Adverse events in health care: a literature review

Aim  This paper aims to develop understanding of the nature, costs and strategies to reduce or prevent a range of adverse events experienced by people within the healthcare system.
Background  Care interventions are not always based on safe practice and adverse events can and do occur that cause or place at risk patients lives and well-being. The nature of adverse events is diverse and can be attributed to a multitude of individual and system contributory factors and causes.
Evaluation  A review of the literature was undertaken in 2006 and 2007 using the following databases: Pubmed, CINAHL, Biomed Ovid, Synergy and the British Nursing Index. This paper evaluates the literature that pertains to adverse events and seeks understanding of this complex issue.
Key issues  Published statistics confirm that globally, professional errors in clinical practice and care delivery occur at an unacceptably high level and result in considerable human and financial consequences.
Conclusion  Reaching understanding of the multiple factors that contribute to unsafe clinical practice situations requires a cultural shift in organizations.
Implication for Nursing Management  Reasons for adverse events are complex and require healthcare managers to evaluate the system issues which impact on the delivery and organization of care.     

A unique program for nursing students to enhance their mentalization capabilities in relation to clinical thinking

While nurses strive to provide optimal patient-centered care, this is not always straightforward, as some cases are more emotionally charged than others – depending on the patient's mental, emotional, and physical state, and on the nurses themselves. Therefore, in order to provide accurate therapeutic responses while maintaining their own personal well-being, nurses must develop strong mentalization capabilities. We present a unique program for nursing students, specifically targeted at enhancing their mentalization abilities as part of their communication skills for dealing with emotionally charged situations. In the program, he students first learn to identify what leads them to experience increased emotional loads and how this affects their mentalization processes. Next, they learn alternative coping patterns for their benefit, enabling their own emotional regulation while providing optimal care for their patients. Conducted in small groups, this holistic four-year program is led by experienced clinical nurses and psychologists; the learning is based on actual experiences encountered by the students during their clinical experience.     

Individual,interpersonal, and organisational factors of healthcare conflict: A scoping review

Unresolved conflicts among healthcare professionals can lead to difficult patient care consequences. This scoping review examines the current healthcare literature that reported sources and consequences of conflict associated with individual, interpersonal, and organisational factors. We identified 99 articles published between 2001 and 2015 from PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database. Most reviewed studies relied on healthcare professionals’ perceptions and beliefs associated with conflict sources and consequences, with few studies reporting behavioural or organisational change outcomes. Individual conflict sources included personal traits, such as self-focus, self-esteem, or worldview, as well as individuals’ conflict management styles. These conflicts posed threats to one’s physical, mental, and emotional health and to one’s ability to perform at work. Interpersonal dynamics were hampered by colleagues’ uncivil behaviours, such as low degree of support, to more destructive behaviours including bullying or humiliation. Perceptions of disrespectful working environment and weakened team collaboration were the main interpersonal conflict consequences. Organisational conflict sources included ambiguity in professional roles, scope of practice, reporting structure, or workflows, negatively affecting healthcare professionals’ job satisfactions and intent to stay. Future inquiries into healthcare conflict research may target the following: shifting from research involving single professions to multiple professions; dissemination of studies via journals that promote interprofessional research; inquiries into the roles of unconscious or implicit bias, or psychological capital (i.e., resilience) in healthcare conflict; and diversification of data sources to include hospital or clinic data with implications for conflict sources.     

Improving the oral health of older people in long-term residential care: a review of the literature

Background.  Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care.
Aims and objectives.  The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents.
Conclusions.  Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools.
Relevance to clinical practice.  The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.     

Simulation et gestion de crise

Human factors characterize how individuals interact with their environments. Analysis of medical errors shows that among human factors, psychological, cognitive, and organizational features are directly related to the quality of care. Therefore, in addition to knowledge and control of technical procedures, care providers should be able to operate within a successful team aiming at developing an adapted therapeutic approach. Simulation is an effective method to train health professionals to these called “non-technical” skills. Various situations provided by simulation offer secured possibilities for training, assessment, and discussion that enable healthcare professionals to face critical situations, develop competences, and improve performance. Based on a literature review, the authors present useful data for the development and promotion of teamwork training in crisis management in simulation centres as well as critical care departments including intensive care, emergency medicine, and anaesthesia departments.     

Calidad de vida laboral y autocuidado en enfermeras asistenciales con alta demanda emocional

ObjectiveTo explore the variables related to the quality of work life and the self-care of nursing professionals working with high emotional demand.MethodQualitative, according to the constructivist paradigm. It combines the phenomenological-hermeneutic/interpretative method with the use of semi-structured interviews. Information was analyzed with Maxqda 11. Interviews included professionals from the Valencian healthcare system, with typical profiles of nurses working in surgical units, emergencies, oncology, home care, and cooperation.ResultsOrganizational factors were reported as a barrier to self-care, affecting healthcare activity. Working with patients was highlighted as a protective factor, based on the satisfaction derived from helping in situations of serious illness and suffering. The quality of work life manifested was assessed as not being what they would desire and deficient. The factors that affected the professionals most were the type of working day and work schedules (shifts, nights, holidays, on call...). The physical, mental and social dimensions of self-care can attenuate the negative effects of this situation.ConclusionsIt is necessary to examine in depth the construct of self-care, to counteract emotionally stressful problems and situations, to propose intervention strategies, training plans and greater involvement of health institutions in the improvement of nurses’ quality of work life.     

Developmental differences and their clinical impact in adolescents

Adolescent mental health is a concern for health professionals as the prevalence of mental health problems appears to peak in adolescence and early adulthood because of the biological and psychosocial transitions that are occurring in this age group. Adolescence is a major transitional period between childhood and adulthood and many changes--physical, emotional and social--occur during this time. These changes can precipitate and perpetuate mental health difficulties in young people. Due to the amount of changes that occur in adolescence, younger and older adolescents are at quite distinct life stages and are biologically, cognitively, socially and emotionally distinct. There are also differences between younger and older adolescents in the prevalence of different disorders and in how they express their difficulties. It is, therefore, important for healthcare professionals to be mindful of the development level of the adolescents with whom they are working and the impact that this can have on the young person's presentation, understanding of their problems and in their ability to use different therapeutic interventions.     

Assessing bias against overweight individuals among nursing and psychology students: an implicit association test

Aim and objectives. To determine the implicit or unconscious attitudes of Nursing and Psychology majors towards overweight individuals in medical and non‐medical contexts. Background. Obesity is a leading health concern today, which impacts both physical and psychological health. Overweight individuals confront social biases in many aspects of their lives including health care. Examining the views of Nursing and Psychology students may reveal implicit attitudes towards overweight individuals that may lead to prejudiced behaviours. Design. A mixed design experiment with one between‐subjects variable (student major: Nursing or Psychology) and one within‐subjects variable (condition: congruent or incongruent) was used to assess implicit attitudes in two convenience samples of Nursing and Psychology students. Methods. A computerised implicit association test was used to determine implicit attitudes towards overweight individuals in medical and non‐medical contexts. A total of 90 students from Nursing (n = 45) and Psychology (n = 45) were recruited to complete an implicit association test. Reaction times in milliseconds between the congruent trials (stereotype consistent) and incongruent trials (stereotype inconsistent) were compared with determine adherence to social stereotypes or weight bias. Results. A statistically significant implicit bias towards overweight individuals was detected in both subject groups and in both target settings (medical vs. non‐medical). Stronger weight bias was found when the stimulus targets were female than male. Conclusions. Findings from this study expand understanding of the implicit attitudes and social biases of Nursing and Psychology students. The views held by these future healthcare professionals may negatively impact patient care. Relevance to clinical practice. Providing education and support to overweight individuals is central to Nursing practice in a society struggling to manage obesity. Negative stereotypes or beliefs about these individuals may result in poor patient care. Therefore, nurses and other healthcare professionals must be aware of personal biases and work to develop methods to address weight‐related issues in a therapeutic manner.     

The importance of assessing psychological status during pregnancy, childbirth and the postnatal period as a multidimensional construct: A literature review

This paper presents a comprehensive review of the literature surrounding women’s psychological health in pregnancy, childbirth and the postnatal periods. The content will provide clinically useful information to midwives and health care professionals involved in caring for women during the antenatal, intranatal and postnatal periods. The impact of psychological health status in pregnancy on clinical outcomes such as preterm labour, pre-eclampsia, epidural use, caesarean section, instrumental deliveries and increased rates of admission to neonatal intensive care, alongside the cognitive and social development of the infant and child are well documented. Less research to date has considered the impact of psychological well-being on the mother throughout pregnancy, the peripartum, postpartum and beyond. Psychological status for these women has traditionally been characterised by anxiety and depression, largely ignoring the complex psychological interrelations that characterise pregnancy. Psychological status in pregnancy cannot be defined within a unidimensional framework but must include a comprehensive assessment of all the dimensions that attribute to mood and emotional status for women during pregnancy, childbirth and the postnatal period. This paper intends to address the constructs of anxiety and depression, worry, control, quality of life, sleep and self-esteem. Screening for, and identification of, maternal psychological distress from a multidimensional perspective enables healthcare professionals to recognise and acknowledge normal and abnormal adjustment and offer interventions, strategies and support to facilitate a woman’s transition to motherhood.     

Developing the scope of practice and education for advanced practice nurses in Finland

Background:  The reorganization of Finnish healthcare services has required a restructuring of the areas of responsibility between healthcare professionals.
Aim:  To describe the need for Advanced Practice Nurses in Finland and the development process of a Master's programme in Health Promotion, Advanced Clinical Care.
Methods:  The study consisted of a survey of nurse managers (24) and focus group interviews with clinical nurse specialists (46).
Findings:  The expanded role includes advanced clinical skills and responsibility for health prevention and promotion, education, supervision, leadership, research and development.
Conclusions:  The legislation, scope and models have to be supported and further developed to promote the full scope of advanced practice.     

Síndrome de burnout en los profesionales de cuidados intensivos: relaciones con la salud y el bienestar

ObjectivesTo determine the predictive models that include the dimensions of burnout that are predictors for physical/mental health, and subjective/psychological wellbeing perceived in intensive care professionals; to analyse the relationships between burnout syndrome, health status and wellbeing experienced by these professionals; and to establish sociodemographic differences in the variables evaluated.MethodA correlational and cross-sectional study was conducted. A total of 52 critical care professionals, mainly nurses, were recruited from an intensive care unit of Madrid. All participants were assessed with the questionnaires: Maslach Burnout Inventory-Human Services Survey, Short Form-12 Health Survey, Satisfaction With Life Scale, Positive and Negative Affect Schedule, and Psychological Well-Being Scales.ResultsNo significant sociodemographic differences were found. High levels in the three burnout dimensions were associated with poor physical/mental health and subjective/psychological wellbeing. High scores in emotional exhaustion and depersonalization, and low in personal accomplishment negatively predicted subjective and psychological well-being scales. The self-acceptance scale had the highest predictive validity. Emotional exhaustion was the only burnout dimension that negatively predicted physical and mental health.ConclusionsHealth status and levels of subjective/psychological wellbeing can be negatively influenced by the burnout syndrome experienced by intensive care professionals. As a result, the implementation of programmes to prevent and treat this syndrome is needed. These preventive interventions can positively impact not only the health and wellbeing of these professionals, but can also improve their ability to practice effectively, improve healthcare quality and patient security, and reduce the economic costs of health institutions. It is therefore imperative to implement burnout preventive programmes for intensive care professionals from universities to health institutions.     

Patient-centred care and nurses' health: the role of nurses' caring orientation

Title.  Patient-centred care and nurses' health: the role of nurses' caring orientation.
Aim.  This paper is a report of a study of the moderating effect of caring orientation on the relationship of patient-centred care to nurses' physical and mental health.
Background.  Providing effective patient-centred care is well-accepted as an important contributor to a host of patients' health outcomes. Based on two theoretical perspectives – person–environment fit and emotional labour – I suggest that providing patient-centred care per se does not potentially harm nurses' health; the cause is the fit (or non-fit) of a nurse's caring orientation and the displayed patient-centred care behaviours.
Method.  Data were collected in 2007 with a random sample of 325 registered nurses working in the Israeli public healthcare sector in in-patient units. Caring orientation, health and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations.
Results.  The mental health of nurses who exhibited high caring orientation combined with high patient-centred care, or that of nurses who exhibited low caring orientation combined with low patient-centred care, was statistically significantly higher in comparison with the mental health of nurses who exhibited incongruent (low/high or high/low) caring orientation and patient-centred care behaviours. For nurses' physical health, the findings revealed that providing patient-centred care was associated with worsened health, and possessing a caring orientation was associated with better health.
Conclusions.  The findings support the hypotheses that were derived from person–environment fit and emotional labour only with regard to mental health. Separate theory needs to be developed on how to maintain nurses' physical health.     

Childhood and adolescent attention-deficit hyperactivity disorder: Diagnosis, clinical practice guidelines, and social implications

Purpose: To review the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), present an overview of the effects that ADHD has on family dynamics, school performance, and substance abuse, and provide an overview of the American Academy of Pediatrics (AAP) clinical practice and treatment guidelines.
Data sources: An extensive health science literature review was carried out using PubMed and Cumulative Index to Nursing and Allied Health Literature. Other information was collected by searching reference lists of published reports.
Conclusions: The diagnostic criteria and guidelines are important to make an accurate clinical assessment and manage a child with ADHD. Early diagnosis and treatment of ADHD decreases academic failure, family conflict, social isolation, substance abuse, and occupational adversity in later years for these children.
Implications for practice: Often primary care nurse practitioners are the first healthcare provider a child with ADHD will see. Awareness of the diagnostic criteria and treatment for children with ADHD can assist with early identification and perhaps eliminate much impairment that accompanies this chronic disorder.     

Impact of suicide on health professionals in psychiatric care mental healthcare professionals' perceptions of suicide during ongoing psychiatric care and its impacts on their continued care work

People who attempt suicide as well as those who actually take their own life often have communicated their suicidal thoughts and feelings to healthcare professionals in some form. Suicidality is one of the most challenging caring situations and the impacts of suicide care affect both the professional and personal lives of healthcare professionals. This study investigates how mental health professionals perceive suicide while providing psychiatric care and how this perception impacts their continued care work. This qualitative exploratory study includes 19 mental health professionals in psychiatry who had provided care for patients who had taken their own life. Analysis followed the principle of phenomenography. The findings reveal that these healthcare professionals experienced an internal conflict that affected them both personally and professionally. In response to these conflicts, the healthcare professionals developed strategies that involved a safety zone and increased vigilance. Those who were able to commute and balance a safe spot and learning to be more vigilant seem to have developed as a result of patient's suicide. These findings have the potential to help establish a post‐suicide caring process where healthcare professionals learn to make better suicide assessments, become more open to talking about death with patients, and develop a humbler approach to understanding a patient's suicide.     

Learning how to handle emotionally challenging situations: the context of effective reflection

This paper reports how, through reflective collaboration between two students, a practitioner and a health lecturer, prospective professional nurses can develop and implement effective strategies to deal with emotionally challenging situations. Using the example of unexpected child death, issues affecting the support for the student provided in both clinical and formal educational settings are explored. The ability to apply a previous learning experience in a further critical situation was found to be dependent on cultural and contextual changes. Following on from the student experience it is demonstrated how learning about emotionally challenging situations can be achieved through reflection in conjunction with supportive processes provided by both practice and education. A supportive network in place for practitioners supporting students needs to be facilitated through mechanisms such as clinical supervision. The new Diploma in Nursing curriculum is examined for its potential to provide a seamless transitional support network from early student experience to experienced practitioner and throughout a career of life-long learning. There is a need for research that critically examines whether the developing system of reflection in education and practice is effective in helping students learn about emotionally challenging situations.     

The emotional needs of care recipients and the psychological well-being of informal caregivers: implications for home care clinicians

In this exploratory study, 77 informal caregivers of older persons in Ohio completed telephone interviews that included questions regarding their perceived difficulty providing emotional and physical care, perceived quality of care, demographic items including caregivers' health status, and a measure of their psychological well-being. Findings suggest that psychological well-being of informal caregivers is diminished when they experience greater difficulty meeting the care recipients' emotional care needs, are in poorer health, or are older. Suggestions for clinical implications and future research based on these findings are discussed.     

Caring for those without words: a perspective on aphasia.

A technical grasp of a medical condition does not always give a person a sense of the emotions behind the disease. Medical professionals, of course, cannot afford to be emotionally invested in every illness they see. Some amount of distance is needed for them to maintain their own emotional health and to give good care to patients. However, emotional or psychological struggles are a large component of a patient's suffering. If these realities are ignored, a medical professional will be much less effective on any level.     

Perception and fulfillment of cancer patients' nursing professional social support needs: from the health care personnel point of view

Purpose

This study aimed to (1) explore the needs of cancer patients regarding common nursing professional social support from the perspective of physicians and nurses, (2) identify what type of needs clinical nurses actually fulfill and what remains to be improved, and (3) analyze the potential reasons for the gap between the identified needs and those that are fulfilled.

Methods

A qualitative approach using focus group interviews was adopted to explore the perception and provision of cancer patients' needs regarding nursing professional social support. A purposive sample of 32 health care professionals was recruited from two teaching hospitals in Anhui province, China. Five focus group interviews were conducted and all interviews were tape-recorded and transcribed verbatim. A content analysis was performed with the data.

Results

The healthcare professionals perceived various nursing professional support needs of cancer patients; these include informational, emotional/psychological, and technical support needs; the mobilization of social resources; and palliative care during certain stages. The findings also indicated that there are still many unmet needs, especially needs related to the mobilization of social resources and palliative care. The reasons for the deficiencies in the fulfillment of these needs varied and included both subjective and objective aspects, such as the patients' lack of awareness of how to search for professional support, a shortage of professional staff, and the lack of a culturally appropriate assessment tool.

Conclusions

Cancer patients' supportive care needs were not always fully provided by nurses, even when these needs were identified by healthcare professionals. Nursing professional social support needs should be assessed quickly and effectively so that the appropriate interventions can be offered to cancer patients.