Exploring Nurses' Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study

A focus group study was conducted to explore nurses' perceptions of medication administration error associated factors in two medical wards of a tertiary hospital. Nurses were invited to participate in focus group discussions. Thematic analysis was employed and identified four themes: professional practice environment related factors, person-related factors, drug-related factors, and processes and procedures. Staffing, interruptions, system failures, insufficient leadership, and patient acuity were perceived as risk factors for medication errors. The findings of this study complement the findings of an observational study which investigated medication administration errors in the same setting. Although some findings were similar, important risk factors were identified only through focus group discussions with nurses. Nurses' perceptions of factors influencing medication administration errors provide important considerations in addressing factors that contribute to errors and for improving patient safety

The hidden ethical element of nursing care rationing

Objective: To explore nurses’ experiences and perceptions about prioritizations, omissions, and rationing of bedside nursing care. Methods: A total of 23 nurses participated in four focus groups. The interviews were based on a semi-structured interview guide; data were analyzed using a thematic analysis approach. Findings: Four themes were developed based on the data: (a) priorities in the delivery of care; (b) professional roles, responsibilities, and role conflicts; (c) environmental factors influencing care omissions; and (d) perceived outcomes of rationing. Discussion: The delivery of nursing care is framed by the biomedical ethos and inter-professional role conflict while the standards of basic care are jeopardized. Organizational and environmental factors appear to exert significant influence on prioritization. Failure to carry out necessary nursing tasks may lead to adverse patient outcomes, role conflict, and an ethical burden on nurses. Conclusion: There is a need for further exploration and possible redesign of the nursing role, scope, and responsibilities, as well as addressing the arising ethical issues of rationing in nursing care

The prevalence and patterns of rationing of nursing care in acute care settings

When resources are insufficient, nurses are forced to ration their attention between care activities with the potential consequence of withholding or failing to carry out certain nursing activities. As a result fundamental patient needs may not be fulfilled leading to adverse patient outcomes (ie: falls, and nosocomial infections). Evidence suggests that individual nurse and patient related characteristics as well as environmental factors can initiate rationing. The aim of the study was to describe and compare the frequency of implicit rationing of nursing care in different clinical settings in Cyprus and identify any relevant environmental factors. Three descriptive, correlational cross-sectional studies were involved. Data were collected using the BERCNA questionnaire from 393 nurses working in medical and surgical units. One hundred and fifty seven nurses working in oncology units responded to a ‘Missed Care’ questionnaire, and data were also data collected from 540 nurses in 14 general medical and surgical wards across five public hospitals, who responded to the question task undone (TU-13) as part of the RN4CAST-cy project. The response rate of all the studies was >60% of the samples. Despite the the use of three different instrumentations, there were similar patterns of implicit rationing. Findings reveal that activities described as frequently or always left undone were: mouth care (61.1%); Comfort/talk with patients (58.3%), educating patient or families (54.0 %); emotional and psychological support (32.5%); and reviewing patient documentation (31%). Environmental dimensions, such as ‘teamwork communication about patients’ were associated with a decreased level of rationing. Nursing care left is a significant problem in acute care hospitals. Rationing of care creates two problems. Firstly it leaves patients vulnerable to unmet educational, emotional, and psychological needs. Secondly, it leaves nurses vulnerable to unmet received knowledge as they lack sufficient information about the patient situation and this may lead to false decisions in prioritising care

The Use of Lego Technologies in Elementary Teacher Preparation

The need to reform science teacher preparation programs has been pointed out in research (Bryan and Abell in J Res Sci Teach 36:121-140, 1999; Bryan and Atwater in Sci Educ 8(6):821-839, 2002; Harrington and Hathaway in J Teach Educ 46(4):275-284, 1995). Science teachers are charged with the responsibility of incorporating both cognitive and non-cognitive parameters in their everyday teaching practices. This often results in their reluctance to teach science because they often lack disciplinary and/or pedagogical expertise required to promote science learning. The purpose of this study is to propose an alternative instructional approach in which Lego vehicles were used as a tool to promote pre-service elementary teachers' development and to examine whether there are non-cognitive parameters that promote or obstruct them from using Lego Technologies as a teaching tool. The context of the study was defined by a teacher preparation program of a private university in a small Mediterranean country. A sample of 28 pre-service elementary teachers, working in five 5-6-member groups were involved in scientific inquiries, during which they had to use vehicles in order to solve scientific problems related to concepts such as gear functioning, force, and motion. The nature of their cognitive engagement in the scientific inquiry process, non-cognitive parameters contributing to their cognitive engagement, and the impact of their involvement in the process on their development were examined through qualitative analysis of pre- and post-inquiry interviews, presentations of their solutions to the scientific problems and of their personal reflective journals

Mobile Agents for WWW Distributed Database Access

The popularity of the web as a universal access mechanism for network information has created the need for developing webbased DBMS client/server applications. However, the current commercial applet-based methodologies for accessing database systems offer limited flexibility, scalability and robustness. In this paper, we propose a new framework for Web-based distributed access to database systems based on Java-based mobile agents. The framework supports light-weight, portable and autonomous clients as well as operation on slow or expensive networks. The implementation of the framework shows that its performance is comparable to, and in some case outperforms, the current approach. In fact, in a wireless and dial-up environments and for average size transactions, a client/agent/server adaptation of the framework provided a performance improvement of approximately a factor of ten. For the fixed network the gains were about 40% and 30% respectively. 1. Introduction The widespread use of ..

Missed nursing care as related to the types of ethical climate in public hospitals

Missed nursing care is defined as "any aspect of required patient care that is omitted (either in part or in whole) or delayed", (Kalisch et al. 2009, p. 1509), it can occur at any stage of the nursing process and it is influenced by factors in the care environment such as the allocation of resources (material and labor), relationships and communication, that affect nurses’ internal processes (e.g. values, beliefs, collective team norms) and guide them in deciding which nursing activity should be completed, should be missed, or should be delayed (Kalisch et al. 2009). Ethical climate in hospitals reflects the collective behavior of health care employees, acts as a reference of behavior when nurses face ethical issues and has a great impact on their decision-making process and on the quality of patient care. Victor and Cullen (1987) defined ethical climate as “the shared perceptions of what is ethically correct behavior and how ethical issues should be handled in organizations’’. Five types appear frequently in healthcare organizations which are the Caring, the Instrumental, the Rules, the Law and Codes and the Independence. Research on the relationship of the types of ethical climate with missed nursing care is limited. Since the nurses' practice environment has been linked to missed nursing care and having in mind that the ethical climate is actually a dimension of the whole working environment, as well as, the results of a previous study (Vryonides et al. 2016) that had examined this relationship in cancer care units (only), the current study further explores this relationship

The ethical dimension of nursing care rationing as it is revealed from existing qualitative research studies

The aim of this presentation is to present the results of a systematic review and a thematic synthesis of qualitative research studies that have revealed an ethical dimension of nursing care rationing. The Objectives of this thematic synthesis were to find out the deeper moral meaning of nursing care rationing (if any) by synthesizing studies that relate this phenomenon with the ethical perspectives of nursing