Identifying self-presentation components among nursing students with unsafe clinical practice: a qualitative study.

BACKGROUND: Maintaining patient safety is a practical standard that is a priority in nursing education. One of the main roles of clinical instructors is to evaluate students and identify if students exhibit unsafe clinical practice early to support their remediation. This study was conducted to identify self-presentation components among nursing students with unsafe clinical practice. METHODS: This qualitative study was conducted with 18 faculty members, nursing students, and supervisors of medical centers. Data collection was done through purposive sampling and semi-structured interviews. Data analysis was done using conventional qualitative content analysis using MAXQDA10 software. RESULTS: One main category labelled self-presentation emerged from the data along with three subcategories of defensive/protective behaviors, assertive behaviors, and aggressive behaviors. CONCLUSION: In various clinical situations, students use defensive, assertive, and aggressive tactics to maintain their professional identity and present a positive image of themselves when they make a mistake or predict that they will be evaluated on their performance. Therefore, it seems that the first vital step to preventing unsafe behaviors and reporting medical errors is to create appropriate structures for identification, learning, guidance, and evaluation based on progress and fostering a growth mindset among students and clinical educators.

Nurses' perspectives of recognising and responding to unsafe practice by their peers: A national cross-sectional survey.

AIMS: This study aimed to identify behaviours and cues that nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and actions nurses take in response. DESIGN: Cross-sectional survey. METHODS: National cross-sectional survey of a random sample of registered nurses (n = 231) in New Zealand, in 2017-2018. The STROBE Checklist was used to report this study. RESULTS: Nurses reported a high rate of episodes of unsafe practices and recognised a range of behaviours and cues that alerted them to the potential for unsafe practice. Several organisational issues were perceived to contribute to unsafe practice occurring. The reporting of episodes of unsafe practice and perceived organisational support was low for nurses compared with managers. CONCLUSION: Failure to recognise and respond to unsafe practice may indicate a tolerance for substandard practice by individual nurses, or by the organisation. Nurses who recognise unsafe practice must be supported by the organisation.

Common risky behaviours checklist: a tool to assist nurse supervisors to assess unsafe practice.

AIM: To describe the development of the Common Risky Behaviour Checklist, a tool to aid nurse supervisors in determining when a nurse may be questionably fit to perform, particularly in cases of substance abuse. BACKGROUND: A significant number of nurses may have substance use disorders that could manifest as unsafe performance at work, and nurse supervisors lack the tools to assess a nurse's fitness to perform at work. METHOD: Job analysis techniques were used to identify the critical impairment behaviours for the tool. Job analysis is a legally defensible, multi-stage process used in the organisational psychology field to develop work performance assessments. RESULTS: A screening tool was developed for nurse supervisors to assess when a nurse may be questionably fit to perform. CONCLUSION: The development of this checklist is one of several needed advancements in order to address the issue of fitness to perform and patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: The Common Risky Behaviour Checklist offers nurse managers assistance in protecting patient safety by providing a quick (one-page), systematic, behaviour-based method to collect information that can inform urgent decisions, trigger performance corrections and can complement formal organisational documentation processes in cases of unsafe practice due to substance abuse.

Nurses' recognition and response to unsafe practice by their peers: A qualitative descriptive analysis.

BACKGROUND: Unsafe practice is an important issue for the nursing profession however few studies have sought to identify how nurses recognise and respond to unsafe practice. OBJECTIVES: To identify the behaviours and cues that registered nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and action nurses take in response. DESIGN: Qualitative descriptive study. SETTINGS: New Zealand health care settings. PARTICIPANTS: New Zealand registered Nurses (n = 13). METHODS: Data were collected via semi-structured interviews and analysis was conducted using constant-comparative and thematic analysis. RESULTS: Nurses identified a range of behaviours, cues, contributing factors and responses to unsafe practice. Three themes emerged from the data: Uncertainty, 'sensing' unsafe practice and disrupted professionalism. CONCLUSION: Understanding the challenges nurses face every day in recognising and responding to unsafe practice in increasingly complex nursing contexts is key to understanding how unsafe practice may be further addressed in clinical practice. Nurses in this study recognised overtly unsafe behaviour and subtle cues as indications of unsafe practice. Participants also identified factors which they perceived contributed to the occurrence of unsafe practice including high workloads and poor skill mix as well as organisational cultures that failed to support safe practice.

Epileptic seizure first aid practices of publics in Northwest Ethiopia 2021: Unsafe practices of nearly three-fourths of the community.

Background: Religious and sociocultural beliefs influence how people with epilepsy (PWE) are treated and cared for. Many communities in Africa and other developing countries, including Ethiopia, believe that epilepsy is caused by evil spirits and should be treated with herbal plants by traditional doctors and religious leaders. The combination of these sociocultural beliefs and the level of community awareness of epilepsy affect first aid practices in the management of epileptic seizures. Objective: This study aimed to assess epileptic seizure first aid practice of public and its associated factors in Northwest Ethiopia, south Gondar zone, Amhara, Ethiopia 2021. Methods: A community-based cross-sectional study was conducted using a previously adapted standard questionnaire. A multistage cluster sampling technique was applied. A total of 756 participants were approached and 741 respondents completed the questionnaire with a response rate of 98.02%. Data were entered into Epi data version 4.4.2 and then exported to Statistical Package for Social Science (SPSS) version 24 for analysis. Descriptive and analytical statistical procedures and bivariable and multivariable binary logistic regressions with odds ratios and 95% confidence interval (CI) were employed. The level of significance of the association was determined at p < 0.05. Results: Overall, 71.7% (95%CI: 68.3, 74.9) of the south Gondar community had unsafe practice measures in managing patients with seizure episodes. Individuals who were illiterate [adjusted odd ratio (AOR) = 1.99, 95%CI: 1.00.3.97] and participants who did not take training related to epilepsy (AOR = 2.07, 95%CI: 1.35, 3.17) and had poor knowledge about (AOR = 1.51, 95%CI: 1.06, 2.14) and a negative attitude toward epilepsy (AOR = 2.20, 95%CI: 1.50, 3.22) had unsafe practices compared to their counterparts. Conversely, participants who reached secondary education had safe practice measures (AOR = 0.4, 95%CI: 0.26, 0.63) in the management of epileptic seizures. Conclusions: In this study, large numbers of the south Gondar community had unsafe practice measures in managing people with epileptic seizure episodes. Greater emphasis should be laid on individuals who were illiterate, in the provision of health education and/or training for the community to help them to acquire good knowledge about epilepsy and develop a positive attitude toward epilepsy.

Gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of malaysia.

To identify gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of Malaysia, we conducted a 20-item questionnaire interview on storage of pesticide (4 questions), mixing of pesticide (3 questions), use of personal protective equipment and clothing while spraying pesticide (7 questions), activities during and after spraying of pesticide (5 questions), and maintenance of pesticide sprayer (1 question) in 496 tobacco farmers (395 males and 101 females) in Bachok District, Kelantan, Malaysia. Duration of employment was significantly longer in females than those in males (p<0.001). In addition, proportion with no formal education in females was significantly higher than those in males (p<0.05). The following eight common factors were extracted from the 20 questionnaires by principal components factor analysis after varimax rotation in all farmers: (1) use of personal protective equipment, (2) unsafe work habit, (3) reading and following instructions on pesticide label, (4) security, storage and disposal of pesticide container, (5) safe work habit, (6) proper handling of pesticide and maintenance of pesticide sprayer, (7) use of personal protective clothing, and (8) safe handling of pesticide. Results of analysis of covariance for the eight factor scores of all male and female farmers, controlling for educational level and duration of employment, showed that: (1) factor scores for use of personal protective equipment (p<0.001), use of personal protective clothing (p<0.001) and safe work habit (p<0.001) in females were significantly lower than those in males; (2) conversely, factor scores for reading and following instruction on pesticide label (p<0.001) and proper handling of pesticide and maintenance of pesticide sprayer (p<0.01) in males were significantly lower than those in females; and (3) there were no significant differences in other three factor scores (p>0.05). We therefore conclude that: (1) for female tobacco farmers, choice of personal attire tend to result in lower scores on use of personal protective equipment and personal protective clothing while personal hygiene practices result in lower score on safe work habit; and, (2) for male tobacco farmers, the lower scores on reading and following instruction on pesticide label and mixing pesticide and maintenance of pesticide sprayer in good condition suggests that they were not primarily involved in these activities. It is postulated that these differences in safe and unsafe practices of pesticide handling across gender is related to the choice of personal attire, personal hygiene practices and division of labour within farming households which in turn is influenced by prevailing sociocultural norms in the community.