interpreting or comparing results, as well as in analyses of psychometric properties of the instrument. Nevertheless, the HSPSC-GE provides first insights in hospital patient safety culture (PSC) in Georgia and we recommend using it in its full form to facilitate deeper analysis and further development of PSC in Georgian healthcare.

11.
Artigo em Inglês | MEDLINE | ID: mdl-31428315

RESUMO

Background: Pathogen transmission plays a major role in the development of healthcare-associated infections. The "patient zone" concept developed as part of the World Health Organization's "Five moments of hand hygiene" aims to distinguish surfaces primarily contaminated by flora of a single patient, i.e. inside the patient zone, from those outside the patient zone containing foreign and potentially harmful microorganisms. Discrepancies in healthcare provider (HCP) internal conceptual representations (i.e. mental models) of the patient zone may lead to missed infection prevention measures that could result in patient harm. We explored HCPs' mental models of the patient zone that shape how they interact with the work environment. Methods: We conducted individual concept mapping interviews supported by a card-sorting technique to examine HCPs' mental models of the patient zone and compared these to IPC expert models. Ten participants (five nurses, five physicians) without IPC specialization and two IPC experts provided definitions of the patient zone and allocated 32 items to "inside" or "outside" the patient zone while verbalizing their thought processes. We calculated similarity as percent agreement among participants and accuracy as percent allocated consistently with expert consensus. A content analysis of interview recordings served to identify mental models underlying the allocation decisions. Results: Our study revealed limited similarity among participants, with seven of 32 items allocated consistently among all participants. Overall, 68% of items were sorted accurately according to expert consensus. Identified mental models were categorized as follows: "Patient contact", the patient zone defined according to objects having patient contact; "Sectors", the patient zone as a defined physical space; "Disinfection", the patient zone deduced based on need to disinfect hands and objects; and "Context-dependency", the patient zone defined depending on the context of an object's use. Conclusions: Our study revealed ambiguity surrounding the patient zone concept as evidenced by low similarity between participants and important discrepancies between participant and expert mental models. Such ambiguity may lead to inconsistent application of the patient zone concept and represents a patient safety risk. Initiatives to improve understanding and application of the patient zone concept should focus on establishing consistent, theoretically founded mental models.

12.
PLoS One ; 14(8): e0221860, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31469866

RESUMO

INTRODUCTION: We aimed to investigate whether noise in delivery rooms is associated with impaired performance of obstetric teams managing major (≥1000 mL) postpartum hemorrhage. MATERIAL AND METHODS: We included video recordings of 96 obstetric teams managing real-life major postpartum hemorrhage. Exposure was noise defined as the occurrence of sound level pressures (SPL) above 90 dB. The outcome was high clinical performance assessed through expert ratings using the TeamOBS-PPH tool. RESULTS: The 23 teams unexposed to noise had a significantly higher chance of high clinical performance than the 73 teams exposed to noise: 91.3% (95% CI; 72.0-98.9) versus 58.9% (95% CI; 46.8-70.3) (p < 0.001). The results remained significant when adjusting for the following possible confounders: team size, non-technical performance, bleeding velocity, hospital type, etiology of bleeding, event duration and time of day. Typical sources of noise above 90 dB SPL were mother or baby crying, dropping of instruments, and slamming of cupboard doors. CONCLUSION: Noise in delivery rooms may be an independent source of impaired clinical performance.

13.
BMJ Open ; 9(7): e027942, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31289075

RESUMO

INTRODUCTION: Self-management interventions show promising results on symptom outcomes and self-management behaviours. The Symptom Navi© Programme (SN©P) is a nurse-led intervention supporting patients' symptom self-management during anticancer treatment. It consists of written patient information (Symptom Navi© Flyers (SN©Flyers)), semistructured consultations and a training manual for nurses. METHODS AND ANALYSIS: This pilot study will evaluate the implementation of the SN©P based on the Reach Effectiveness-Adoption Implementation Maintenance framework at Swiss outpatient cancer centres. We will use a cluster-randomised design and randomise the nine participating centres to the intervention or usual care group. We expect to include 140 adult cancer patients receiving first-line systemic anticancer treatment. Trained nurses at the intervention clusters will provide at least two semistructured consultations with the involvement of SN©Flyers. Outcomes include patients' accrual and retention rates, patient-reported interference of symptoms with daily functions, symptom burden, perceived self-efficacy, quality of nursing care, nurse-reported facilitators and barriers of adopting the programme, nurses' fidelity of providing the intervention as intended, and patients' safety (patients timely reporting of severe symptoms). We will use validated questionnaires for patient-reported outcomes, focus group interviews with nurses and individual interviews with oncologists. Linear mixed models will be used to analyse patient-reported outcomes. Focus group and individual interviews will be analysed by thematic analysis. ETHICS AND DISSEMINATION: The Symptom Navi© Pilot Study has been reviewed and approved by Swiss Ethic Committee Bern (KEK-BE: 2017-00020). Results of the study will be disseminated in peer-reviewed journal and at scientific conferences. TRIAL REGISTRATION NUMBER: NCT03649984; Pre-results.

14.
Trials ; 20(1): 386, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253188

RESUMO

BACKGROUND: Improving patient safety is a major goal in healthcare systems worldwide. There are several international training programs to improve patient safety, but they are often focused on single topics and professions. Therefore, one inter-professional training program for inpatient care teams, which combines key areas of patient safety (Teamwork, Error management and Patient involvement), was developed by our research group. In the present study we aim to (1) pilot this training program by comparing two different training formats (e-learning only versus blended learning) with a waiting control group and (2) evaluate the feasibility of the intervention. METHODS AND ANALYSIS: (1) To pilot the intervention a cluster randomized controlled trial will be performed at three study sites. Therefore, an e-learning group and a blended learning group will be compared to a waiting control group at three points of assessment; (2) The feasibility of the intervention will be evaluated using qualitative methods. We will conduct problem-focused individual interviews as part of the post-intervention measurement in order to collect information on acceptance, implementation, promoting factors and barriers from the staffs' perspective. DISCUSSION: The study puts forth a training program which has the potential to improve patient safety in inpatient care. Members of inter-professional inpatient care teams can receive systematic training in three competencies which are central to patient safety management. Thus, we expect the greatest improvement in staff Safety-related behavior regarding Teamwork, Error management and Patient involvement as well as Subjectively perceived patient safety in the blended learning group. In addition, the development of an optimal implementation strategy can foster implementation of the intervention in healthcare practice. Consequently, the intervention could be used continuously and comprehensively for advanced training of hospital staff. TRIAL REGISTRATION: The study has been registered in the German Register of Clinical Trials ( DRKS-ID: DRKS00012818 ). Registered on August 8, 2017.


Assuntos
Pacientes Internados , Capacitação em Serviço , Equipe de Assistência ao Paciente , Segurança do Paciente , Recursos Humanos em Hospital/educação , Gestão da Segurança/métodos , Atitude do Pessoal de Saúde , Estudos de Viabilidade , Alemanha , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comunicação Interdisciplinar , Estudos Multicêntricos como Assunto , Participação do Paciente , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
J Patient Saf ; 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30889050

RESUMO

OBJECTIVES: In recent years, several instruments for measuring patient safety culture (PSC) have been developed and implemented. Correct interpretation of survey findings is crucial for understanding PSC locally, for comparisons across settings or time, as well as for planning effective interventions. We aimed to evaluate the influence of gender, profession, and managerial function on perceptions of PSC and on the interplay between various dimensions and perceptions of PSC. METHODS: We used German and Swiss survey data of frontline physicians and nurses (n = 1786). Data analysis was performed for the two samples separately using multivariate analysis of variance, comparisons of adjusted means, and series of multiple regressions. RESULTS: Participants' profession and managerial function had significant direct effect on perceptions of PSC. Although there was no significant direct effect of gender for most of the PSC dimensions, it had an indirect effect on PSC dimensions through statistically significant direct effects on profession and managerial function. We identified similarities and differences across participant groups concerning the impact of various PSC dimensions on Overall Perception of Patient Safety. Staffing and Organizational Learning had positive influence in most groups without managerial function, whereas Teamwork Within Unit, Feedback & Communication About Error, and Communication Openness had no significant effect. For female participants without managerial functions, Management Support for Patient Safety had a significant positive effect. CONCLUSIONS: Participant characteristics have significant effects on perceptions of PSC and thus should be accounted for in reporting, interpreting, and comparing results from different samples.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

17.
Swiss Med Wkly ; 149: w20033, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30905060

RESUMO

AIM: The levels of teamwork and clinician burnout in healthcare differ depending on demographic and unit characteristics. However, the impact of these characteristics varies between clinical settings. In addition, the impact of objectively measured workload in such settings is largely unknown. The aim of this study was to analyse the predictive role of demographic (e.g., professional experience) and unit (e.g., unit size) characteristics, and workload (e.g., nursing interventions) in explaining teamwork and clinician burnout in Swiss intensive care units (ICUs). METHODS: This was as cross-sectional multi-source study. Participants were 1148 nurses and 243 physicians working in 55 ICUs. They provided demographic information and answered a questionnaire on teamwork and clinician burnout. In addition, unit characteristics and surrogate measures of workload were extracted from a central database that accumulates patient and unit data routinely collected by the ICUs. We conducted multilevel regression analyses to detect relationships between study variables. RESULTS: Clinicians who worked predominantly dayshifts reported better teamwork and lower burnout. Physicians and clinicians in leadership positions also reported better teamwork. Clinicians in leadership positions furthermore reported higher personal accomplishment, whereas clinicians in training reported higher emotional exhaustion. Of the unit characteristics, workload was positively associated with self-reported burnout. Clinicians working in medical and surgical ICUs (compared with interdisciplinary and paediatric ICUs) reported higher emotional exhaustion. Clinicians working in university hospitals and in surgical/medical ICUs reported lower teamwork quality and higher burnout. CONCLUSION: We identified several demographic and unit-based factors in Swiss ICUs that were associated with lower perceptions of the quality of teamwork and higher self-reported burnout. Discrepant experiences regarding the quality of teamwork based on professional role, professional status and experience might affect team effectiveness. Furthermore, this study showed the importance of workload management, as objectively measured workload was associated with higher self-reported burnout. Results suggested that certain clinician groups (e.g., working predominantly night shifts) were at higher risk for burnout, thus highlighting the importance of providing additional support to these groups. Lastly, special attention should be paid to medical and surgical ICUs, which reported the highest level of burnout. Because this is a cross-sectional study, no conclusions can be drawn regarding causal relationships.


Assuntos
Esgotamento Profissional/psicologia , Demografia , Unidades de Terapia Intensiva , Recursos Humanos de Enfermagem no Hospital/psicologia , Médicos/psicologia , Carga de Trabalho , Adulto , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Inquéritos e Questionários , Suíça
18.
BMC Health Serv Res ; 19(1): 53, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30665401

RESUMO

BACKGROUND: Promoting patient and occupational safety are two key challenges for hospitals. When aiming to improve these two outcomes synergistically, psychosocial working conditions, leadership by hospital management and supervisors, and perceptions of patient and occupational safety climate have to be considered. Recent studies have shown that these key topics are interrelated and form a critical foundation for promoting patient and occupational safety in hospitals. So far, these topics have mainly been studied independently from each other. The present study investigated hospital staffs' perceptions of four different topics: (1) psychosocial working conditions, (2) leadership, (3) patient safety climate, and (4) occupational safety climate. We present results from a survey in two German university hospitals aiming to detect differences between nurses and physicians. METHODS: We performed a cross-sectional study using a standardized paper-based questionnaire. The survey was conducted with nurses and physicians to assess the four topics. The instruments mainly consisted of scales of the German version of the COPSOQ (Copenhagen Psychosocial Questionnaire), one scale of the Copenhagen Burnout Inventory (CBI), scales to assess leadership and transformational leadership, scales to assess patient safety climate using the Hospital Survey on Patient Safety Culture (HSPSC), and analogous items to assess occupational safety climate. RESULTS: A total of 995 completed questionnaires out of 2512 distributed questionnaires were returned anonymously. The overall response rate was 39.6%. The sample consisted of 381 physicians and 567 nurses. We found various differences with regard to the four topics. In most of the COPSOQ and the HSPSC-scales, physicians rated psychosocial working conditions and patient safety climate more positively than nurses. With regard to occupational safety, nurses indicated higher occupational risks than physicians. CONCLUSIONS: The WorkSafeMed study combined the assessment of the four topics psychosocial working conditions, leadership, patient safety climate, and occupational safety climate in hospitals. Looking at the four topics provides an overview of where improvements in hospitals may be needed for nurses and physicians. Based on these results, improvements in working conditions, patient safety climate, and occupational safety climate are required for health care professionals in German university hospitals - especially for nurses.


Assuntos
Pessoal de Saúde/psicologia , Liderança , Segurança do Paciente , Gestão da Segurança , Adulto , Idoso , Esgotamento Profissional , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
19.
BMC Health Serv Res ; 19(1): 12, 2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621682

RESUMO

BACKGROUND: Patient centeredness is an important component of patient care and healthcare quality. Several scales exist to measure patient centeredness, and previous literature provides a critical appraisal of their measurement properties. However, limited knowledge exists regarding the content of the various scales in terms of what type of patient centeredness they represent and how they can be used for quality improvement. The aim of this study was to explore the measurement properties of patient centeredness scales and their content with a special focus on patient involvement, and assess whether and how they can be used for quality improvement. METHODS: A systematic review of patient centeredness scales was conducted in Medline, CINAHL, Embase, and SCOPUS in April and May 2017. Inclusion criteria were limited to articles written in English published from 2005 to 2017. Eligible studies were critically appraised in terms of internal consistency and reliability, as well as their content, structural, and cross-cultural validity. Type of studies included were scale-development articles and validation studies of relevant scales, with healthcare personnel as respondents. We used directed content analysis to categorize the scales and items according to Tritter's conceptual framework for patient and public involvement. RESULTS: Eleven scales reported in 22 articles were included. Most scales represented individual, indirect, and reactive patient involvement. Most scales included items that did not reflect patient centeredness directly, but rather organizational preconditions for patient centered practices. None of the scales included items explicitly reflecting the use of patient experiences of quality improvement. CONCLUSIONS: There is a lack of patient centeredness scales focusing on direct and proactive involvement of patients in quality improvement. It would be useful to develop such instruments to further study the role of patient involvement in quality improvement in healthcare. Furthermore, they could be used as important tools in quality improvement interventions.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Participação do Paciente/estatística & dados numéricos , Melhoria de Qualidade/normas , Pessoal de Saúde , Humanos , Reprodutibilidade dos Testes , Estudos de Validação como Assunto
20.
J Nurs Care Qual ; 34(1): E1-E7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29346187

RESUMO

BACKGROUND: A safe and efficient patient handover is important to ensure high-quality patient care and reduce the risk of patient harm. Few studies have explored handover activities beyond information transfer. PURPOSE: The aims were to assess overall postoperative handover quality and relate quality assessments to handover circumstances, conduct, and teamwork and to compare transferring and receiving nurses' evaluations of handover quality. METHOD: This was a cross-sectional study using the Norwegian Handover Quality Rating Form (N-HQRF). In addition, data were collected on nurses' evaluations of the patient condition, handover preparation, and participating nurses' clinical experience. RESULTS: Although total perceived handover quality was high in a large majority of cases, there were significant differences between transferring and receiving nurses' evaluations of the same handover. Lower-quality handovers had a higher frequency of time pressure, uncertainty, and patient-related problems. CONCLUSION: The findings point to the need to assess handover quality in a wider perspective. Handover circumstances might impact handover quality and should be considered when procedures for handover quality are designed and implemented.


Assuntos
Comunicação , Papel do Profissional de Enfermagem/psicologia , Transferência da Responsabilidade pelo Paciente , Percepção , Cuidados Pós-Operatórios/enfermagem , Estudos Transversais , Humanos , Noruega , Segurança do Paciente , Inquéritos e Questionários
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