Correlation between workplace culture, learning and medication errors

The occurrence of medication errors in intensivecare units can bring about irreparable damageand even lead to death in hospitalized patients.In this respect, numerous investigations have suggestedthat many factors including workplace culture and learningfrom error can affect the incidence rates of such errorsin these units. Accordingly, the present study was to shedlight on the correlation between workplace culture, learningfrom error, and reporting rate of medication errorsamong nurses in intensive care units affiliated to teachinghospitals of Shahid Beheshti University of Medical Sciencesin Iran.Methods: A descriptive-analytical study was conductedamong 120 nurses working in intensive care units in fourteaching hospitals in the city of Tehran. Then, the questionnairesdeveloped by Gulley et al., Rybowiak et al., andWakefield et al. were used to collect the data related toworkplace culture, learning climate, and medication errors.Results: The findings of this study indicated that increasedlearning from error in nurses working in intensivecare units could lower reporting rate of medication errors(r=-0.312, p-value=0.001); there was also a significantrelationship between workplace culture and reportingrate of medication errors, so that enhancing workplaceculture could reduce reporting rate of medication errors(r=-0.239, p-value=0.012).Conclusion: Improving workplace culture via supportingemployee creativity and innovation as well as promotinglearning environment through an employee reward systemalong with avoidance of punishments and reprimands fornurses during the occurrence of errors could be effective inmitigating the incidence rates of medication errors

Vigilant Care: Experiences of In-Home Caregivers of Coronavirus Disease 2019 Patients

Background: Home care is always appreciated as an effective alternative method to manage critical conditions, expand hospital capacity, and admit further cases suspected of more severe clinical symptoms.Aim: The present study aimed to reflect on the experiences of in-home caregivers of patients with coronavirus disease 2019 (COVID-19) in Iran.Method: For this qualitative descriptive study, 13 participants (i.e., the Iranian family caregivers of patients with COVID-19) were selected and included using the purposive sampling method. Caregivers were those who accompanied the patient to the outpatient department for three months from 22 June to 22 August 2021. An interview was conducted in a private room with family caregivers of patients. The data were obtained through a series of semi-structured interviews, each one lasting 30-40 min. The data were completed via the MAXQDA software (version 10). Analysis was performed according to the approach of Granheim and Landman 2004 by the conventional content analysis method.Results: The results lead to the emergence of the final theme "vigilant care" containing four categories (e.g., Quarantine fence, Economic management as a bottleneck, Confusion and difficulty in care, as well as Conflicting adaptation and mitigation of psychological stress) and 14 subcategories.Implications for Practice: Vigilance care is a major challenge for caregivers of patients with Covid-19 at home. Therefore, providing educational solutions or training booklets in outpatient wards during discharge can partially resolve the ambiguities and be effective in improving care

Orlando’s nursing process application on anxiety levels of patients undergoing endoscopy examination

Background and aims: Anxiety is a common reaction when people encounter new problems where they do not know what expect. The nurses are responsible for assessing the patient and helping them with the procedure of endoscopy. This study investigates differences in anxiety level of patients who receive nursing process of Orlando's theory prior to endoscopy examination compared to a control group. Methods: A Quasi -experimental research design was used in this study. Samples were 60 adult patients who were randomly assigned to two groups (30 patients each). Patients in the study group receive nursing process of Orlando's theory by the researcher plus the routine hospital intervention, while the control group only received the routine hospital intervention. The Spielberger State-Trait Anxiety Inventory (STAI scale) is administering to both groups before and after endoscopy examination. STAI, a self-reporting psychometric test, is used to assess state anxiety levels. STAI has demonstrated reliability and validity in previous studies. Results: Statistically significant difference was evident between the 2 groups regarding the mean of anxiety level of patients after the intervention. Before the intervention, the mean of anxiety level in the control and study groups were 47±9 and 58 ±11 and after the intervention were: 41±7, 35±7, respectively. Conclusion: Intervention groups have the lower mean of anxiety level after the intervention. Female patients in this study experienced low level anxiety compared to male patients after Orlando nursing process. The data suggest that endoscopy unit personnel and the referring physician should consider the patient’s perception of the procedure. Detailed information on the procedure and training in relaxation techniques should be given. Positive re-appraisal and information on sensations to be anticipated, rather than procedural details, will be more successful in alleviating stress and anxiety

Psychometric characteristics of nursing care complexity scale in medication errors, Iran

Twenty-first century challenges of nursing work is increasing complexity of care in the workplace. On the other word, medical errors is major challenge threaten for patient safety in all countries. The most common medical errors that identified are medication errors. With changing patterns of health services, the complexity increases in all workplaces. Since the medication administration is the main duties of nurses and drug companies influence of different drugs and different drugs for many patients, illegible handwriting of doctors, no prescription necessary recommendations, policies and new technology enterprise to apply, so it is a complicated process and in health care, the care complexity is one of the variables the affect on the occurrence of medication errors by nurses. This aim of study was translation, validity and reliability of care complexity scale in medication errors by nurses that for this purpose, the scale translates by Wilde and colleagues model (2005), content and face validity using the 12 specialists and nurses reviewed and revised. Then the 115 nurses in teaching - therapeutic centers of shaheed Beheshti University of Medical Sciences were asked to complete the scale. Factor analysis revealed that scale had single factor. Also reliability using Cranach's alpha coefficient for internal consistency showed moderate reliability of scale (α =0.61) and correlation coefficient in test- retest for stability (r =0.88). Although translation of care complexity scale in medical errors has satisfactory reliability and validity and can be used in the Iranian health system but is recommended criterion validity of scale examine by using other scales

Nurses’ Perspectives on Factors Affecting Patient Safety: A Qualitative Study

Patient safety is a global concern that involves all healthcare members, so that achieving a high level safe care is responsibility of all healthcare services, particularly nurses. This qualitative study aimed to describe nurses’ perspectives on factors affecting patient safety. We recruited 32 nurses working in teaching hospitals by purposeful sampling method. Data were collected by semi-structured interviews, and transcripts were analyzed by conventional content analysis approach. Two themes were extracted from data analysis including “Patient-Centered Care” and “Organizational-Based Factors”, and eight categories delineated from participants' experiences with regard to the patient safety. Based on the results, complexity of patient centered-care is an obstacle for implementation in practice. Therefore, educating nurses for focusing on patient interaction and cooperation is essential for achievement to proper care and improving quality of care.Furthermore, improving facilities and equipment, providing sufficient and efficient personnel by the executive director are necessary in effective clinical services

The Effect of Liaison Nurse Service on Patient Outcomes after Discharging From ICU: a Randomized Controlled Trial

Introduction: Recent studies suggest that liaison nurse intervention might be effective to solve the gap between intensive care unit and wards, but little studies are known about the effect of this intervention. The aim of this study was to investigate the effect of liaison nurse service on patient outcomes after discharging from intensive care unit. Methods: In this single blinded randomized controlled trial, a total of 80 patients were selected by convenience sampling method from two teaching hospitals located in Tehran, Iran. Patients were randomly allocated to either the experimental or the control groups. Patients in the experimental group received post-ICU care from a liaison nurse and patients in the control group received the routine care. After the intervention, patients’ vital signs, level of consciousness, length of hospital stay, need for re-hospitalization in ICU, and satisfaction with care were measure. Data were analyzed by SPSS Ver.13 software. Results: None of the participants experienced ICU re-hospitalization. According to the result and there were no significant differences between the study groups regarding heart rate, respiratory rate, systolic blood pressure, post-ICU level of consciousness, satisfaction with care, and length of hospitalization in medical-surgical wards. However, the study groups differed significantly in terms of body temperature. Conclusion: Care services provided by an ICU liaison nurse has limited effects on patient outcomes. However, considering the contradictions among the studies, further studies are needed for providing clear evidence about the effectiveness of the liaison nurse strategy

The Experiences of Nursing Internship Students during the COVID-19 Pandemic in Iran

Background: Nursing internship is a vital period for the formation of professional identity and development of clinical competency of nursing students, which has undergone extensive changes during the COVID-19 pandemic. The present study aimed to explain the experiences of nursing internship students during the COVID-19 pandemic in Iran.Methods: This qualitative-descriptive study was conducted using the conventional content analysis method. Data were collected through semi-structured interviews. Participants included 15 nursing internship students of Shahid Beheshti University of Medical Sciences in Iran, who were selected using purposive sampling. The interviews continued until data saturation. The trustworthiness of the data was ensured using Lincoln and Guba’s criteria. Data were analyzed via MAXQDA (version 10).Results: Data analysis led to the identification of two themes: (1) Paradoxes in clinical education path (with two categories including impaired learning and effective clinical education) and (2) Psychological pressure in patient care (with two categories including student protection and safety concerns and disruption of professional interaction).Conclusion: The present study showed that the COVID-19 pandemic has created many challenges for clinical nursing education that will affect professional competency in the future. Therefore, educational administrators must take into account the experiences of students as the main stakeholders in clinical education planning

Factors Affecting Medication Errors from Nurses\' Perspective: Lessons Learned

Introduction: Medical errors are among the most threatening faults against patient’s safety in all countries. The most frequent medical errors are medication errors which can lead to serious effects and even death in patients. Therefore, this study aimed to explain factors affecting medication eroors from the viewpoints of nurses in order to present strategies to reduce these errors. Methods: This study is a qualitative research based on directed content analysis approach. A porpuseful sample of 20 nurses working in Imam Hossein teaching hospital of Tehran, who had at least two years of clinical experience participated in semi-structured interviews. The regour and confirmability of data were verified through external check (member and peer check) as well as confirmation by participants. Data was simultaneously analyzed using qualitative content analysis. Results: Participants stated factors influencing errors in two themes: individual approach (including "individual and psychological characteristics of nurses," "characteristics of patients", "error resulted from physician orders"), and organizational culture and approach (including" working conditions"," learning process", "risk management procedures and how to deal with it", "drug information", "inevitability of errors in nursing", and "complications of medication errors"). Conclusion: Factors affecting medication errors are diverse, variable, and influenced by personal, organizational, and situational factors. The results of this study showed the importance of comprehensive educational programs, qualified role models, opportunity for field experience, and availability of useful feedbacks in a favorable environment during academic years and in workplace

Clinical Competence among MSc Students of Critical Care Nursing

Introduction: Assessment of clinical competence is of great importance in nursing which identifies the scientific gap between university education and clinical needs among graduate nurses. Hence, the aim of this study was to evaluate the clinical competence among MSc students of critical care nursing. Methods: In this descriptive cross-sectional study, 250 MSc students of critical care nursing were selected by convenience sampling from 17 state nursing schools of Iran in 2013-2014. A researcher-made questionnaire was used to collect data in five areas of care management, technical competence, individual management, patient-oriented care and scholarship. The content and face validity of the questionnaire were assessed and its reliability was calculated by Cronbach’s alpha coefficient for internal consistency (α = 0.86).A five-point Likert scale was used to measure the items. The collected data were analyzed using independent t-tests and one-way ANOVA. Results: Ultimately, 217 questionnaires were analyzed. The total mean score of clinical competence was 4.30±0.41. The mean scores were 4.38±0.43 for care management, 4.40±0.56 for technical competence, 4.36±0.45 for individual management, 4.29±0.60 for patient-oriented care, and 3.66±0.79 for scholarship. Clinical competence was 4.23±0.43 in males and 4.36±0.39 in females (p=0.001, T=-2.15). There was a significant difference between years of education in scholarship area (p =0.01, T=30.15). Conclusion: The results showed that the clinical competence of female students was higher than male students. Also the level of clinical competence was high in most areas however, it was different in terms of years of education in the scholarship area. Accordingly, a revised curriculum is recommended to enhance the efficiency of this course. It is recommended that more field studies be conducted on this area