Limiting Harm in Health Care: A Nursing Perspective (Nursing)


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Clinical nurses may be reluctant to voice concerns and may develop behaviors that drift or unknowingly create risk in an effort to provide efficient patient care. Risky behaviors increase the likelihood of human error.

It's more than policy

Nurse leaders need to implement visible and meaningful system improvements while ensuring that the outcomes are communicated to clinical nurses to validate and encourage error identification. Closing this communication feedback loop is critical to confirm the value of clinical nurses' escalation of potential and actual error. Objective analysis of each event to identify inherent risks must include clinical nurses.

Nurses at the “Sharp End” of Patient Care - Patient Safety and Quality - NCBI Bookshelf

An organization can recover when it can catch an upstream error before it leads to an adverse outcome. Just culture isn't a blame-free culture, rather a culture of balanced accountability. Safe patient care outcomes include organizational system design and individual behavioral choices. The study results support findings from previous studies and are consistent with the organization's and AHRQ Survey on Patient Safety Culture results. Although approximately 1, participants were contacted to complete the survey, the sample size was Another limitation was the survey's length.

Impact of Heath Information Technology on the Quality of Patient Care

Staff members may have been reluctant to complete the survey due to time constraints and this may have contributed to the small sample size. A third limitation was related to the survey tools. Both utilized Likert scales with neutral choices and contained questions with reverse wording.

The researcher noted reverse-worded items and the items were reverse scored. However, if respondents didn't carefully read each item and note the reverse wording, it's possible that they answered differently than their intended response. Despite these identified limitations, the research questions were supported. The study's findings offer practical suggestions for organizations to develop a trusting and just culture.

This can lead to an environment where incidents are analyzed based on the system in which clinical nurses function. Including every member of the interdisciplinary team in the debriefing can also help destigmatize the incident and normalize the event. Collaborative debriefing following an incident helps the nurse understand why he or she made the behavioral choice, as well as identify opportunities for potential system redesign.

A fair and balanced approach to incident investigation includes the provision of education and training only when needed. If the best choice a clinical nurse can make is a risky one, then retraining doesn't impact the root cause. Leaders who utilize just culture principles of consoling staff and fixing faulty systems that create the risky behavioral choice foster trust. To decrease risky behaviors, leaders must acknowledge and manage workplace stress, which can result from chronic understaffing, supply shortages, and technology failure and, in turn, degrade performance by leading to risky behavioral choices.

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Frontline leaders can ensure that staff members have the requisite tools to perform duties without taking short cuts. When behavioral choices and trust align, the approach to performance improvement becomes the standard work of all staff. Use of an objective algorithm assists leaders to investigate potential and actual incidents with fairness and transparency. This can strengthen the trusting environment and reinforce the value of being an error identifier.

During onboarding of new employees, trainees must be made aware of the importance of error identification as a piece of systemic information beneficial to the organization. Stressing the partnership between the organization and clinical nurses in creating a culture of safety can support mutual trust. Griffith and Marx report that accountability is a fundamental component of a just culture, which emphasizes the human system components within the larger organizational system.

When just culture concepts are integrated into the Magnet Model, the organization can systematically improve the safety culture. Transformational leadership and structural empowerment provide a blueprint and process to unravel the complexities of an event, learn from it, and improve safety.

Leaders should take advantage of consistent, unit-based teamwork by openly supporting and recognizing clinical nurses and frontline nurse leaders who value high-reliability principles and model optimal clinical outcomes. The shift to a just culture is a slow process that takes years to develop and hardwire. Hospital-wide policies that incorporate just culture principles are a first step.

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Studies are needed to regularly assess trust and just culture perceptions among nurse leaders and clinical nurses. Ensuring alignment of nurses' perceptions of just culture and trust can increase employee satisfaction, improve patient safety outcomes, and ultimately reduce the third-leading cause of death in the US. Purpose: This study examined whether there was a relationship between trust, just culture, and error reporting in nurse leaders and clinical nurses.

Location: The study site, located in Brooklyn, N. Time frame: March through May Population: The majority of nurses who responded to the survey were employed more than 10 years in the organization and provided direct care to patients. The average age of the respondents was Sample size: The convenience sample of nurses surveyed included 1, clinical nurses and 80 nurse leaders.

At the end of the open enrollment, nurses responded. The sample size exceeded the required number identified by power analysis and resulted in an Twenty-four surveys were discarded due to omission of responses that measured the research questions. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.

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Send a copy to your email. Some error has occurred while processing your request. Please try after some time. Back to Top Article Outline. Table 1. Figure 1. Table 2. Makary MA, Daniel M. Medical error—the third leading cause of death in the US. Cited Here Gerstle CR.

go to site Parallels in safety between aviation and healthcare. J Pediatr Surg. PubMed CrossRef. Agim T, Sheridan L. James Reason's safety culture in aged care: frontline staff perspectives on reporting, just, learning and flexible culture in a large Australian residential aged care provider.

J Health Saf Environ. Outcome Engenuity. What does our model of accountability look like? Petschonek S, Burlison J, Cross C, et al Development of the just culture assessment tool: measuring the perceptions of health-care professionals in hospitals. J Patient Saf. Gap assessment of hospitals' adoption of the just culture principles.

PA Patient Saf Adv. Reason J. Human error: models and management. DuPree E. High reliability: the path to zero harm.


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Healthc Exec. Griffith K, Marx D. Just culture: a shared commitment.

Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing) Limiting Harm in Health Care: A Nursing Perspective (Nursing)
Limiting Harm in Health Care: A Nursing Perspective (Nursing)

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