Suffering in Silence: Medical Error and its Impact on Health Care Providers

Background

All humans are fallible. Because physicians are human, unintentional errors unfortunately occur. While unintentional medical errors have an impact on patients and their families, they may also contribute to adverse mental and emotional effects on the involved provider(s). These may include burnout, lack of concentration, poor work performance, posttraumatic stress disorder, depression, and even suicidality.

护理一般差错瞒报情况调查与分析

目的:了解护理人员发生护理差错后的瞒报情况及影响瞒报的因素,为建立护理安全管理文化提供依据.方法:自制调查问卷对广东省67 家医院402 个科室的护理人员进行调查,内容包括护理差错的发生情况、发生原因、瞒报情况、所在科室的责罚情况、影响主动上报的因素等.结果:71.1% 的护理人员曾经发生过护理差错,主动上报的只有42.3% ;其压力源主要来自"怕病人及家属知道后提意见或投诉"、"怕领导知道了批评,扣奖金"、"担心自己失面子"等.当发生一般差错时,50.5% 的科室只批评不扣奖金,41.3%的科室又批评又扣奖金;当发生严重差错时,不管是否主动报告,85.3% 的科室均有所责罚.结论:护理管理者应摒弃基于"个体认识观"的"苛责文化",根除护理人员担心"失面子"等心理障碍,建立无惩罚性的护理差错自愿报告系统,减少瞒报现象的发生.     

Attitudes of health care providers and students towards tattooed people

Attitudes of health care providers and medical and nursing students ( n =513) towards tattooed adults and adolescents were examined. No respondent group had mean scores reflecting a positive attitude towards tattooed persons. Overall, physicians (MDs) and registered nurses (RNs) rated tattooed people less positively than did students. Womens' attitudes were consistently less favourable than those of men, especially towards tattooed professional women. Attitudes towards tattooed adolescents were generally less positive than attitudes towards the adult groups. Research has found that negative attitudes impact patient care. This study suggests that tattooed persons, especially adolescents, may be at risk of being negatively perceived when they seek health care. Increased efforts are needed to assure that those with tattoos receive non-judgemental and sensitive care.     

Rethinking Traditional Emergency Department Care Models in a Post-Coronavirus Disease-2019 World

As the nursing shortage in United States emergency departments has drastically worsened since the coronavirus disease-2019 (COVID-19) pandemic, emergency departments have experienced increased rates of inpatient onboarding, higher rates of patients leaving without being seen, and declining patient satisfaction scores. This paper reviews the impacts of the coronavirus disease-2019 pandemic on the current nursing shortage and considers how various medical personnel (emergency nurse-extenders) can ameliorate operational challenges by redesigning emergency department systems. During the height of the coronavirus disease-2019 pandemic, the psychological effects of increased demand for emergency nurses coupled with the fear of coronavirus infection exacerbated nursing turnover rates. Health care workers who can be trained to augment the existing emergency department workforce include paramedics, Emergency Medical Technicians, emergency department technicians, ancillary staff, scribes, and motivated health sciences students. Utilizing non-nurse providers to fulfill tasks traditionally assigned to emergency nurses can improve emergency department flow and care delivery in a post-coronavirus disease-2019 world.     

Ageism among health care providers and interventions to improve their attitudes toward older adults: an integrative review

The purpose of this study was to review relevant literature on ageism among health care providers and assess interventions used to improve their attitudes toward older adults. Literature published between 1983 and 2011 was reviewed using the keywords attitudes, older adults, nursing, and nursing students using CINAHL, MEDLINE, and the Education Resources Information Center. Previous relevant research is discussed and includes studies categorized according to health care provider populations: (a) nurses, (b) nursing students, (c) medical students, and (d) direct care workers. Studies in nursing and medical professions that highlight ageism have been conducted; however, there is a gap in the literature concerning ageism among direct care workers. This often neglected, yet critical population of health care providers is essential to the care of older adults; recommendations regarding their training and mentoring are emphasized.     

Medical Error Identification,Disclosure, and Reporting: Do Emergency Medicine Provider Groups Differ?

Objectives: To determine if the three types of emergency medicine providers—physicians, nurses, and out‐of‐hospital providers (emergency medical technicians [EMTs])—differ in their identification, disclosure, and reporting of medical error. Methods: A convenience sample of providers in an academic emergency department evaluated ten case vignettes that represented two error types (medication and cognitive) and three severity levels. For each vignette, providers were asked the following: 1) Is this an error? 2) Would you tell the patient? 3) Would you report this to a hospital committee? To assess differences in identification, disclosure, and reporting by provider type, error type, and error severity, the authors constructed three‐way tables with the nonparametric Somers' D clustered on participant. To assess the contribution of disclosure instruction and environmental variables, fixed‐effects regression stratified by provider type was used. Results: Of the 116 providers who were eligible, 103 (40 physicians, 26 nurses, and 35 EMTs) had complete data. Physicians were more likely to classify an event as an error (78%) than nurses (71%; p = 0.04) or EMTs (68%; p < 0.01). Nurses were less likely to disclose an error to the patient (59%) than physicians (71%; p = 0.04). Physicians were the least likely to report the error (54%) compared with nurses (68%; p = 0.02) or EMTs (78%; p < 0.01). For all provider and error types, identification, disclosure, and reporting increased with increasing severity. Conclusions: Improving patient safety hinges on the ability of health care providers to accurately identify, disclose, and report medical errors. Interventions must account for differences in error identification, disclosure, and reporting by provider type.     

The evolving role of nurses in primary care medical settings

The role of nurses in primary care is understudied. The purpose of this study was to describe the current registered nurse (RN) role in three Primary Care Networks (PCNs) in western Canada and to identify opportunities for optimal utilization of RNs in these settings. Case study methodology included interviews and document review. Although the RN role evolved during the study, most RNs focused on chronic disease management. Role ambiguity was evident between nurses and with interprofessional team members. Relationships of RNs to other providers, particularly physicians, impacted the enactment of the nursing role. Other barriers to role enactment included physician fee‐for‐service remuneration, management structures and processes, lack of access to electronic medical records and lack of previous opportunities to apply primary health‐care education in the practice setting. Further work is needed to optimize the RN role in primary care to ensure maximum impact for patients, providers and the health system overall.     

Second victim phenomenon: Is ‘just culture’ a reality? An integrative review

BackgroundDespite rigorous and multiple attempts to establish a culture of patient safety and a goal to decrease incidence of patient deaths in the health care, estimations of preventable mortality due to medical errors varied widely from 44,000 to 250,000 in hospital settings. This magnitude of medical errors establishes patient safety as being at the forefront of public concerns, healthcare practice and research. In addition to the potential negative impact on patients and the healthcare system, medical errors evoke intense psychological responses in health care providers' responses that threaten their personal and professional selves, and their ability to deliver high quality patient care. Studies show half of all hospital providers will suffer from second victim phenomena at least once in their careers. Health care institutions have begun a paradigm shift from blame to fairness, referred to as ‘just culture’. ‘Just culture’ better ensures that a balanced, responsible approach for both providers who err and healthcare organizations in which they practice, and shifts the focus to designing improved systems in the workplace.ObjectivesThe aim of this review was to identify: how medical errors affect health care professionals, as second victims; and how health care organizations can make ‘just culture’ a reality.DesignAn integrative review was performed using a methodical three-step search on the concept of second victims' perceptions and responses, as well as ‘just culture’ of health care institutions.ResultsA total of 42 research studies were identified involving health care professionals: 10 qualitative studies; eight mixed-method studies; and 24 quantitative studies. Second victims' perceptions of the current ‘just culture’ included: 1) fear of repercussions of reporting medical errors as a barrier; 2) supportive safety leadership is central to reducing fear of error reporting; 3) improved education on adverse event reporting, developing positive feedback when adverse events are reported, and the development of non-punitive error guidelines for health care professionals are needed; and 4) the need for development of standard operating procedures for health care facility peer-support teams.ConclusionsSecond victims' perceptions of organizational and peer support are a part of ‘just culture’. Enhanced support for second victims may improve the quality of health care, strengthen the emotional support of the health care professionals, and build relationships between health care institutions and staff. Although some programs are in place in health care institutions to support ‘just culture’ and second victims, more comprehensive programs are needed.     

Work‐related behaviour and experience patterns of nurses in different professional stages and settings compared to physicians in Germany

Working in a health‐care profession is correlated with high levels of stress and potential burnout that are likely to increase over time. Few studies differentiate psychosocial stress between nurses in different clinical settings or professional stages. In this cross‐sectional study, we compared the work‐related behaviour and experience of nurses (n = 389) and physicians (n = 344) and of nurses across different career stages and clinical settings in Germany. Nurses had the lowest proportion of a healthy behaviour and experience pattern (11.6%) compared with student nurses (32.6%), senior nurses (25%), and physicians (16.7%). They also had the highest proportion of a burnout‐related behaviour and experience pattern (32.8% vs 26.1% of student nurses, 18.3% of senior nurses, and 27.3% of physicians). In comparison with medical nurses, psychiatric nurses presented a significantly (P < 0.01) lower proportion with a healthy (10.6% vs 21.8%) and burnout‐related behaviour pattern (23.5% vs 29.6%), and a higher proportion showing a low commitment to work (61.4% vs 34.4%). Differences in health‐related dimensions were primarily observed in the domains of professional commitment and stress resistance. The observed differences in behaviour and experience patterns as a function of health‐care settings and career stages emphasize the need for specific interventions.     

Model testing on the crisis interventions and actions to prevent medical disputes: a Taiwanese nursing perspective

Aims and objectives. This study investigated the contributions of comprehensiveness and necessity scales on crisis interventions and actions toward nursing practice‐related medical disputes in Taiwanese hospitals and institutions’ demographic characteristics, to overall satisfaction toward nursing‐related crisis management policies and interventions and overall satisfaction toward their institution's crisis management system. Background. In a health‐care environment that is focused on cost containment, for overworked nurses and understaffed medical wards, patients still expect nurses to provide high quality, compassionate care. Patients usually regard nurses as the principal link between the technical and interpersonal aspects of their care. However, current hospital systems tend to require patients to be self‐reliant in managing their own care. Patient mistrust of medical care providers might have contributed to the current medical error/dispute crisis. Methods. In this cross‐sectional study, the subjects were nursing directors of Taiwanese hospitals (197 valid subjects). The author developed the questionnaire used in this study. Results. The ordinal logistic regression analyses demonstrated that being a public hospital managed by the government, being a hospital operated by a corporate body, the more comprehensive the technical/structural aspect and the assessment aspect and the more needed the psychological aspect, contribute to higher general satisfaction levels toward nursing‐related crisis management. The more comprehensive the strategic aspect and having more acute beds, contributes to higher satisfaction levels with their institution's overall crisis management activities. Conclusions. These findings inferred a possible change in a hospital's resource allocation or power structure when dealing with issues of patient care quality, including nursing practice‐related crisis management policies, interventions and actions. Relevant to clinical practice. A good crisis management system may help to keep a crisis from worsening, which might lead to a serious situation that includes malpractice litigation. It is believed that the questionnaire used in this study may be used as a diagnostic tool for assessing a crisis management system within a hospital's nursing environment.     

Knowledge and awareness concerning chemical and biological terrorism: continuing education implications

BACKGROUND: A survey on knowledge and awareness concerning chemical and biological terrorism was used to assess the knowledge base of health care providers at an urban medical center in preparation for developing a workshop on domestic terrorism preparedness. A second survey assessing domestic terrorism preparedness of infection control personnel and nurse educators also was conducted. METHOD: A total of 291 nurses, physicians, nursing students, and medical students completed the knowledge and awareness survey. A total of 24 infection control personnel and nurse educators completed the second survey on domestic terrorism preparedness. FINDINGS: The knowledge scores of the respondents were low, with less than one fourth of the knowledge questions answered correctly. In addition, less than 23% of the respondents reported confidence to provide health care in a hypothetical chemical terrorism situation. CONCLUSION: These findings indicate a need for nurses in continuing education and staff development to develop, implement, and evaluate innovative domestic terrorism preparedness programs.     

Nurse‐Managed Free Clinic Fosters Care Connection for Homeless Population

The goal of this article is to demystify the process that healthcare providers must follow when working with homeless patients who sustain injuries or exhibit illnesses that necessitate rehabilitation care. Observations made over a period of more than 12 years at an inner‐city medical/psychiatric nurse‐managed free clinic that delivers cutting‐edge services and educates multidisciplinary students to care for disenfranchised populations led the author to several conclusions: homeless people frequently lose their identity as individuals when facing healthcare providers; previous negative perceptions of homelessness can turn positive when care providers meet these patients on a person‐to‐person level; the concept of health and rehabilitation must be clearly understood in the same way by both providers and patients for nursing goals to be realistic and achievable; and a collaborative relationship must be formed between nurses and patients.     

Nursing and medical student attitudes towards nursing disclosure of information to patients: a pilot study

The American Hospital Association 'Patient's Bill of Rights' encourages greater disclosure of medical information to patients. However, the 'Bill of Rights' and conventional hospital practice centre responsibility for disclosure on physicians. The standing of nurses with regard to disclosure of information remains unclear. Many features of the nursing role indicate nurses could participate more fully in disclosure. A questionnaire exploring issues of disclosure by nurses was circulated to senior nursing students and fourth-year medical students. The 28 nursing respondents and 28 medical respondents differed significantly on 20 of the 87 items. In 15 of these, nursing students clearly showed more support than medical students for an active nursing role in disclosure, informed consent, expressing professional opinions, and patients' decision-making. A more active role by nurses in disclosing information may support increased patient participation in decision-making.     

Partnering to Lead Change: Nurses’ Role in the Redesign of Health Care

Health care has a long-held perception of perioperative nurses as providers who advocate for patients and who carry out physician orders. According to the Institute of Medicine’s 2010 report on the future of nursing, not only must that view evolve, but nurses also must play a leading role, in partnership with physicians and other health care colleagues, if health care reform is to succeed. Several factors will prepare nurses for this new role of partnering to advance health, including advancing their formal education, developing leadership as a core competency, acquiring leadership skills, and being active in new models of leadership (ie, mentorship, volunteering, advocacy).     

Coming full circle: mentorship in HIV/AIDS care.

The role of the mentor has been found to be crucial for learning, yet mentorship in HIV/AIDS nursing care has not been well documented. The purpose of this study was to (a) examine the characteristics of a nurse mentor in HIV care as perceived by nursing and medical students and HIV staff, and (b) explore an HIV nurse mentor's perceptions of her role and responsibilities in the professional development of students and staff. Mentorship, as a process of "coming full circle," was highlighted by the mentor's accounts of early influences in her career as well as students' and staff members' intents to facilitate the professional development of the next generation. The legacy of excellent HIV nursing care can be continued if expert HIV nurse mentors are identified and encouraged to work with students, inexperienced nurses, and health care providers. Health care institutions have a responsibility to foster mentorship in HIV/AIDS care to assure quality health care for clients and the professional development of expert nurses in HIV/AIDS care.     

Impact of Organisational Culture on Use of Scientific Knowledge in Nursing Practice

ABSTRACT The aim of this study was to answer the question: How does organisational culture influence nurses' use of scientific knowledge in practice? The culture of the health care organisation was analysed mainly in terms of professionals (nurses, physicians and managers). All three professional subcultures, medical, nursing and managerial, seem to be very important from the patients' point of view. Nursing subculture has, for example, different philosophy, knowledge and values about the purpose and practices of the work. Despite this, many nurses hold medical norms, values and expectations to be more important than those of their own subculture. Consequently, when caring for patients such nurses act and behave according to medical knowledge and cultural assumptions. The influence of cultural factors on use of scientific knowledge in nursing practice can be classified as follows: (1) the nursing subculture is strong but old-fashioned and conservative, (2) the nursing subculture is weak and nurses are expected to act according to some of the competitive subcultures, (3) the content and construction of the process of work socialisation prevent the application of new scientific knowledge. These results must be confirmed in further empirical studies to determine their general validity for the primary health care system in Finland. The cultural analysis of health care system provides new information about why systematic scientific knowledge has not changed nursing practice as much as expected.     

Health care and nursing in Saudi Arabia

Aim:  This paper reviews healthcare provision in Saudi Arabia and the development of nursing together with its current challenges.
Background:  Health care in Saudi Arabia is developing fast with multiple governmental and independent service providers. Economic growth has impacted upon health needs through population and health behaviour change. The development of the indigenous nursing workforce has been slow resulting in much nursing care being delivered by migrant nurses.
Conclusion:  There is a need to increase the proportion of indigenous nurses so that culturally appropriate holistic care can be delivered. Without shared culture and language, it will be difficult to deliver effective health education within nursing care to Saudis.     

Registered nurses' experiences of interaction with patients with mental health challenges in medical wards in Johannesburg

poggenpoel m. , myburgh c.p.h. & morare m.n. (2011) Journal of Nursing Management 19, 950–958 Registered nurses’ experiences of interaction with patients with mental health challenges in medical wards in Johannesburg Aim The aims of this research were to explore and describe registered nurses’ experiences of interacting with patients with mental health challenges in the medical wards of a public hospital in Johannesburg. Background Nurses are the major providers of hospital care and have become an important resource in the delivery of mental health care to patients with mental health challenges. However, the attitude and ability of many nurses in providing this care have been shown to be poor. Method In-depth phenomenological interviews were conducted with eight female registered nurses working in four medical wards where they interact with patients with mental health challenges. Results From the findings it is clear that registered nurses experienced frustration, unhappiness, fear and perception of danger when interacting with patients with mental health challenges in their wards. This could be attributed to a lack of knowledge and skills in mental health. Conclusion Registered nurses have negative experiences with interaction with patients with mental health challenges in medical wards because of a lack of knowledge and skills in mental health. Implications for nursing management Ward managers can facilitate the psychological empowerment of registered nurses.