The contribution of nurses to incident disclosure: A narrative review

Objectives

To explore (a) how nurses feel about disclosing patient safety incidents to patients, (b) the current contribution that nurses make to the process of disclosing patient safety incidents to patients and (c) the barriers that nurses report as inhibiting their involvement in disclosure.

Design

A systematic search process was used to identify and select all relevant material. Heterogeneity in study design of the included articles prohibited a meta-analysis and findings were therefore synthesised in a narrative review.

Data sources

A range of text words, synonyms and subject headings were developed in conjunction with the York Centre for Reviews and Dissemination and used to undertake a systematic search of electronic databases (MEDLINE; EMBASE; CENTRAL; PsycINFO; Health Management and Information Consortium; CINAHL; ASSIA; Science Citation Index; Social Science Citation Index; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Health Technology Assessment Database; Health Systems Evidence; PASCAL; LILACS). Retrieval of studies was restricted to those published after 1980. Further data sources were: websites, grey literature, research in progress databases, hand-searching of relevant journals and author contact.

Review methods

The title and abstract of each citation was independently screened by two reviewers and disagreements resolved by consensus or consultation with a third person. Full text articles retrieved were further screened against the inclusion and exclusion criteria then checked by a second reviewer (YB). Relevant data were extracted and findings were synthesised in a narrative empirical synthesis.

Results

The systematic search and selection process identified 15 publications which included 11 unique studies that emerged from a range of locations. Findings suggest that nurses currently support both physicians and patients through incident disclosure, but may be ill-prepared to disclose incidents independently. Barriers to nurse involvement included a lack of opportunities for education and training, and the multiple and sometimes conflicting roles within nursing.

Conclusions

Numerous potential benefits were identified that may result from nurses having a greater contribution to the disclosure process, but the provision of support and training is essential to overcome the reported barriers faced by nurses internationally.     

Health,Emergency Department Use,and Early Identification of Young Children Exposed to Trauma

Background

Childhood trauma is an important public health problem with financial, physical health, and mental health repercussions. Emergency departments (EDs) are often the first point of contact for many young children affected by emotionally or psychologically traumatic events (e.g., neglect, separation from primary caregiver, maltreatment, witness to domestic violence within the family, natural disasters).

Study Objectives

Describe the prevalence of physical health symptoms, ED use, and health-related problems in young children (birth through 5 years) affected by trauma, and to predict whether or not children experiencing trauma are more likely to be affected by health-related problems.

Methods

Community-based, cross-sectional survey of 208 young children. Traumatic events were assessed by the Traumatic Events Screening Inventory – Parent Report Revised. Child health symptoms and health-related problems were measured using the Caregiver Information Questionnaire, developed by ORC Macro (Atlanta, GA).

Results

Seventy-two percent of children had experienced at least one type of traumatic event. Children exposed to trauma were also experiencing recent health-related events, including visits to the ED (32.2%) and the doctor (76.9%) for physical health symptoms, and recurring physical health problems (40.4%). Children previously exposed to high levels of trauma (four or more types of events) were 2.9 times more likely to report having had recently visited the ED for health purposes.

Conclusions

Preventing recurrent trauma or recognizing early trauma exposure is difficult, but essential if long-term negative consequences are to be mitigated or prevented. Within EDs, there are missed opportunities for identification and intervention for trauma-exposed children, as well as great potential for expanding primary and secondary prevention of maltreatment-associated illness, injury, and mortality.     

Association between physical performance characteristics and independence in activities of daily living in middle‐aged and elderly men

Aim: Functional status at one moment in time is a determinant of future functional status and survival. Physical deterioration tends to occur early in the disabling process; however, etiological questions remain. This study investigated the association between physical performance characteristics and functioning independently in middle‐aged and elderly men. Methods: A total of 400 independently‐living men aged 40–80 years were included in this cross‐sectional study. Preservation of function was measured using the Stanford Health Assessment Questionnaire. Physical characteristics were muscle strength and power by dynamometer, lung function, lower extremity function by physical performance score, and physical activity by Voorrips‐questionnaire. Logistic regression analysis was used to estimate the association between potential determinants and the dichotomized Health Assessment Questionnaire score. The odds ratios (OR) were adjusted for age, body mass index, education, socioeconomic status, smoking, alcohol and number of chronic diseases. Results: After adjustment for confounders, higher walking speed (OR = 2.96, 95% CI 1.31–6.72) and shorter time to carry out the chair stand test (OR = 0.84, 95% CI 0.76–0.94) were associated with a higher probability of being independent in activities of daily living (ADL). Borderline significant associations were found for higher lung function and higher leg strength with higher probability of being independent in ADL. No associations were found for grip strength, physical performance score, standing balance and physical activity. Conclusion: Lower body function and lung function were associated with a higher probability of being independent in ADL. Geriatr Gerontol Int 2013; 13: 274–280 .