责任制整体护理模式对患者安全保障体系的作用

目的：探讨责任制整体护理模式在临床护理工作中对患者安全保障体系所产生的作用。方法：通过＂督导式＂的管理模式来指导护理工作;每名护理人员参加主任医师查房,能主次分明、重点突出地了解患者的病情。对于特殊病例、疑难病例通过会议的形式组织学习以提高护理人员的专业知识。还能明确各岗位护士的职责,护理服务内涵、服务目标和工作标准。结果：可提供一个安静、整洁、安全、有序的病房环境;又能很好落实患者的基础护理、安全管理制度,提高了护理质量、服务满意度。结论：责任制整体护理模式既可持续提高护理质量,又能很好的为患者的安全提供保障。     

Complementary therapy in critical care settings: a review of surveys and implications for nurses

Critical care nurses have been leaders in this field and need to further expand their influence in the work environment and healthcare system. The time is ideal for initiating meaningful system-wide changes in policy and practice. This review provides an historical context of surveys conducted in a variety of critical care settings in this country. It is important for nurses to become familiar with these studies to communicate better with others and make recommendations based on research. Critical care nurses can maintain their lead by becoming principal investigators in this area of research. In this day and age there is no reason to dismiss or arbitrarily evaluate the use of CAM. Consumer use does not end when crossing over the threshold of a healthcare setting. The focus should be equally spread over safety issues and modalities that can enhance an individual's quality of life. The staff has an ethical and legal responsibility to be aware of and knowledgeable about any healthcare modality practiced by their patients regardless of whether "sufficient" randomized, double-blind controlled studies have been completed.     

How can we improve the nursing work environment?

It has been suggested by many recently that the nursing work environment needs to be altered to make it more responsive to both nurse and patient needs. One essential aspect of this change would be to increase patient safety. This article suggests that to improve patient safety as well as satisfaction of nurses, the culture of the nursing organization should be transformed into one of a "learning organization." Using this model of an organization, every member of the nursing organization would be encouraged to reach his or her greatest potential, the welfare of the team would become paramount, and a shared vision of where the organization needs to go would emerge, thus maximizing productivity, safety, and job satisfaction for all healthcare team members. This transformation could mean that the terms "Nursing Organizations" and "Learning Organizations" would not have to be oxymorons.     

Implementing small tests of change to improve patient satisfaction

The Institute of Medicine supports proposed changes in the overall delivery of healthcare and the nurses' work environment to achieve improved patient outcomes and protect the public from unnecessary harm. Allowing nurses to have a voice in decision making and influence over their practice, in an environment that fosters autonomy and interdisciplinary collaboration, enhances nurse satisfaction while improving the quality of patient care. The authors describe how a pediatric medical unit engaged in small tests of change to improve communication and patient satisfaction on an inpatient unit.     

Nurses at the table: A naturalistic inquiry of nurses on governing boards

In an environment in which there is little or no nursing presence on governing boards in healthcare organizations (HCOs), physicians, and nonclinicians take responsibility for keeping the other board members apprised of the quality of patient care, including nursing‐generated, patient safety initiatives. Governing boards in HCOs are either not appointing nurses to governing boards or are not appointing nurses in numbers that are commensurate with the size and vital contributions of the profession. As a result, competent nursing professionals with an intimate understanding of quality care and patient safety are not in decision‐making roles that may redesign health care and improve patient care. The purpose of this qualitative study was to describe experiences of nurse board members who hold governing board appointments in HCOs, and to describe the facilitators of and barriers to holding governing board appointments, as experienced by those nurse board members. This novel research employed naturalistic inquiry to explore the experiences of 12 nurse board members who held appointments with voting privileges in HCOs. From the interview data emerged four distinct themes: leveraging relationships and networking, valuing the mission of the board, feeling respected for my participation, and committing to board work. Facilitators of and barriers to governing board appointments were suggested. Findings validated the few previous research studies found in the literature and have implications for nursing leadership and governance.     

Healthy work environments: a validation of the literature

Nursing leaders are under intense pressure to ensure that safety and quality exist at every point of service. Landmark reports set forth many calls to action to transform systems and processes of care to improve healthcare delivery. Evidence indicates that healthy work environments (HWEs) are at the heart of the solutions to significantly affect patient outcomes and professional nursing practice. Findings from an HWEs literature review and focus groups indicate that nursing leaders must prioritize efforts to improve the culture in the work environment. Three elements emerged to help nursing leaders set the tone and standard of practice for HWEs: (1) effective communication, (2) collaborative relationships, and (3) promoting decision making among nurses.     

The pull of magnetism: a look at the standards and the experience of a western academic medical center hospital in achieving and sustaining Magnet status

Many hospitals are working to improve the work environment for their staff. Research has indicated a linkage between work environment characteristics and patient outcomes and this research along with the nursing shortage has been the impetus for focusing on improving the work environment. The authors described the experience of an academic medical center hospital in achieving Magnet hospital status. The process and the required resources and support are discussed. Outcome data from staff nurses regarding their perception of the work environment in a Magnet hospital are presented.     

Performance obstacles of intensive care nurses

BACKGROUND: The work environment of intensive care nurses may have substantial impact on both nursing outcomes and patient safety. The factors in a nurse's immediate work environment, in the local work context, have not been studied in detail to provide useful, specific information for work redesign efforts to improve nurse's work and patient safety. Performance obstacles are the factors that hinder intensive care nurses' capacity to perform their jobs and that are associated closely with their immediate work environment. OBJECTIVES: To identify the performance obstacles experienced by intensive care nurses in their work environment. METHODS: A multisite, cross-sectional study was conducted. Data were collected using a 36-item questionnaire and analyzed using univariate statistical analysis. The frequencies of performance obstacles reported by intensive care nurses were computed. RESULTS: Nurses (n = 272) from 17 intensive care units (ICUs) of seven hospitals in Wisconsin participated in the study. The most frequently experienced performance obstacles included noisy work environment (46%), distractions from families (42%), hectic (40%) and crowded work environments (37%), delay in getting medications from pharmacy (36%), spending considerable amount of time teaching families (34%), equipment not being available-someone else using it (32%), patient rooms not well-stocked (32%), insufficient workspace for completing paperwork (26%), seeking for supplies (24%) or patients' charts (23%), receiving many phone calls from families (23%), delay in seeing new medical orders (21%), and misplaced equipment (20%). DISCUSSION: Intensive care nurses experience a variety of performance obstacles in their work environment. Future research should investigate the impact of various performance obstacles on nursing workload, nursing quality of working life, and quality and safety of care, as well as the impact of interventions aimed at redesigning the work system of ICU nurses to remove performance obstacles.     

Authentic leaders creating healthy work environments for nursing practice.

Implementation of authentic leadership can affect not only the nursing workforce and the profession but the healthcare delivery system and society as a whole. Creating a healthy work environment for nursing practice is crucial to maintain an adequate nursing workforce; the stressful nature of the profession often leads to burnout, disability, and high absenteeism and ultimately contributes to the escalating shortage of nurses. Leaders play a pivotal role in retention of nurses by shaping the healthcare practice environment to produce quality outcomes for staff nurses and patients. Few guidelines are available, however, for creating and sustaining the critical elements of a healthy work environment. In 2005, the American Association of Critical-Care Nurses released a landmark publication specifying 6 standards (skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership) necessary to establish and sustain healthy work environments in healthcare. Authentic leadership was described as the "glue" needed to hold together a healthy work environment. Now, the roles and relationships of authentic leaders in the healthy work environment are clarified as follows: An expanded definition of authentic leadership and its attributes (eg, genuineness, trustworthiness, reliability, compassion, and believability) is presented. Mechanisms by which authentic leaders can create healthy work environments for practice (eg, engaging employees in the work environment to promote positive behaviors) are described. A practical guide on how to become an authentic leader is advanced. A research agenda to advance the study of authentic leadership in nursing practice through collaboration between nursing and business is proposed.     

Work environmental factors and retention of nurses

Perceptions of the work environment were studied among acute care nurses working in a large county hospital who left their units during an 18-month period, compared to those who stayed. Analysis using Moos' work environment subscales suggests that the nurses who remained in their units perceived less work pressure and had greater perception of peer cohesion, supervisor support, and autonomy than nurses who left. Moos' Work Environment Scale suggests that a supportive work environment enables nurses to provide quality patient care, enhance their own self-esteem, increase job satisfaction, and provide cost savings to their employers. Such an environment promotes retention of skilled, caring, knowledgeable, and experienced nurses who provide better patient care with fewer complications, and reduces the economic and social costs of healthcare for both providers and consumers.     

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey

Objective: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness.

Design: Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience.

Results: Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N?=?470) and triage nurses (N?=?189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors.

Conclusions: Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents’ profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture.

• Key Points

• Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that:

• ??healthcare providers in Dutch GP cooperatives perceive patient safety culture positively;

• ??triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals – on several patient safety culture factors; and

• ??within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.

     

Reformation of the nursing administration and management system

In today's rapidly changing healthcare environment, nursing administrators and managers must enhance their abilities to anticipate and manage change in order to minimize the impact of such on healthcare delivery systems. To maintain patient care quality, nursing leaders should be familiar with change trends and implement innovative strategies that improve the work environment for nurses. This paper describes current major challenges faced by nursing administrators and introduces the concept of change and related strategies and available change management tools. This paper used five core competencies proposed by the Institute of Medicine (IOM) to illustrate and share experiences of managing change in clinical settings.     

Accidental extubation in intensive care units: what implications for nursing care?

Unplanned extubations are defined as unwelcome extubations. The phenomenon is classified in "accidental extubation", if occurring during procedures performed by healthcare workers, or in "self extubation", if the patient removes the endotracheal tube. Unplanned extubations are increasingly being considered an indicator of healthcare quality in ICU. Their rate varies from 3% to 14% of the intensive care units patients, the highest percentages being in burn units (27%). Re-intubations rate varies from 31% to 74%, determining increased length of hospitalisations without affecting mortality rates. Analysis of the local setting is required to improve the safety and quality of care, in order to plan appropriate measures, such as staff education. Preventive strategies include: increasing safety during nursing interventions, research for risk indicators of self-extubation, patient's comfort and sedation protocols, and finally alternative methods to physical and pharmacological restraints. The relationship between unplanned extubations and nursing workload can be used as indicator for the optimization of staff resources in intensive care unit.     

Hospital nursing organizational factors,nursing care left undone,and nurse burnout as predictors of patient safety: A structural equation modeling analysis

BackgroundPromotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian’s Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.ObjectiveThe objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.DesignThis was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.MethodsWork environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses’ perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.ResultsThe findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.ConclusionsImproving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.     

Clinical supervision for mental health nurses in Northern Ireland: formulating best practice guidelines

Nurses work in a constantly challenging and changing environment. Within this context, there is a continuing need for support. Such support will help increase morale, decrease strain and burnout, and encourage self-awareness and self-expression. Clinical supervision address all these issues and enhances the quality of care for patients. While clinical supervision is a policy imperative in Northern Ireland, it was clear that there were problems in its implementation in mental health nursing. The aim of this project was to explore ways to make clinical supervision available to all mental health nurses and to improve and evaluate their contribution to patient care. The research team undertook a comprehensive literature review and a baseline survey of relevant stakeholders. Results represent the outcome of the group work. They will assist healthcare providers to develop local policies and procedures on clinical supervision for practising mental health nurses.     

The link between leadership and safety outcomes in hospitals

squires m., tourangeau a., spence laschinger h.k. & doran d . (2010) Journal of Nursing Management 18, 914–925
The link between leadership and safety outcomes in hospitals Aim To test and refine a model examining relationships among leadership, interactional justice, quality of the nursing work environment, safety climate and patient and nurse safety outcomes. Background The quality of nursing work environments may pose serious threats to patient and nurse safety. Justice is an important element in work environments that support safety initiatives yet little research has been done that looks at how leader interactional justice influences safety outcomes. Method A cross-sectional survey was conducted with 600 acute care registered nurses (RNs) to test and refine a model linking interactional justice, the quality of nurse leader–nurse relationships, work environment and safety climate with patient and nurse outcomes. Results In general the hypothesized model was supported. Resonant leadership and interactional justice influenced the quality of the leader–nurse relationship which in turn affected the quality of the work environment and safety climate. This ultimately was associated with decreased reported medication errors, intentions to leave and emotional exhaustion. Conclusions Quality relationships based on fairness and empathy play a pivotal role in creating positive safety climates and work environments. Implications for Nursing Management To advocate for safe work environments, managers must strive to develop high-quality relationships through just leadership practices.