Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective

Background : Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre‐transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. Objectives : To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre‐transfusion checking behaviours. Measures : A cross‐sectional design was employed assessing willingness to participate in pre‐transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1–7. Participants : One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. Results : Mean scores for patients' willingness to participate in safety‐relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4·96–6·27 to 4·53–6·66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. Conclusion : Overall, both patients and healthcare professionals view patient involvement in transfusion‐related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety.     

急诊科护士对患者参与患者安全认知现状调查分析

目的了解急诊科护士对患者参与患者安全的认知状况及存在的阻碍因素,为制订具体有效干预策略提供依据。方法采用护理人员对患者参与患者安全认知现状调查表于2016年9月对陕西省34所医院的735名急诊护士进行调查。结果急诊护士对患者参与患者安全的整体认知得分为(3.74±0.48)分,在具体参与内容上,护士感知的患者现实参与方面,决策性参与(3.90±0.68)分高于照护性参与(3.89±0.70)分,并高于诉求性参与(3.55±0.93);而在护士对患者参与的支持和鼓励方面,照护性参与条目均分均高于决策性参与,并高于诉求性参与,患者参与患者安全存在的障碍因素,急诊科护士认为媒体有失公正的报道和患者疾病相关的认知水平占主要因素。结论急诊科护士认为患者参与患者安全的利大于弊,建议未来应呼吁媒体客观报道,加强护患沟通,提升患者参与患者安全的能力及意愿,引导患者理性参与,充分发挥患者在保障患者安全方面的能动作用。     

Patients' and health care professionals' attitudes towards the PINK patient safety video

Rationale, aims and objectives Patients can play an important role in reducing health care harm. Finding strategies to encourage patients to take on an active role in issues related to the quality and safety of their care is therefore essential. The aim of this study was to examine patients' and health care professionals' attitudes towards a video aimed at promoting patient involvement in safety‐related behaviours. Method A within‐subjects design was used where participants were required to complete a questionnaire pre and post screening of a patient safety video. Participants are 201 patients aged 19–103 years (mean 52) and 95 health care professionals aged 23–48 years (mean 32). Main outcome measures include (i) patients' willingness to participate and perceived importance in participating in safety‐related behaviours; and (ii) health care professionals' willingness to support patient involvement. Results After watching the video patients elicited more positive attitudes towards asking doctors and nurses if they had washed their hands and notifying them about issues to do with personal hygiene. No significant effects were observed in relation to patients notifying staff if they have not received their medication or if they were in pain or feeling unwell. In relation to health care professionals, doctors and nurses were more willing to support patient involvement in asking about hand hygiene after they had watched the video. Conclusion Video may be effective at changing patients' and health care professionals' attitudes towards patient involvement in some, but not all safety‐related behaviours. Our findings suggest video may be most effective at encouraging involvement in behaviours patients are less inclined to participate in and health care professionals are less willing to support.     

Registered Nurses’ experiences of patient participation in hospital care: supporting and hindering factors patient participation in care

Background

Promoting patient participation in care is an international priority identified by the World Health Organization and various national bodies around the world and an important aspect of person‐centred care.

Aim

The aim of this study was to describe Registered Nurses’ experiences with patient participation in nursing care including their barriers and facilitators for participation.

Method

The study setting was a University Hospital in Sweden. Interviews were conducted with twenty Registered Nurses working at medical wards in 2013. Thematic data analysis was used to analyse the transcribed interview data.

Results

Twenty nurses from four wards in two hospitals were included. Five themes emerged from the analysis including listening to the patient, engaging the patient, relinquishing some responsibility, sharing power and partnering with patients. The core theme ‘partnering with patients’ was enacted when nurses listened to and engaged patients and when they relinquished responsibility and shared power with patients. In addition, hindering and facilitating factors to participation were identified, such as patients wanted to take on a passive role, lack of teamwork which participants understood would enhance interprofessional understanding and improve patient safety. Patient participation was hindered by medical jargon during the ward round, there was a risk of staff talking over patients’ heads but sometimes inevitable having conversations at the patient's bedside. However, nurses preferred important decisions to be made away from bedside.

Conclusions

It all came down to partnering with the patient and participants described how they made an effort to respect the patients’ view and accept patient as a part of the care team. Identified hindering factors for participation were lack of teamwork, patients’ taking on passive roles and communication during ward rounds having conversations at the patient's bedside. Nurses wished for a change but lacked strategies on how. Nurses preferred important decisions to be made away from bedside.

     

Patient participation in clinical decision-making in nursing: A comparative study of nurses' and patients' perceptions

Aims and objectives. The aim of this study was to compare the degree of concordance between patients and Registered Nurses’ perceptions of the patients’ preferences for participation in clinical decision‐making in nursing care. A further aim was to compare patients’ experienced participation with their preferred participatory role. Background. Patient participation in clinical decision‐making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients’ preferences. Methods. A comparative design was adopted with a convenient sample of 80 nurse–patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. Results. A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision‐making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. Conclusions. Registered Nurses are not always aware of their patients’ perspective and tend to overestimate patients’ willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision‐making in nursing care according to their own perceptions and not even to the patients’ more moderate preferences of participation. Relevance to clinical practice. A thorough assessment of the individual's preferences for participation in decision‐making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.     

Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review

Pro re nata (PRN) medication is widely used and studied in psychiatric care, but our knowledge about patient participation in its administration is fragmented. The aim of this integrative review was to describe and synthesize previous knowledge of patient participation in PRN in psychiatric inpatient settings. We conducted both electronic and manual searches, using the CINAHL, Scopus, PsycINFO, and PubMed databases, and eight scientific journals. Searches were limited to the English language, to the years 2006–2016, and to selected papers using inclusion, exclusion, and quality criteria. We identified 16 relevant papers, and these showed that patient participation included patient‐related starting points, including the patients’ willingness to participate and their knowledge of the medication. The patients’ participation in PRN practices was demonstrated by the opportunity to request PRN and to refuse any PRN that was offered. Patient participation was shown to be linked to certain situations where PRN was recommended. The role that the professionals played in patient participation included interacting with patients, providing counselling and alternatives for PRN. Our results also revealed that coercion was used administering PRN. The existing literature exposed challenges that need to be addressed if patient participation in the use of PRN medication is to be effectively achieved in psychiatric inpatient settings. Equal partnerships between patients, nurses, and physicians are an essential part of this process, and further research into PRN medication is urgently needed, particularly studies that focus on patients’ experiences.     

The medical student as a patient: attitudes towards involvement in the quality and safety of health care

Background In recent years, factors that affect patients' willingness and ability to participate in safety‐relevant behaviours have been investigated. However, how trained healthcare professionals or medical students would feel participating in safety‐relevant behaviours as a patient in hospital remains largely unexplored. Objectives To investigate medical students' willingness to participate in behaviours related to the quality and safety of their health care. Design A cross‐sectional exploratory study using a survey that addressed willingness to participate in different behaviours recommended by current patient safety initiatives. Three types of interactional behaviours (asking factual or challenging questions, notifying doctors or nurses of errors/problems) and three non‐interactional behaviours (choosing a hospital based on the safety record, bringing medicines and a list of allergies into hospital, and reporting an error to a national reporting system) were assessed. Participants One hundred and seventy‐nine medical students from an inner city London teaching hospital participated in the study. Findings Students' willingness to participate was affected (P < 0.05) by the action required by the patient and (for interactional behaviours) whether the patient was engaging in the specific action with a doctor or nurse. Students were least willing to ask ‘challenging’ questions to doctors and nurses and to report errors to a national reporting system. Doctors' and nurses' encouragement appeared to increase self‐reported willingness to participate in behaviours where baseline willingness was low. Conclusion Similar to research on lay patient populations; medical students do not view involvement in safety‐related behaviours equally. Interventions should be tailored at encouraging students to participate in behaviours they are less inclined to take on an active role in. Future research is required to examine students' motivations for participation in this important but heavily under‐researched area.     

Perceived adverse patient outcomes correlated to nurses’ workload in medical and surgical wards of selected hospitals in Kuwait

Aim. This study was carried out to identify the perceived adverse patient outcomes as related to nurses’ workload. It also assessed nurses’ perception of variables contributing to the workload and adverse patient outcomes. Background. Several studies have been published on adverse patient outcomes in which a correlation was found between nurses’ workload and some adverse patient outcomes. Design. A cross‐sectional survey was conducted between registered nurses (n = 780) working in medical and surgical wards of five general governmental hospitals in Kuwait. Data collection instruments. Data were collected using a self‐administered questionnaire consisting of three sections to elicit information about the sample characteristics, perception of workload and perceived adverse patient outcomes during the last shift and last working week. Results. The three major perceived adverse outcomes reported by the nurses while on duty during their last shift were: complaints from patients and families (2%), patients received a late dose or missed a dose of medication (1·8%) and occurrences of pressure ulcer (1·5%). Similarly, the reported adverse outcomes over the past week were complaints from patients and families (5%), patients received a late dose or missed a dose of medication (5·3%) and discovery of a urinary tract infection (3·7%). Increases in nurse‐patient load, bed occupancy rate, unstable patients’ condition, extra ordinary life support efforts and non‐nursing tasks; all correlated positively with perceived adverse patient outcomes. Conclusion. This study sheds light on an important issue affecting patient safety and quality of care as perceived by the nurses themselves as caregivers. Relevance to clinical practice. Nurses’ perception of variables contributing to adverse patient outcomes and their workload could significantly affect the provided nursing care and nursing care recipients. The findings could help in policy formulation and planning strategies to decrease adverse patient outcomes in many countries with a health care structure similar to that of Kuwait.     

‘Promoting and preserving safety and a life‐oriented perspective’: A qualitative study of nurses’ interactions with patients experiencing suicidal ideation

Suicide prevention is an important imperative in psychiatric hospitals, where nurses have a crucial role in and make essential contributions to suicide prevention and promoting the recovery of patients experiencing suicidal ideation. The present qualitative grounded theory study aimed to uncover and understand the actions and aims of nurses in psychiatric hospitals during their interactions with patients experiencing suicidal ideation. Interviews were conducted with 26 nurses employed on 12 wards in four psychiatric hospitals. The data analysis was inspired by the Qualitative Analysis Guide of Leuven. The findings show that nurses’ actions and aims in their interactions with patients experiencing suicidal ideation are captured in the core element ‘promoting and preserving safety and a life‐oriented perspective’. This core element represents the three interconnected elements ‘managing the risk of suicide’, ‘guiding patients away from suicidal ideation’, and ‘searching for balance in the minefield’. The enhanced understanding of nurses’ actions and aims can inform concrete strategies for nursing practice and education. These strategies should aim to challenge overly controlling and directing nursing approaches and support nurses’ capacity and ability to connect and collaborate with patients experiencing suicidal ideation.     

Patient participation in patient safety still missing: Patient safety experts' views

The aim of this study was to elicit patient safety experts' views of patient participation in promoting patient safety. Data were collected between September and December in 2014 via an electronic semi‐structured questionnaire and interviews with Finnish patient safety experts (n = 21), then analysed using inductive content analysis. Patient safety experts regarded patients as having a crucial role in promoting patient safety. They generally deemed the level of patient safety as ‘acceptable’ in their organizations, but reported that patient participation in their own safety varied, and did not always meet national standards. Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programmes for healthcare professionals. Patient participation in patient safety is still lacking in clinical practice and systematic actions are needed to create a safety culture in which patients are seen as equal partners in the promotion of high‐quality and safe care.     

Nurses' ethical perceptions about coercion

PURPOSE OF THE STUDY: The purpose of this study was to describe Finnish psychiatric nurses' ethical perceptions about coercive measures in acute psychiatric setting. METHODS: The data were collected with a questionnaire developed for this study. The sample included 170 Finnish psychiatric nurses on acute wards in five psychiatric hospitals. The data were analysed using frequency and percentage distributions, mean and standard deviations. The internal consistency of the instrument was explored with Cronbach's alpha. The association between the background variables and the sum score of the items of the questionnaire was tested with Mann-Whitney U-test and Kruskal-Wallis test. The open-ended question was analysed with content analysis. RESULTS: Some psychiatric nurses perceived coercive measures as ethically problematic. In particular, the implementation of forced medication (18%), four-point restraints (16%) and patient seclusion (11%) were perceived as ethically problematic. Female nurses and nurses who worked on closed wards perceived the measures to be more problematic than male nurses and nurses who did not work on closed wards. CONCLUSION: In Finland, special attention has been paid to ethical questions related to the care of psychiatric patients and to the enhancement of patients' rights, yet the majority of the nurses participating in the survey did not perceive coercive measures as ethically problematic. More research on this issue as well as further education of the personnel and more extensive teaching of ethics in nursing schools are needed to support the ability of the psychiatric personnel to identify ethically problematic situations. In addition, it is important to consider new measures for generating genuine moral reflection among the personnel on the usage of coercive measures as well as on their effectiveness and legitimacy in the psychiatric care.     

Nurses’ articulations of the patients’ role when the vision is partnership: A qualitative study

Although principles such as ‘patient participation’ and ‘patient involvement’ have become ideals in health‐care, they have proven to be difficult to apply in practice. In 2014, one Danish region issued an official document that included the vision of ‘the patient as partner’. However, little is known about how such a vision affects clinical practice. The purpose of this study was to investigate nurses’ views on how partnerships between them and patients are established considering this vision. We conducted semi‐structured interviews with eight nurses working in Danish hospitals. Then, we analysed the interviews in a Norman Fairclough‐inspired critical discourse analysis. During this three‐dimensional analysis, we identified three discourses. We found that a liberalistic discourse wins hegemony based on the nurses’ expectations of the patient's role. Nurses construct a picture of the patient's role, expecting the patient to be responsible and to participate. For the partnership to arise as envisioned, the patient is perceived as being dependent on the nurse's professional knowledge. Surprisingly, the nurses’ articulations of the patient's role were identical to the vision's elements. Therefore, we suggest that the vision reflects prevailing societal norms for individuals, thereby reflecting society's attitude towards people's responsibility for their own lives.     

Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards

There is disagreement among psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. This study explored patient, staff, and visitor perceptions about the acceptability of locking the ward door on acute psychiatric inpatient wards. Interviews were conducted with 14 registered nurses, 15 patients, and six visitors from three different acute wards. Findings revealed commonalities across all groups, with general agreement that locking the door reduced absconding. Staff expressed feelings of guilt, embarrassment, and fear of being blamed when a patient absconded. Staff also reported that open wards created anxious vigilance to prevent an abscond and increased workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door, expressing depression, a sense of stigma, and low self-esteem when the door was locked. The issue of balancing safety and security on acute psychiatric wards against the autonomy of patients is not easily resolved, and requires focused research to develop innovative nursing practices.     

Patient participation in hospital care: Nursing staffs' point of view

The aim was to investigate nursing staff's perceptions related to patient participation and the parameters affecting it during nursing care. A cross‐sectional study with both a quantitative and qualitative orientation was conducted. The sample consisted of all nursing staff working in medical and surgical wards in three Greek hospitals. A questionnaire was developed and the data were analysed with exploratory factor analysis, whereas content analysis was used for qualitative data. Nursing staff perceived participation as the process of information giving to patients, communication of symptoms by patients and compliance with the staff's orders. ‘Information providing’ and ‘ability to influence and responsibility’ were significant aspects of the content of participation, whereas the parameters affecting participation were related to patients, nursing staff and the care context. These results support patient engagement in dialogue and shared decision‐making, while highlighting the need to implement participation systematically and stimulate changes in nursing care organization.     

Spiritual support for terminally ill patients: nursing staff assessments

This study is part of a larger questionnaire survey concerned with the views of nursing staff on physical, emotional and spiritual support for terminally ill patients and decision making on the transition to the terminal phase of treatment. This article discusses the results concerning the spiritual support offered to terminally ill patients. The results describe the readiness and willingness of nursing staff to provide spiritual support, the expression of spiritual needs by patients, the provision of spiritual support, and problems occurring in providing this support. A total of 328 nurses working on the in-patient wards of 32 community health centres took part. Data were collected with a questionnaire including both multiple choice items and open-ended questions. The data were processed with SPSS software and the responses to the open-ended questions were interpreted using content analysis. The results revealed shortcomings in nurses' readiness and willingness to provide spiritual support and clearly highlighted the need for further training. Half of the nurses said they only rarely offered spiritual support to their patients. The nurses drew attention to problems within themselves, their patients and with the availability of the chaplain's services. The results also pointed to factors related to the health centre and nursing staff.     

Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China

Aims. The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context. Background. Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture‐based study about caring in nursing. Methods. A qualitative research design was used and 20 cancer patients were interviewed using a semi‐structured interview guide. A qualitative content analysis was used to identify themes in the data. Results. Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses’ caring attitudes and their professional responsibility for providing emotional support, nurses’ professional knowledge and their professional responsibility for providing informational support and nurses’ professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients’ needs. A model of caring in nursing was formulated. Conclusions. Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients. Relevance to clinical practice. Caring is manifested in nursing actions through nurse–patient communication process. Patients have their inner expectation for nurses’ caring behaviour and attitudes and nurses’ performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.