患者的安全共同的责任

患者安全是护理质量中基本和重要的部分。然而，国际卫生保健系统是易于出现过失的，并且对患者的安全性护理是有害的，是基本系统缺陷所造成的。大量的利益相关者（社会大众、患者、护士、护理教育者、管理者和研究者、医师、政府和立法机关、职业协会和委任机构）对促进患者安全出院及无伤害发生是负有责任的。本文讨论了护理缺陷中相关者对患者安全的职责与特殊功能及继续接受和促进安全护理。     

低视力或盲住院患者护理安全路径的实施与评价

目的：探讨护理安全路径应用于低视力或盲住院患者的实施效果。方法：编制“低视力或盲住院患者护理安全路径”,并将2012年8月至2013年1月期间的734例低视力或盲住院患者设为对照组,实施常规护理模式;将2013年2-7月期间的809例低视力或盲住院患者设为实验组,对其施行护理安全路径。比较两组患者护理安全不良事件数量、患者满意度等指标。结果：路径实施后,护理安全不良事件数量减少,患者满意度提高。结论：实施护理安全路径,能够降低护理风险、保障患者安全,提高住院患者对护理工作的满意度,规范护理工作流程,提升病区护理管理水平。     

Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education

BackgroundSince the ground-breaking report ‘To Err is Human: Building a Safer Health Care System’ was published nearly two decades ago, patient safety has become an international healthcare priority. Universities are charged with the responsibility of preparing the future nursing workforce to practise in accordance with relevant patient safety standards. Consequently, simulation-based learning is increasingly used for developing the technical and non-technical skills graduates require to provide safe patient care.AimTag Team Patient Safety Simulation is a pragmatic group-based approach that enhances nursing students’ knowledge and skills in the provision of safe patient care. The aim of this paper is to describe the Tag Team Patient Safety Simulation methodology and illustrate its key features with reference to a medication safety scenario.MethodsInformed by the National Safety and Quality Health Service Standards and the Patient Safety Competency Framework for Nursing Students, Tag Team Patient Safety Simulation methodology actively engage large numbers of nursing students in critical conversations around every day clinical encounters which can compromise patient safety.ConclusionTag Team Patient Safety Simulation is a novel simulation methodology that enhances nursing students’ skills and knowledge, fosters critical conversations, and has the potential to enhance students’ resilience and capacity to speak up for safe patient care.     

Introducing Nursing Students to an Environmental Safety Assessment Through Simulation

In response to the Institute of Medicine report criticizing health care professionals' competence in providing safe patient care, health care educators were challenged to transform their nursing programs. One powerful tool in developing competent nurses, without endangering patients, is simulation. This article discusses advantages and disadvantages of using simulation as a teaching strategy and describes how to teach environmental safety concepts to beginning nursing students, through a simulated patient room using an environmental safety assessment.     

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。     

Patient safety to frame and reconcile nursing issues

Canadian nursing leadership is called to advance a national patient safety agenda for the delivery of safe, quality care in professional practice environments. Yet, the nursing discipline is burdened by issues and challenges related to clinical practice and workplace dilemmas that contribute to barriers and obstacles to safe, quality and humane care. We propose that the many clinical challenges faced by nurses in Canada can be more fully understood when framed by a patient safety perspective. Nurse executive leaders and nurse scientists are called to reform clinical practice and conduct research to reconcile patient care safety issues. This paper applies findings obtained from nurses via focus groups led by the Academy of Canadian Executive Nurses (ACEN) and integrates these findings into a patient safety perspective via a conceptual framework.     

The Professional Nursing Association's role in patient safety

The purpose of this article is to describe the documents and activities of nursing's multipurpose, professional nursing association, the American Nurses Association, that promote patient safety. The roles of the professional nursing association in promoting the safety of the recipient of nursing care are numerous. These roles include developing and disseminating foundation documents, lobbying for legislation and regulations that protect and serve users of nursing services, and advocating for patients and issues which affect a nurse's ability to deliver safe care. Although the professional associations' usual purpose is to work for the welfare of the public, at times this can conflict with the association's need to advocate for its members. The professional association must balance the needs and interests of the association, the profession, and the public so as to promote the safety of patients receiving care.     

安全目标管理在重度烧伤并反应性精神障碍病人中的应用

[目的]探讨安全目标管理在重度烧伤并精神障碍病人中的应用效果,为病人提供一套科学系统的安全护理。[方法]将85例重度烧伤并精神障碍病人分为干预组45例和对照组40例,干预组实施安全目标管理,制定护理安全目标;准确评估病人,制定安全防范预案;加强病房及病人安全管理,注意用药安全,防止意外,对病人进行认知行为干预,促进精神康复。对照组则按烧伤并反应性精神障碍的常规护理。[结果]实施安全目标管理以来,干预组护理不安全事件的发生率明显低于对照组(P<0.05),病人精神症状的持续时间较对照组短(P<0.01),家属对护理工作的满意度较对照组高(P<0.01)。[结论]实施安全目标管理,能提高护士的安全防范意识,有效减少反应性精神障碍病人不安全事件的发生,避免护理风险,确保医疗护理安全。     

安全目标管理在重度烧伤并反应性精神障碍病人中的应用

[目的]探讨安全目标管理在重度烧伤并精神障碍病人中的应用效果,为病人提供一套科学系统的安全护理。[方法]将85例重度烧伤并精神障碍病人分为干预组45例和对照组40例,干预组实施安全目标管理,制定护理安全目标;准确评估病人,制定安全防范预案;加强病房及病人安全管理,注意用药安全,防止意外,对病人进行认知行为干预,促进精神康复。对照组则按烧伤并反应性精神障碍的常规护理。[结果]实施安全目标管理以来,干预组护理不安全事件的发生率明显低于对照组（P〈0.05）,病人精神症状的持续时间较对照组短（P〈0.01）,家属对护理工作的满意度较对照组高（P〈0.01）。[结论]实施安全目标管理,能提高护士的安全防范意识,有效减少反应性精神障碍病人不安全事件的发生,避免护理风险,确保医疗护理安全。     

High reliability and implications for nursing leaders

Aim  To review high reliability theory and discuss its implications for the nursing leader.
Background  A high reliability organization (HRO) is considered that which has measurable near perfect performance for quality and safety.
Evaluation  The author has reviewed the literature, discussed research findings that contribute to improving reliability in health care organizations, and makes five recommendations for how nursing leaders can create high reliability organizations.
Key issues  Health care is not a safe industry and unintended patient harm occurs at epidemic levels. Health care can learn from high reliability theory and practice developed in other high-risk industries.
Conclusions  Viewed by HRO standards, unintended patient injury in health care is excessively high and quality is distressingly low. HRO theory and practice can be successfully applied in health care using advanced interdisciplinary teamwork training and deliberate process design techniques.
Implications for nursing management  Nursing has a primary leadership function for ensuring patient safety and achieving high quality in health care organizations. Learning HRO theory and methods for achieving high reliability is a foremost opportunity for nursing leaders.     

A practice model for patient safety: the value of the experienced registered nurse

Creating a culture of patient safety often involves developing nursing care models that effectively use nursing resources. These authors discuss a nursing care model that focuses on the experienced nurses to enhance the use of their expertise. They provide more direct oversight and surveillance for the care given to all patients through leadership, mentoring, and collaborative practice. The experienced nurse is valued as a clinical leader, instrumental to the development of a safe practice environment. Implementation of this model has resulted in dramatic improvements in safety and registered nurse retention.     

Cultural safety in New Zealand and the United States: looking at a way forward together

Cultural safety emerged in Aotearoa, New Zealand as a nursing response to bicultural interactions between indigenous Maori and other New Zealanders. The purpose of this research is to describe the meaning and experience of cultural safety as depicted by nurses in New Zealand and to illustrate the potential for this to inform U.S. nursing education and practice. This interpretive hermeneutic study explored cultural safety as described by 12 experienced nurses who were selected through snowball and purposive sampling. Audiotaped interviews were conducted after ethics approval. Interpretive analysis uncovered five themes that are described with data and paradigm cases. Cultural safety considers the perspective of the patient as the norm in contrast to the culture of health care. Understanding historical power differences and personal biases can help challenge victim-blaming responses by health care providers. Incorporating these understandings into reflective practice enhances the possibility of culturally safe learning for students and culturally safe care for patients.     

HI I CARE: A mnemonic device to frame safe patient encounters and support simulation experiences for novice nursing students

BackgroundRemembering the many safety behaviors and patient care activities expected during a patient encounter can be difficult for novice nursing students. The HI I CARE mnemonic device was created to assist novice nursing students to remember and organize key safety behaviors and patient care activities. Subsequently, the mnemonic device was drafted into a checklist to be used as a performance support tool for students’ first simulation experience.MethodsA survey was designed and administered to beginning nursing students to explore their perception if the HI I CARE mnemonic device helped to (1) reduce anxiety prior to simulation experiences; (2) plan, organize, and deliver care; and (3) integrate classroom learning into the simulated patient encounter.ResultsOverwhelmingly, participants agreed or strongly agreed that the HI I CARE mnemonic helped to achieve these goals.ConclusionThe HI I CARE mnemonic device and correlating checklists are effective performance support tools that can be used to help novice nursing students to recall key safety behaviors and organize patient care activities in the nursing skills laboratory and the simulation setting. This mnemonic device, as a performance support tool, offers associate degree nursing students the opportunity to develop optimal habits that exemplify the safe patient encounter.     

Health Outcomes for Better Information and Care (HOBIC): integrating patient outcome information into nursing undergraduate curricula

Nursing-sensitive outcomes provide common information across sectors, thus eliminating duplication that frequently occurs as individuals move across settings. These outcomes also facilitate increased trust among colleagues and support common understandings of patient care needs, thus enhancing continuity of care. Outcomes-oriented information is also likely to increase patient safety and improve overall quality of care. Shared standards and data support consistent decision-making, as nursing decisions can be tracked back over time to assess patient care outcomes. Consequently, nurses will have the means to determine the impact of their interventions on patient outcomes. At the same time, adoption of common approaches to patient assessment leads to greater professional accountability and moves nursing care from a task orientation to an outcomes focus. For administrators, such improvements in monitoring and evaluating patient outcomes translate into improvements in efficiencies and effectiveness, thus providing a return on investment in implementing these outcomes within their agency. For nurses, integration and utilization of outcomes information increases the visibility and significance of their decision-making and patient care. Together with patients, nurses can utilize the outcomes information to make evidence-based decisions and advocate for appropriate care. At an aggregate level, the use of outcomes information creates a continuous feedback loop that is essential to ensuring evidence-based care and the best possible patient outcomes, not only for individuals, but also for families, communities and populations. Outcomes-oriented care provides a gateway for transforming the way we care for patients; puts safe, ethical, high-quality care for patients first; embodies the principles of evidence-based practice; ensures that the value of nursing is clearly understood within the larger system; and ensures that the requirements for measurability and accountability can be achieved. This journey is continuous and is being expanded to engage all other health disciplines in understanding and documenting their contributions to patient care, both as individual practitioners and as members of a healthcare team. Preparing nursing students in an outcomes approach will facilitate systemwide adoption of HOBIC patient outcomes over time and provide a means to determine the impact of nursing care on our patients.     

Placement alternatives for long-term ventilator care.

Management of the patient receiving long-term ventilator care is facing many changes, among them new alternatives in placement outside hospitals. These include the home and two new options--the skilled nursing facility and the residential care facility. Government and insurance carriers are now more willing to pay for these alternatives to hospitalization. Home has been the traditional placement of choice for ventilator-dependent patients; this placement requires extensive training of the patient and careproviders to ensure safety. The skilled nursing facility (SNF) has been in the past an unsafe alternative placement; however, some SNFs are developing special units for ventilator-dependent patients that will make a placement to these facilities safe and practical. Residential care facilities, developed as a model program in California, can care for small numbers of ventilator-dependent persons in a homelike setting. These new placement alternatives will make it possible for virtually all medically stable, ventilator-dependent patients to live away from the hospital.     

Providing Good Care in the Shadow of Violence – An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden

The aim was to describe the nursing staff and ward managers' experiences of safety and violence in everyday meetings with the patients. The qualitative content analyses resulted in four themes: the relationship with the patient is the basis of care; the organizational culture affects the care given; knowledge and competence are important for safe care; and the importance of balancing influence and coercion in care. The staff had a varied ability to meet patients in a respectful way. One way of creating a common approach could be to discuss and reflect upon different options in the meeting with the patient.     

A model for developing high-reliability teams

riley w., davis s.e., miller k.k. & mccullough m. (2010) Journal of Nursing Management 18, 556–563
A model for developing high-reliability teams Aim To develop a model for high reliability in health care quality and patient safety. Background A high-reliability health organization (HRO) has measurable near perfect performance in quality and safety. High reliability is necessary in health care where the consequences of error are high and the frequency is low. Key issues Despite a decade of intense focus on quality and safety since a series of reports from the Institute of Medicine (IOM), health care is not a completely safe industry and quality is not what it should be to ensure high reliability for patients. Conclusions A model for high reliability is presented that includes the individual skills necessary to assure high-reliability teams on a patient care unit. High-reliability teams (HRT) form an essential core of a HRO. These teams and their organizations value a culture of safety every day with every patient encounter. Implications for nursing management Nurse managers can lead in creating a HRO by first developing HRTs on their patient care unit.     

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system’s success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: ‘providing environmental prerequisites for safe nursing practice’, ‘uniting and integrating health-care providers’, and ‘creating an atmosphere of safe care’. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses’ working conditions, develop the nurses’ practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers’ professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.