Patient Safety, Human Factors, and Simulation and Their Impact upon the Delivery and Quality of Healthcare

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality and Patient Safety".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 34547

Special Issue Editors

1. Department of Nursing, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
2. University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK
Interests: spirituality; spiritual care; nursing; education; dignity in care; compassionate care
Special Issues, Collections and Topics in MDPI journals
Department of Midwifery and Allied Health Professions, School of Health and Social Care, Staffordshire University, Stafford ST18 0YB, UK
Interests: dementia; ageing; care; human factors in healthcare; leadership and management
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The scope of this special edition is aligned with the key themes of patient safety, human factors, and simulation in healthcare. The emphasis is upon how principles, concepts and practices associated with these themes can enhance the systems, environments and organisational cultures that shape patient experience. This spans from micro-level instances of interaction between professionals and patients, to macro-level structural and cultural contexts.

Specific matters for consideration could include: clinical governance; professional responsibility and accountability; regulation and scrutiny; measuring impact and outcomes; learning from incidents; audit and inspection; technology and equipment; and knowledge management.

The purpose of this special edition of Healthcare is thus to collate a body of international papers on patient safety, human factors, and simulation, which will ultimately inform the improvement of healthcare contexts and practice.

We welcome article submissions from across the full-breadth of healthcare-related disciplines including medicine, nursing, allied health professions, psychology, economics, and sociology. We will also be very pleased to receive submissions that have a multidisciplinary basis, covering dimensions such as safety science, operations research, improvement science and simulation pedagogy.

Prof. Dr. Wilfred McSherry
Dr. Edward Tolhurst
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Patient experience
  • Patient Safety
  • Human Factors
  • Simulation
  • Healthcare
  • Quality
  • Compassion and Care

Published Papers (13 papers)

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Research

10 pages, 1062 KiB  
Article
A Knowledge, Attitude, and Practice Survey on Medication Safety in Korean Older Adults: An Analysis of an Ageing Society
by Mijin Lee, Kyungim Kim, Kiyon Rhew and Kyung-Hee Choi
Healthcare 2021, 9(10), 1365; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9101365 - 14 Oct 2021
Cited by 4 | Viewed by 3943
Abstract
Background: Older adults have certain limitations in acquiring and understanding information regarding medication safety. This study surveyed their medication habits and analysed the importance of relevant education to improve knowledge, attitudes, and practice (KAP). Methods: Our survey included adults aged 65 years or [...] Read more.
Background: Older adults have certain limitations in acquiring and understanding information regarding medication safety. This study surveyed their medication habits and analysed the importance of relevant education to improve knowledge, attitudes, and practice (KAP). Methods: Our survey included adults aged 65 years or older. We developed a questionnaire on medication safety based on the KAP model. To identify the interrelationships among KAP, we calculated the correlation coefficients using Pearson’s correlation analysis. A t-test was performed to verify the differences in KAP associated with the respondents’ medication safety education experience. Results: We found that 79.4% of respondents self-administered their medications. Of the respondents, 28.2% had received medication safety education. Overall, the respondents had typical levels of knowledge, attitude responses, and behavioural practices associated with medication safety. The results showed significant differences between knowledge and practice; those who were educated on medication safety performed higher levels of safe practice than those who were not (p < 0.05). Conclusion: The KAP survey confirmed that knowledge about the safe use of medication positively affected older adults’ attitudes and practices. To improve their medication usage habits, older adults should receive well-organised medication safety education. Full article
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12 pages, 252 KiB  
Article
Doctors’ Views on How to Improve Communication and Quality of Care for Patients Experiencing End-of-Life: A Qualitative Descriptive Study
by Fiona McCormack, Rachel Hopley, Judith Kurth and Zafar Iqbal
Healthcare 2021, 9(10), 1294; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9101294 - 29 Sep 2021
Cited by 1 | Viewed by 1820
Abstract
(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: [...] Read more.
(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: This qualitative descriptive study used semi-structured individual interviews. Through purposive sampling, sixteen doctors from primary care (three general practices) or acute care (one National Health Service hospital trust) participated. Interviews were audio-recorded, transcribed and thematic analysis conducted. (3) Results: Two main themes were identified: First, planning for patient-centred care—conversations about end-of-life care should take place earlier to allow for care that is planned and personalised. The need for more training and improvements to documenting patient wishes were highlighted. Second, delivering on patients’ wishes: improvements to the healthcare system—the importance of a record of patient wishes that can be shared across the system was identified. Improved utilisation of available resources is also needed to better deliver quality patient-centred care. (4) Conclusion: More effective communication and coordination across acute and primary care settings is needed. The importance of patient wishes and advance care planning was emphasised. More guidance at a strategic level may help provide clarity about expectations, roles and responsibilities. Full article
14 pages, 566 KiB  
Article
Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study
by Tao Zhang and Xiaohe Wang
Healthcare 2021, 9(9), 1206; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091206 - 13 Sep 2021
Cited by 3 | Viewed by 1611
Abstract
Background: Continuity of general practitioner (GP) care, widely known as the core value of high-quality patient care, has a positive association with health outcomes. Evidence about the relationship between continuity and health service utilisation has so far been lacking in China. This [...] Read more.
Background: Continuity of general practitioner (GP) care, widely known as the core value of high-quality patient care, has a positive association with health outcomes. Evidence about the relationship between continuity and health service utilisation has so far been lacking in China. This study aimed to analyse the association of continuity of GP care with utilisation of general practitioner and specialist services in China. Method: A cross-sectional mixed methods study was conducted in 10 urban communities in Hangzhou. Quantitative data were collected from a random sample of 624 residents adopting the self-developed questionnaire. Measurement of continuity of GP care included informational continuity (IC), managerial continuity (MC) and relational continuity (RC). With adjustment for characteristics of residents, multivariate regression models were established to examine the association of continuity of GP care with the intention to visit GP, frequency of GP and specialist visitations. Qualitative data were collected from 26 respondents using an in-depth interview, and thematic content analysis for qualitative data was conducted. Results: Quantitative analysis showed that the IC was positively associated with the intention to visit GP and frequency of GP visitations. Those people who gave a high rating for RC also used GP services more frequently than their counterparts. MC was negatively associated with frequency of specialist visitations. Qualitative analysis indicated that service capabilities, doctor–patient interaction and time provision were regarded as three important reasons why patients chose GPs or specialists. Conclusions: Overall, high IC and RC are independently associated with more GP service utilisation, but a high MC might reduce specialist visitations. Continuity of GP care should be highlighted in designing a Chinese GP system. Full article
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10 pages, 1482 KiB  
Article
Appointment Length with Patients in Medical Consultations in Bangladesh: A Hospital-Based Cross-Sectional Study
by Madhab Chandra Das, Muhammad Zakaria, Feng Cheng and Junfang Xu
Healthcare 2021, 9(9), 1164; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091164 - 05 Sep 2021
Cited by 5 | Viewed by 2396
Abstract
In medical consultations, the length of the visit has a significant impact on the quality of care. It is significantly associated with a better quality of treatment and better health outcomes. In this study, we analyzed doctors’ consultation length with patients and associated [...] Read more.
In medical consultations, the length of the visit has a significant impact on the quality of care. It is significantly associated with a better quality of treatment and better health outcomes. In this study, we analyzed doctors’ consultation length with patients and associated factors in Bangladesh. A cross-sectional survey was conducted among the patients (N = 763) who visited the doctors in six district/upazila (sub-district) hospitals in the Chittagong Hill Tracts (CHT) area. Linear regression analyses were performed to identify the determining factors associated with the length of doctors’ appointments with patients. Data were analyzed using IBM SPSS version 24.0. Among the patients, 319 (41.8%) were female and 688 (90.2%) lived in rural/suburban areas. This study revealed that the average length of medical consultations was 9.10 min. Additionally, our findings illustrated that doctors’ patient-centered communication behavior (β = 0.23, p < 0.001) appeared to be the strongest predictor of longer visit length. It was also found that patients’ higher education level (β = 0.10, p = 0.006), having adequate knowledge about the health problem (β = 0.13, p < 0.001), follow-up visits (β = 0.13, p < 0.001), and the presence of female doctors (β = 0.19, p < 0.001) were significantly associated with longer interview times between doctors and patients in primary care settings. Given that doctors’ patient-centered communication behavior appears to play the most important role, this study suggests that practicing professionalism in medical consultations, developing effective communication skills and increasing awareness of sociodemographic discrepancies are important to ensure longer appointment lengths and better health outcomes of patients, regardless their sociodemographic and socioeconomic status. Full article
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12 pages, 1502 KiB  
Article
Understanding the Role of External Facilitation to Drive Quality Improvement for Stroke Care in Hospitals
by Tharshanah Thayabaranathan, Nadine E. Andrew, Rohan Grimley, Enna Stroil-Salama, Brenda Grabsch, Kelvin Hill, Greg Cadigan, Tara Purvis, Sandy Middleton, Monique F. Kilkenny, Dominique A. Cadilhac and on behalf of the Stroke123 Investigators and AuSCR Consortium
Healthcare 2021, 9(9), 1095; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091095 - 25 Aug 2021
Cited by 2 | Viewed by 2133
Abstract
The use of external facilitation within the context of multicomponent quality improvement interventions (mQI) is growing. We aimed to evaluate the influence of external facilitation for improving the quality of acute stroke care. Clinicians from hospitals participating in mQI (Queensland, Australia) as part [...] Read more.
The use of external facilitation within the context of multicomponent quality improvement interventions (mQI) is growing. We aimed to evaluate the influence of external facilitation for improving the quality of acute stroke care. Clinicians from hospitals participating in mQI (Queensland, Australia) as part of the Stroke123 study were supported by external facilitators in a single, on-site workshop to review hospital performance against eight clinical processes of care (PoCs) collected in the Australian Stroke Clinical Registry (AuSCR) and develop an action plan. Remote support (i.e., telephone/email) after the workshop was provided. As part of a process evaluation for Stroke123, we recorded the number and mode of contacts between clinicians and facilitators; type of support provided; and frequency of self-directed, hospital-level stroke registry data reviews. Analysis: We measured the association between amount/type of external facilitation, (i) development of action plans, and (ii) adherence to PoCs before and after the intervention using AuSCR data from 2010 to 2015. In total, 14/19 hospitals developed an action plan. There was no significant difference in amount or type of external facilitator support provided between hospitals that did, and did not, develop an action plan. There was no relationship between the amount of external facilitation and change in adherence to PoCs. Most (95%) hospitals accessed stroke registry performance data. In the Stroke123 study, the amount or type of external facilitation did not influence action plan development, and the amount of support did not influence the changes achieved in adherence to PoCs. Remote support may not add value for mQI. Full article
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15 pages, 822 KiB  
Article
Student Nurses Undertaking Acute Hospital Paid Placements during COVID-19: Rationale for Opting-In? A Qualitative Inquiry
by Robert McSherry, Charlotte Eost-Telling, Dean Stevens, Jan Bailey, Rhian Crompton, Louise Taylor, Paul Kingston and Angela Simpson
Healthcare 2021, 9(8), 1001; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9081001 - 05 Aug 2021
Cited by 1 | Viewed by 2643
Abstract
The research aim was to evaluate the rationale of undergraduate final-year student nurses to undertake paid clinical placements during COVID-19 (Wave 1). The nursing profession reacted innovatively to meet demands placed on the National Health Service during COVID-19. Temporary changes to professional regulation [...] Read more.
The research aim was to evaluate the rationale of undergraduate final-year student nurses to undertake paid clinical placements during COVID-19 (Wave 1). The nursing profession reacted innovatively to meet demands placed on the National Health Service during COVID-19. Temporary changes to professional regulation enabled final-year United Kingdom nursing students to voluntarily undertake paid placements in the National Health Service. Neither full-time employees nor full-time students, volunteers undertook a unique hybrid role bolstering the front-line health workforce. Using reflective qualitative inquiry, 17 volunteers evaluated reasoning for entering practice in acute hospitals. Online surveys based around the UK Nursing and Midwifery Council Competency Framework (NMC 2012) were completed weekly for 6 weeks. Data were thematically analysed. Six themes were identified, including sense of duty, and opting-in or out. These highlighted the importance of collaboration and the tripartite relationship between University, host and student during placement, and the influence of these on the learning experience. Several significant insights emerged for nurse education and curricula during pandemics related to patient safety, safety climate and governance. The insights were used to develop a “Student Nurses Placement Framework” with recommendations for Pre-During-Post placement, offering a guide for future nursing workforce recruitment and retention. Full article
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14 pages, 256 KiB  
Article
Perceived Stigma as a Contextual Barrier to Early Uptake of HIV Testing, Treatment Initiation, and Disclosure; the Case of Patients Admitted with AIDS-Related Illness in a Rural Hospital in South Africa
by Sphiwe Madiba, Evelyn Ralebona and Mygirl Lowane
Healthcare 2021, 9(8), 962; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9080962 - 29 Jul 2021
Cited by 19 | Viewed by 2494
Abstract
We explored the extent to which perceived HIV-related stigma influences the disclosure and concealment of HIV status to family among adult patients hospitalised for AIDS-related illness, and described reports of negative responses and enacted stigma following disclosure. We conducted interviews with a purposeful [...] Read more.
We explored the extent to which perceived HIV-related stigma influences the disclosure and concealment of HIV status to family among adult patients hospitalised for AIDS-related illness, and described reports of negative responses and enacted stigma following disclosure. We conducted interviews with a purposeful sample of 28 adult patients in a rural South African hospital. Data analysis was deductive and inductive and followed the thematic approach. We found evidence of delayed HIV diagnosis and initiation of treatment. There was delayed and selective disclosure as well as concealment of the HIV-positive status. The disclosure was delayed for months or even years. During that time, there was active concealment of the HIV status to avoid stigma from family, friends, and community. When disclosure occurred, there was selective disclosure to close family members who would keep the secret and respond favorably. Although the participants disclosed mostly to close family, some of their post-disclosure experiences included incidents of enacted stigma and discrimination. The fear of perceived stigma and self-stigma influenced the active concealment of their HIV status from others. Continuous concealment of one’s HIV status and delayed disclosure limit the opportunities for support and care. There is a need to take into consideration the interaction between HIV-related stigma and disclosure to develop disclosure-counselling strategies in primary health care settings. Full article
14 pages, 268 KiB  
Article
Comparison of Stigmatization of Suicidal People by Medical Professionals with Stigmatization by the General Population
by Jill Julia Eilers, Erich Kasten and Thomas Schnell
Healthcare 2021, 9(7), 896; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9070896 - 15 Jul 2021
Cited by 2 | Viewed by 1620
Abstract
Stigmatization of suicide (SOS) affects help-seeking for suicidality and impedes successful treatment. This study aimed to identify different types of stigmatization and understand the causes and glorification of suicide by comparing three groups; within each of the following groups, the impact of age [...] Read more.
Stigmatization of suicide (SOS) affects help-seeking for suicidality and impedes successful treatment. This study aimed to identify different types of stigmatization and understand the causes and glorification of suicide by comparing three groups; within each of the following groups, the impact of age and gender was explored: (1) practicing medical professional in direct contact with suicidality (psychotherapists, psychiatrists, related medical professions (nurses, etc.)), (2) future medical professionals still in training, (3) and the general population with no professional contact with suicidality. German adults completed an online survey with a total of 742 participants. A MANCOVA was calculated with age and gender being controlled as covariates, due to different distribution. Practicing professionals showed significantly higher levels of SOS than the other groups, while the future professionals showed no differences in SOS from the general population. The understanding of suicide causes was similar across all groups. Men showed higher levels of SOS than women, while women scored higher at understanding of causes and glorification of suicide. Within the individual groups, female professionals in the age group “36–65 years” stigmatized suicide most, while showing the least glorification. The results suggest that tendencies towards SOS are promoted by practical experience with suicidality. Therefore, special training is recommended to reduce SOS. Full article
10 pages, 458 KiB  
Article
Patient Safety Culture Assessment in Primary Care Settings in Greece
by Ioannis Antonakos, Kyriakos Souliotis, Theodora Psaltopoulou, Yannis Tountas and Maria Kantzanou
Healthcare 2021, 9(7), 880; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9070880 - 13 Jul 2021
Cited by 8 | Viewed by 2302
Abstract
Introduction: A positive safety culture is considered a pillar of safety in health organizations and the first crucial step for quality health services. In this context, the aim of this study was to set a reference evaluation for the patient safety culture in [...] Read more.
Introduction: A positive safety culture is considered a pillar of safety in health organizations and the first crucial step for quality health services. In this context, the aim of this study was to set a reference evaluation for the patient safety culture in the primary health sector in Greece, based on health professionals’ perceptions. Methods: We used a cross-sectional survey with a 62% response rate (n = 459), conducted in primary care settings in Greece (February to May 2020). We utilized the “Medical Office Survey on Patient Safety Culture” survey tool from the Agency for Healthcare Research and Quality (AHRQ). The study participants were health professionals who interacted with patients from 12 primary care settings in Greece. Results: The most highly ranked domains were: “Teamwork” (82%), “Patient Care Tracking/Follow-up” (80% of positive scores), and “Organizational Learning” (80%); meanwhile, the lowest-ranked ones were: “Leadership Support for Patient Safety” (62%) and “Work Pressure and Pace” (46%). The other domains, such as “Overall Perceptions of Patient Safety and Quality” (77%), “Staff Training“ (70%), “Communication about Error” (70%), “Office Processes and Standardization” (67%), and “Communication Openness” (64%), ranked somewhere in between. Conclusions: A positive safety culture was identified in primary care settings in Greece, although weak areas concerning the safety culture should be addressed in order to improve patient safety. Full article
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12 pages, 458 KiB  
Article
Awareness and Attitudes towards Advance Care Directives (ACDs): An Online Survey of Portuguese Adults
by Carlos Laranjeira, Maria dos Anjos Dixe, Luís Gueifão, Lina Caetano, Rui Passadouro and Ana Querido
Healthcare 2021, 9(6), 648; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060648 - 29 May 2021
Cited by 11 | Viewed by 2442
Abstract
(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards [...] Read more.
(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = −0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death. Full article
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18 pages, 1377 KiB  
Article
Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study
by Anne Lotte Lemmers and Peter H. J. van der Voort
Healthcare 2021, 9(2), 208; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9020208 - 15 Feb 2021
Cited by 6 | Viewed by 3853
Abstract
Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making [...] Read more.
Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making and the dependency of patients on health care professionals. The objectives of this study are the development of a trust framework and then to use this framework in a case study in the intensive care. In three steps we developed a comprehensive trust framework from the literature concerning trust. First, we identified the elements of trust. Second, we adapted and integrated the dimensions to six concepts to construct the trust framework. Third, these concepts are incorporated into a comprehensive trust framework. In a case study we explored the facilitators and barriers within this framework in eight semi-open interviews with healthcare professionals and eight patients or partners. Trust was first explored inductively and then deductively. We showed that HCPs, patients, and family have largely the same perspective regarding the facilitators of trust, in which communication emerged as the most important one. Other facilitators are maintaining an open feedback culture for HCPs and being aware of patients’ physical and informational privacy. Patients want to be approached as an individual with individual needs. Dishonesty and differences in values and norms were the most important barriers. To contribute to a positive perception of health delivery and to avoid conflicts between HCP and patients or their family we formulated five practical recommendations. Full article
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6 pages, 193 KiB  
Article
Relational Quality of Registered Nurses and Nursing Assistants: Influence on Patient Safety Culture
by Amy Campbell, Diana Layne and Elaine Scott
Healthcare 2021, 9(2), 189; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9020189 - 09 Feb 2021
Cited by 4 | Viewed by 4141
Abstract
Registered nurses (RNs) working within acute care hospitals have an incredible responsibility to provide safe care in a complex environment which requires trust, teamwork, and communication. Nursing assistants (NAs) play a critical role in working with RNs to meet these growing demands of [...] Read more.
Registered nurses (RNs) working within acute care hospitals have an incredible responsibility to provide safe care in a complex environment which requires trust, teamwork, and communication. Nursing assistants (NAs) play a critical role in working with RNs to meet these growing demands of inpatient care. Minimal evidence exists exploring the relational quality between RNs and NAs within hospitals. The aim of this study is to explore RN and NA behaviors and experiences that promote patient safety and teamwork and enhance communication between RNs and NAs within the hospital environment. Qualitative analysis was used, with two focus groups which included six participants within each group (three RNs and three NAs) from two separate inpatient units. Transcripts were reviewed and coded for themes. Collaborative teamwork and two-way communication were commonly reported as behaviors that promote patient safety. Trust between RNs and NAs was identified as a key component of positive relationships between RNs and NAs. Participants identified four common behaviors that build trust, which were accountability, effective conflict resolution, collaborative teamwork, and prioritizing patient needs. Finally, teamwork was identified as a common strategy to increase communication effectiveness between RNs and NAs. High relational quality (RQ) between the RN and NA is an important component of teamwork and patient safety culture. Full article
15 pages, 2348 KiB  
Article
Differences in and Prognostic Value of Quality of Life Data in Rectal Cancer Patients with and without Distant Metastases
by Fabian Frank, Markus Hecht, Florian Loy, Sandra Rutzner, Rainer Fietkau and Luitpold Distel
Healthcare 2021, 9(1), 1; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9010001 - 22 Dec 2020
Cited by 7 | Viewed by 1691
Abstract
(1) Background: Individualization of treatment is a major challenge in oncology and requires a variety of predictive and prognostic parameters. In addition to tumor biology analyses, baseline health-related quality of life might be a valid tool to predict overall survival. This study was [...] Read more.
(1) Background: Individualization of treatment is a major challenge in oncology and requires a variety of predictive and prognostic parameters. In addition to tumor biology analyses, baseline health-related quality of life might be a valid tool to predict overall survival. This study was conducted to evaluate the prognostic relevance of baseline quality of life data in patients with rectal cancer. In this context, differences between patients with and without distant metastases were of particular interest. (2) Methods: Our cohort included 258 patients with rectal cancer treated in the radiotherapy department of the University Hospital Erlangen. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) core quality of life questionnaire (QLQ C30) and colorectal cancer questionnaire (CR38). Clinical and survival data were provided by the Gießener Tumor Documentation System (GTDS) of the Comprehensive Cancer Center Erlangen-EMN (CCC, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany). Statistical analyses were performed using Kaplan–Meier analyses and univariate and multivariate Cox regression. (3) Results: A cohort of 258 patients with rectal adenocarcinoma was analyzed including 50 patients (19.4%) with metastatic disease. No differences were observed between patients with and without distant metastases in most areas of quality of life studied, with the exception of physical function, loss of appetite, chemotherapy side effects and weight loss. Gender, baseline physical function, sexual function, diarrhea, and weight loss over time had a prognostic value in the entire cohort. Appetite loss was an additional prognostic parameter in patients with distant metastases. (4) Conclusions: The quality of life of patients with metastatic disease differed only slightly from non-metastatic patients. Health-related quality of life data provide prognostic information for patients with rectal cancer. Full article
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