Perceived barriers to healthcare utilization among Jordanian families: A family centered approach

AimThis study aimed to understand the barriers to health services utilization by Jordanian families.BackgroundAccess to quality healthcare services is a significant issue facing healthcare systems. Healthcare systems must identify and apply measures to overcome barriers that face utilizing health services and thus increase clients' satisfaction.MethodsA cross-sectional qualitative research design was used in this study. Semi-structured interviews were conducted with twenty-five families to elicit the model of health services barriers.ResultsThe analysis of the family interviews led to four main themes related to health services barriers: service system, structural/physical barriers, equipment and medication, and staff competency. This study would increase awareness about underserved populations that avoid seeking medical care.ConclusionPublic health efforts are required to increase awareness about the importance of contacting the healthcare system as early as possible. However, public health policy may require developing new initiatives that reduce these perceived barriers, such as enhancing communication skills among healthcare workers, increasing supervision and inspection of healthcare quality, and enhancing patient engagement by using phone calls and messages as appointment reminders and careful follow-up.     

Emergency nurses' perspective of workplace violence in Jordanian hospitals: A national survey

BackgroundEmergency departments are considered high-risk areas, where violence against nurses is a serious and prevalent problem. Such violence has negative effects on nurses, and therefore on the quality of care provided.Aims of the studyTo explore the risk factors behind violence, and to specify reasons for the level of low reporting of violence among Jordanian nurses in emergency departments.MethodA cross-sectional design through conducting a survey in emergency departments in Jordanian hospitals.ResultsThe total number of emergency department nurses who participated in the study was 227. Of these, 172 (75%) had experienced some form of violence. Verbal violence was the most reported (63.9%), compared to physical violence (48%). The most reported reasons for violence from the nurses' perspective were waiting time, overcrowding, and patient and family expectations not being met, with frequencies of 54.3%, 53.3%, and 46% respectively. The treatment room was the most common place where the violence occurred. Only 16.6% of the nurses who experienced violence actually reported it. Being accustomed to workplace violence is the most stated reason for not reporting violence to the hospital administration or the authorities.ConclusionViolence against emergency department nurses is a significant issue that cannot be ignored. There are multiple reasons. The key point in dealing with the problem is to treat its specific causes.     

Medication error reporting: a survey of nursing staff

The objective of this article is to describe findings from a medication error (ME) survey, to estimate the extent of ME underreporting by comparison of survey results with written incident reports (IRs), and to determine factors associated with IR reporting of MEs. Participants were registered nurses from the 38-bed infant unit of a pediatric hospital. Most recent ME in each of four stages of the medication process was classified as to: timing, nature, whether the error was prevented from the patient, patient injury, and completed IR. Surveys were administered to nurses during mandatory skills session and were compared with IRs for MEs for the previous 6 months. The survey response rate was 93.5 percent; 72 nurses described 177 errors, 40.3 percent observed an ME in the previous week, 62.1 percent were prevented from reaching the patient and the likelihood of prevention was reduced in the later stages of the medication process. About 30 percent of MEs resulted in IRs. Administration errors were more likely to result in IRs compared with ordering errors, especially when the error was not prevented from the patient. There were 51 IRs for MEs. A multivariate logistic regression with completed IRs as the dependent variable showed a decreased likelihood of IRs for ordering than administration errors. IRs were more likely for wrong medication or dose errors and IRs were less likely for errors prevented from reaching the patient. The study found that by augmenting IR reporting of MEs and classifying errors by stage, anonymous ME surveys can be used for monitoring and guiding improvements to hospital medication systems.     

The perceptions of patient safety culture: A difference between physicians and nurses in Taiwan

AimsIn order to pursue a better patient safety culture and provide a superior medical service for patients, this study aims to respectively investigate the perceptions of patient safety from the viewpoints of physicians and nurses in Taiwan.BackgroundLittle knowledge has clearly identified the difference of perceptions between physicians and nurses in patient safety culture. Understanding physicians and nurses' attitudes toward patient safety is a critical issue for healthcare organizations to improve medical quality.MethodsConfirmatory factor analysis (CFA) is used to verify the structure of data (e.g. reliability and validity), and Pearson's correlation analysis is conducted to demonstrate the relationships among seven patient safety culture dimensions.ResultsResearch results illustrate that more teamwork is exhibited among team members, the more safety of a patient is committed. Perceptions of management and emotional exhaustion are important components that contribute to a better patient safety. More importantly, working conditions and stress recognition are found to be negatively related from the perceptions of nurses. Compared to physicians, nurses reported higher stress and challenges which result from multi-task working conditions in the hospital.ConclusionsThis study focused on the contribution of a better patient safety culture from different viewpoints of physicians and nurses for healthcare organizations in Taiwan. A different attitudes toward patient safety is found between physicians and nurses. The results enable the hospital management to realize and design appropriate implications for hospital staffs to establish a better patient safety culture.     

Electronic error-reporting systems: A case study into the impact on nurse reporting of medical errors

BackgroundUnderreporting of errors in hospitals persists despite the claims of technology companies that electronic systems will facilitate reporting. This study builds on previous analyses to examine error reporting by nurses in hospitals using electronic media.PurposeThis research asks whether the electronic media creates additional barriers to error reporting, and, if so, what practical steps can all hospitals take to reduce these barriers.MethodThis is a mixed-method case study nurses’ use of an error reporting system, RiskMan, in two hospitals. The case study involved one large private hospital and one large public hospital in Victoria, Australia, both of which use the RiskMan medical error reporting system.ConclusionInformation technology–based error reporting systems have unique access problems and time demands and can encourage nurses to develop alternative reporting mechanisms. This research focuses on nurses and raises important findings for hospitals using such systems or considering installation. This article suggests organizational and technical responses that could reduce some of the identified barriers.     

Neonatal nurses’ perceptions of supportive factors and barriers to the implementation of skin-to-skin care in extremely low birth weight (ELBW) infants - A qualitative study

There is currently a lack of evidence around perceptions of implementation of skin-to-skin care (SSC) in infants weighing <1000 gms amongst neonatal nurses. Majority of published work mainly focuses on infants weighing <2500 gms.AimThis study aimed to investigate neonatal nurses’ perceptions of supportive factors and barriers to the implementation of SSC in extremely low birth weight (ELBW) infants in a tertiary level neonatal intensive care unit (NICU) in London.MethodsA broad qualitative approach that included semi-structured interviews with seven neonatal nurses was used.ResultsAll seven nurses interviewed supported SSC in ELBW infants. There was a general consensus on barriers of its implementation. Humidity was perceived as a significant barrier for SSC in ELBW infants. Other barriers included concerns for infant safety, insufficient training, increased workload, lack of clear guidelines and management support.ConclusionsThis study identified supportive factors and barriers of SSC in ELBW infants in a tertiary neonatal unit. It ascertained the facilitation of parental readiness, development of clear guidelines, provisions of continuing education as well as organisational support as supportive factors in the implementation of SSC in ELBW infants. Furthermore, humidity was perceived as an additional barrier for SSC in these infants.     

Spiritual care in critically ill patients during COVID-19 pandemic

IntroductionSpiritual care has a positive influence when patients are subjected to serious illnesses, and critically ill situations such as the case of the COVID-19 pandemic.PurposeThe purpose of this study was to investigate the perceptions and attitudes of nurses working at critical care units and emergency services in Spain concerning the spiritual care providing to patients and families during the COVID-19 pandemic.MethodsA qualitative investigation was carried out using in-depth interviews with 19 ICU nursing professionals.FindingsDuring the pandemic, nurses provided spiritual care for their patients. Although they believed that spirituality was important to help patients to cope with the disease, they do not had a consensual definition of spirituality. Work overload, insufficient time and lack of training were perceived as barriers for providing spiritual healthcare.DiscussionThese results support the role of spirituality in moments of crisis and should be considered by health professionals working in critical care settings.     

Barriers to reporting medication errors and near misses among nurses: A systematic review

ObjectiveTo explore barriers to nurses’ reporting of medication errors and near misses in hospital settings.DesignSystematic review.Data sourcesMedline, CINAHL, PubMed and Cochrane Library in addition to Google and Google Scholar and reference lists of relevant studies published in English between January 1981 and April 2015 were searched for relevant qualitative, quantitative or mixed methods empirical studies or unpublished PhD theses. Papers with a primary focus on barriers to reporting medication errors and near misses in nursing were included.Review methodsThe titles and abstracts of the search results were assessed for eligibility and relevance by one of the authors. After retrieval of the full texts, two of the authors independently made decisions concerning the final inclusion and these were validated by the third reviewer. Three authors independently assessed methodological quality of studies. Relevant data were extracted and findings were synthesised using thematic synthesis.ResultsFrom 4038 identified records, 38 studies were included in the synthesis. Findings suggest that organizational barriers such as culture, the reporting system and management behaviour in addition to personal and professional barriers such as fear, accountability and characteristics of nurses are barriers to reporting medication errors.ConclusionsTo overcome reported barriers it is necessary to develop a non-blaming, non-punitive and non-fearful learning culture at unit and organizational level. Anonymous, effective, uncomplicated and efficient reporting systems and supportive management behaviour that provides open feedback to nurses is needed. Nurses are accountable for patients’ safety, so they need to be educated and skilled in error management. Lack of research into barriers to reporting of near misses’ and low awareness of reporting suggests the need for further research and development of educational and management approaches to overcome these barriers.     

Nurses’ perceptions on the skills,knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study

BackgroundPeople experiencing homelessness have unmet healthcare needs often related to chronic health conditions and injury. Nurses are often the first and only point of contact for people experiencing homelessness accessing healthcare. However, education that prepares them to meet the needs of this vulnerable population is limited.AimTo qualitatively explore nurses’ perceptions on the skills, knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia that could underpin an educational pathway.DesignSemi-structured interviews with registered nurses and nurse practitioners.MethodsParticipants of a national survey were invited to undertake an interview. Interview data were analysed thematically and reported here in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.FindingsThe registered nurses (n = 11) and nurse practitioners (n = 6) had varying levels of experience providing care for homeless Australians. Overarching themes that arose from the registered nurse and nurse practitioner participants included equitable access to care, knowledge around homelessness, contribution of nursing, and nurses’ role. However, nurse practitioners had a greater sense of agency and empowerment to enact care, while registered nurses perceived being underprepared and overwhelmed by the unmet needs of people experiencing homelessness.ConclusionsThe findings suggest that nursing practice holds opportunities to improve access and care provision for people experiencing homelessness. Capitalising on these opportunities requires that nurses are educationally prepared with the skills, knowledge, and attributes to meet the needs of this vulnerable population without necessarily becoming nurse practitioners. These findings will be used to underpin the development of an educational pathway for nurses to enhance their response to homeless populations.     

Awareness,perception and utilization of a mobile health clinic by people who use drugs

IntroductionPeople who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs.MethodsSemi-structured interviews were conducted with 31 PWUD – 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) – to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory.ResultsClients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients.DiscussionMHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment.

KEY MESSAGES

• People who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma.
• People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.

     

Nurses’ perspectives regarding the disclosure of errors to patients: A qualitative study

BackgroundThere is often a mismatch between patients’ desire to be informed about errors and clinical reality. In closing the “disclosure gap” an understanding of the views of all members of the healthcare team regarding errors and their disclosure to patients is needed. However, international research on nurses’ views regarding this issue is currently limited.ObjectivesExplore nurses’ attitudes and experiences concerning disclosing errors to patients and perceived barriers to disclosure.DesignInductive, exploratory study employing semi-structured interviews with participants, followed by conventional content analysis in which investigators read and discussed transcribed data to identify important themes.SettingsNursing departments from hospitals in two German-speaking cantons in Switzerland.ParticipantsPurposive sample of 18 nurses from a range of fields, positions in organisational hierarchy, work experience, hospitals, and religious perspectives.MethodsData were collected via individual, face-to-face interviews using a researcher–developed semi-structured interview guide. Interviews were transcribed in German and analysed using the qualitative data analysis software package Atlas-Ti (Berlin) and conventional content analysis. The most illustrative quotes were translated into English.ResultsNurses generally thought that patients should be informed about every error, but only a very few nurses actually reported disclosing errors in practice. Indeed, many nurses reported that most errors are not disclosed to the patient. Nurses identified a number of barriers to error disclosure that have already been reported in the literature among all clinicians, such as legal consequences and the fear of losing patients’ trust. However, nurses in this study more frequently reported personal characteristics and a lack of guidance from the organisation as barriers to disclosure. Both issues suggest the need for a systematic institutional approach to error disclosure in which the decision to inform the patient stems from within the organisation and is not shouldered by individual nurses alone.ConclusionsOur study suggests that hospitals need to do more to support and train nurses in relation to error disclosure. Such measures as hospitals establishing a disclosure support system, providing background disclosure education, ensuring that disclosure coaching is available at all times, and providing emotional support for all parties involved, would likely go a long way to address the barriers identified by nurses.