Patients perceptions of safety in emergency medical services: an interview study

Background Research on patient safety in emergency medical services (EMS) has mainly focused on the organisation's and/or the EMS personnel's perspective. Little is known about how patients perceive safety in EMS. This study aims to describe the patients' experiences of their sense of safety in EMS. Methods A qualitative design with individual interviews of EMS patients (n=21) and an inductive qualitative content analysis were used. Results Patients' experiences of EMS personnel's ability or inability to show or use their medical, technical and driving skills affected the patients' sense of safety. When they perceived a lack of professionalism and knowledge among EMS personnel, they felt unsafe. Patients highlighted equality in the encounter, the quality of the information given by EMS personnel and the opportunity to participate in their care as important factors creating a sense of safety during the EMS encounter. Altogether, patients' perceptions of safety in EMS were connected to their confidence in the EMS personnel. Conclusions Overall, patients felt safe during their EMS encounter, but the EMS personnel's professional competence alone is not enough for them to feel safe. Lack of communication or professionalism may compromise their sense of safety. Further work is needed to explore how patients' perceptions of safety can be used in improving safety in EMS.Peer reviewe

Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study

Aims and Objectives To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship. Background Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills. Design The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions. Methods Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study. Results Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork. Conclusions This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services. Relevance to clinical practice Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.Peer reviewe

Exploring safety culture in the Finnish ambulance service with Emergency Medical Services Safety Attitudes Questionnaire

Publisher Copyright: © 2021, The Author(s).Background: Emergency Medical Services (EMS) is, by its nature, a challenging context that may create risks for both patients and employees. It is also known that an organisation’s safety culture has an influence on both patient and employee safety. Finnish EMS organisations lack knowledge of how their safety culture is perceived by their employees. Aim: This study aims to test the psychometric properties of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ) in a Finnish EMS setting. We also explore the connections between individual- and organisation-based characteristics and safety attitudes in the Finnish EMS. Methods: A cross-sectional survey study design was used. The EMS-SAQ was used to collect data via social media. The instrument measures six domains of workplace safety culture: safety climate, teamwork climate, perceptions of management, job satisfaction, working conditions and stress recognition. The 5-point Likert scale was converted to a 100-point scale and mean ≥ 75 was dichotomized as a positive. Confirmatory factor analysis (CFA) was carried out to validate the EMS-SAQ in a Finnish setting. Other results were analysed by using non-parametric tests. Results: 327 responses were included in the analysis. CFA showed that the total EMS-SAQ model had acceptable goodness-of-fit values in the Finnish EMS setting. Total mean scores for each safety culture domain were identified non-positively (mean score < 75); safety climate 60.12, teamwork climate 60.92, perceptions of management 56.31, stress recognition 64.55, working conditions 53.43 and job satisfaction 70.36. Higher education was connected to lower job satisfaction and the teamwork climate within the individual characteristics. All organisation-based characteristics caused at least one significant variation in the safety culture domain scores. Working area significantly affected (p < 0.05) five out of the six safety culture domain scores. Conclusions: The EMS-SAQ is a valid tool to evaluate safety culture among the Finnish EMS organisations; it offers a novel method to evaluate safety and patient safety within the Finnish EMS organisations. According to the findings, the organisation-based characteristics more likely had an impact on safety attitudes than did the individual-based characteristics. Therefore, it is suggested that the Finnish EMS organisations undertake safety culture development at the organisational level.Peer reviewe

Patient safety culture in the emergency medical services : the patients, students, and professionals’ perspectives

Patient safety culture (PSC) is a complex phenomenon, and it is important to understand, especially in prehospital settings where the working conditions are more unpredictable than in other healthcare settings. Knowledge and understanding of PSC can help enhance and develop patient safety in emergency medical services (EMS) at the organisational, team, and even individual levels. Therefore, this study aims to describe how PSC manifests in Finnish EMS from the patient, prehospital nursing students, EMS personnel, and EMS management perspective. The study consisted of four sub studies. All the data used in this study was collected between 2018 and 2021. EMS patients in study I were encountered and transported by the EMS after calling to the emergency medical communication centre (EMCC). EMS professionals in study II were recruited via social media aiming to achieve EMS personnel working full- or part-time in the EMS from different areas in Finland. Final year prehospital nursing students in study III were recruited from three different University of Applied Sciences. EMS managers and medical directors in study IV were recruited from five healthcare districts to participate the study. Participants job descriptions should include managerial/supervisor responsibilities. Results of this thesis were analysed using qualitative (I, III and IV) and statistical analysis methods (II). Interviews were analysed using inductive content analysis in study I while (reflexive) thematic analysis was used in studies III and IV. In study II, confirmatory factor analysis (CFA) was conducted to validate the EMS safety attitudes questionnaire (EMS-SAQ) in a Finnish setting. Connections between individual and organisation-based characteristics and six safety culture domains (safety climate, job satisfaction, perceptions of management, teamwork climate, working conditions, and stress recognition) were explored by using appropriate non-parametric tests. Altogether, 384 persons participated in the four studies conducted. Of those participants, 21 were patients (I), 327 were EMS professionals (II), 17 were prehospital nursing students (III), and were 19 EMS managers and medical directors (IV). According to the findings of qualitative studies (studies I, III, IV), PSC in EMS forms the operational environment, behaviour, attitudes, and feelings. The changing working and operational environment was highlighted when patients, prehospital nursing students, EMS managers, and medical directors described their experiences or views of patient safety issues in EMS. EMS managers and medical directors considered patient safety an organisational responsibility, but according to the students, there was lack of reporting patient safety events. The EMS personnel and EMS managers’ and medical directors’ interaction skills and behaviour were highlighted when EMS professionals and students described PSC in EMS. Also, patients highlighted the meaning of EMS personnel behaviour when patients described their experiences regarding safety in the EMS. Feelings and assumptions also have connection to experienced PSC in the EMS. According to the CFA results, the EMS-SAQ model fit was not totally optimal, and the correlations between five out of the six factors were high. The total mean scores for each safety culture domain were identified as non-positive. Within the individual characteristics, only education level was linked with significant variation in safety culture scores. All organisation-based characteristics were connected in significant variation in at least one safety culture domain scores. Changing working and operational environment in the EMS clearly manifests circumstances where EMS operates and is linked to the PSC in EMS. However, the nature of the EMS missions could affect the patient participation to develop patient safety in EMS. Attitudes and behaviour are seemingly in connection to PSC in EMS from the patients, students, and EMS professionals’ perspective. EMS does not always seem to be a psychologically safe environment for EMS patients, prehospital nursing students and EMS professionals. Overall, it looks like PSC in Finnish EMS is not optimal and needs development.Ensihoidon toimintaympäristössä olosuhteet eivät ole niin vakioidut kuin muualla terveydenhuollossa. Tietoisuus ja ymmärrys monimutkaisesta potilasturvallisuuskulttuurista voi auttaa parantamaan ja kehittämään potilasturvallisuutta ensihoidossa organisaatio- työyhteisö- ja yksilötasolla. Tämän väitöskirjan tarkoituksena on kuvata sitä, miten potilasturvallisuuskulttuuri ilmenee suomalaisessa ensihoidossa potilaan, ensihoitajaopiskelijan, ensihoitohenkilöstön ja ensihoidon johdon näkökulmista. Väitöskirja koostuu neljästä osatutkimuksesta. Osatutkimuksessa I haastateltiin hätäkeskukseen soittaneita ensihoidon hoitamia ja kuljettamia potilaita (n =21). Osatutkimukseen II rekrytoitiin koko- tai osa-aikaisesti ensihoidossa työskenteleviä ammattilaisia eri puolilta Suomea (n =327) sosiaalisen median kautta. Osatutkimukseen III rekrytoitiin viimeisen vuoden ensihoidon opiskelijoita (n = 17) kolmesta suomalaisesta ammattikorkeakoulusta. Osatutkimuksen IV ensihoidon esihenkilöt ja vastuulääkärit (n = 19) rekrytoitiin viiden eri sairaanhoitopiirin alueelta. Edellytyksenä oli, että työnkuvan tuli sisältää johtamiseen ja esihenkilötyöhön liittyviä velvoitteita. Väitöstutkimuksen tulokset analysoitiin käyttämällä laadullisia (I, III ja IV) ja tilastollisia menetelmiä (II). Potilaiden, ensihoitajaopiskeiljoiden ja esihenkilöiden sekä vastuulääkäreiden kuvailemissa näkemyksissä korostui ensihoidon muuttuva työskentely- ja toimintaympäristö. Ensihoidon esihenkilöiden ja vastuulääkäreiden näkemysten mukaan potilasturvallisuus on organisaation vastuulla. Opiskelijoiden havaintojen perusteella potilasturvallisuustapahtumien raportoinnissa oli kuitenkin puutteita. Ensihoitohenkilöstön ja esihenkilöiden sekä vastuulääkäreiden vuorovaikutustaitoja ja käyttäytymisen merkitystä korostettiin, kun ensihoidon ammattilaiset ja opiskelijat kuvailivat potilasturvallisuuskulttuuria ensihoidossa. Myös potilaat korostivat ensihoitohenkilöstön käyttäytymistä, kun he kuvailivat kokemuksiaan turvallisuudesta ensihoidossa. Kuvausten ja kokemusten perusteella myös tunteilla ja olettamuksilla oli yhteys koettuun potilasturvallisuuskulttuuriin. Faktorianalyysin tulokset osoittivat, että tällä aineistolla ensihoidon turvallisuusasennekyselyn malli ei ollut täysin optimaalinen. Kokonaisuudessaan kaikki turvallisuuskulttuurin osa-alueet (turvallisuusilmapiiri, työtyytyväisyys, käsitykset johtamisesta, työskentelyolosuhteet, tiimityöilmapiiri ja stressin tunnistaminen) arvioitiin heikoiksi. Johtopäätöksenä voidaan todeta, että ensihoidon muuttuvalla työskentely- ja toimintaympäristöllä vaikuttaa olevan yhteys ensihoidon potilasturvallisuuskulttuuriin. Ensihoitotehtävien luonne saattaa kuitenkin vaikuttaa potilaiden osallistumiseen potilasturvallisuuden kehittämiseen ensihoidossa. Ensihoidon ammattilaisten, opiskelijoiden että potilaiden näkemysten mukaan vaikuttaa siltä, että asenteilla ja käytöksellä on yhteys ensihoidon potilasturvallisuuskulttuuriin. Näyttää siltä, että ensihoito ei ole psykologisesti turvallinen ympäristö potilaille, opiskelijoille ja ensihoidon ammattilaisille. Tulosten perusteella vaikuttaa siltä, että potilasturvallisuuskulttuuri suomalaisessa ensihoidossa ei ole optimaalinen ja se vaatii kehittämistä

Pintaa syvemmällä : ensihoitotyön esimiesten ja ensihoidon vastuulääkäreiden käsityksiä työturvallisuuskulttuurista ja -ilmapiiristä

Opinnäytetyön tarkoituksena oli selvittää ensihoidon esimiesten ja vastuulääkäreiden käsityksiä ensihoidon työturvallisuuskulttuurista ja –ilmapiiristä Suomessa. Selvitystä varten laadittiin kysely, joka perustui ensihoidon YAMK-opiskelijoilla teetettyihin esseekirjoitelmiin, aiempiin tutkimuksiin ja teoriatietoon. Opinnäytetyö oli osa Tehy ry:n ja Suomen Ensihoitoalan liitto ry:n valtakunnallista turvallisuushanketta. Hankkeen tarkoituksena oli selvittää ensihoidon työympäristöön liittyviä turvallisuusuhkia ja –riskejä ja tutkia ensihoidon kaikkien toimijoiden käsityksiä ja näkemyksiä turvallisuuskulttuurista. Suomessa ei ole aiemmin tässä laajuudessa tutkittu ensihoidon turvallisuuskulttuuria. Opinnäytetyössä käytettiin menetelmä- ja tutkijatriangulaatiota. YAMK-opiskelijoiden kirjoittamat esseet analysoitiin teoriaohjaavan sisällönanalyysin keinoin. Tutkimusta varten laadittu strukturoitu kysely toteutettiin Webropol-kyselynä. Kyselyn analysointi suoritettiin SPSS 23.0 –ohjelmalla. Esseeaineiston analyysissä muodostettiin ensihoidon turvallisuuskulttuuriin uusi pääluokka eli valtakunnallinen taso, joka täydentää aiempien turvallisuuskulttuuriteorioiden mukaisia turvallisuuskulttuurin tasoja. Eniten tilastollisesti merkitseviä eroja löytyi suurimmasta, organisatorista tasoa kuvaavasta kysymysryhmästä. Keskeisimmät havainnot tuloksista olivat, että suhtautuminen turvallisuuteen on varsin vaihtelevaa ja ikä vaikuttaa voimakkaasti asenteisiin ja arvoihin. Lisäksi havaittiin, että työhyvinvointi on mahdollisesti tärkein turvallisuuskulttuuriin vaikuttava tekijä. Tuloksista pääteltiin, että yhtenäistä käsitystä turvallisuuskulttuurista ei ole. Työturvallisuuden johtaminen ensihoidossa vaatii vielä kehittämistä.The purpose of this study was to do a survey of the perceptions of emergency medical care managers, supervisors and medical directors concerning safety culture and safety climate in emergency care. This thesis is a part of a nationwide occupational safety project, which was initiated by The Union of Social and Health Care Professionals in Finland (Tehy) and The Union of Finnish Prehospital Medical Care (SEHL). In this thesis, both qualitative and quantitative methods were used. The essays about safety culture in emergency medical care were written by experienced paramedics. Based on the essay data findings and previous theoretical knowledge, a Webropol questionnaire was composed for emergency medical care managers, supervisors, and medical directors. The survey was analyzed using the SPSS 23.0 software. A new national level for emergency medical care safety culture was formed based on the qualitative analysis and it complements the present safety culture theory. Statistically most significant differences were found within the largest question group regarding organizational level. The most prominent discovery was that attitudes towards safety vary and that age has a very high impact on attitudes and values. Furthermore, it could be stated that well-being at work might be the most significant factor in prehospital safety culture. The results of the survey showed that there is no common understanding of safety culture. The occupational safety management in the emergency medical care environment is defective and needs improvement

Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study

Aims and Objectives To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship. Background Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills. Design The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions. Methods Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study. Results Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork. Conclusions This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services. Relevance to clinical practice Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.Peer reviewe

Finnish emergency medical services managers’ and medical directors’ perceptions of collaborating with patients concerning patient safety issues: a qualitative study

Peer reviewe

Healthcare Workers’ Experiences and Views of Using Surgical Masks and Respirators, and Their Attitudes on the Sustainability: A Semi-Structured Survey Study during COVID-19

A universal mask use was instituted in healthcare during COVID-19 pandemic in 2020. The extensive growth in the consumption of surgical masks and respirators brought new challenges. Healthcare workers had to get accustomed to wearing the facemasks continuously, raising concerns on the patient, occupational, and environmental safety. The aim of this study is to describe frontline healthcare workers and other authorities’ views and experiences on continuous use of surgical masks and respirators (facemasks) and their attitudes towards environmental and sustainability issues. A cross-sectional web-based survey was conducted in Finland during the COVID-19 pandemic in autumn 2020. The respondents(N = 120) were recruited via social media, and the data were collected using a purpose-designed questionnaire. Descriptive statistics and inductive content analysis were used to analyze the quantitative data and qualitative data, respectively. The healthcare workers perceived their own and patient safety, and comfortability of facemasks as important, but according to their experiences, these properties were not evident with the current facemasks. They considered protection properties more important than environmental values. However, biodegradability and biobased material were seen as desired properties in facemasks. Based on the results, the current facemasks do not meet users’ expectations well enough. Especially the design, breathability, and sustainability issues should be taken more into account.Peer reviewe