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Building patient safety in intensive care nursing: Patient safety culture, team performance and simulation-based training
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing.

Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven ICUs and ten RNs from a post-graduate programme (II). The data were collected with questionnaires (II) and measurement scales (III), and analysed with statistics. In Study IV, 18 RNs were interviewed and the data were analysed with a qualitative content analysis.

Main findings: The RNs had positive perceptions of the overall patient safety culture in the ICUs. Hence, a potential for improvements was identified at both the unit and hospital level. Differences between types of ICUs and between hospitals were found. The dimensions at the unit level were predictors for the outcome dimensions (I). The RNs evaluated the simulation-based team training programme in a positive way. Differences with regard to scenario roles, prior simulation experience and area of intensive care practice were found (II). The expert raters assessed the teams’ performance as advanced novice or competent. There were differences between the expert raters’ assessments and the RNs’ self-assessments (III). One main category emerged to illuminate the RNs’ perceptions of simulation-based team training for building patient safety: Regular training increases the awareness of clinical practice and acknowledges the importance of structured work in teams (IV).

Conclusions: Patient safety culture measurements have the potential to identify areas in need of improvement, and simulation-based team training is appropriate to create a common understanding of structured work in teams with regard to patient safety.

Abstract [en]

Baksidestext

Intensive care represents potential patient safety challenges for critically ill patients. Human errors are the most common cause of incidents, and failures in team performance are identified as contributory factors. The measurements of patient safety culture and simulation-based team training are recommended initiatives to improve patient safety. The aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. The nurses had a positive perception of the overall patient safety culture. A potential for improvements were found in incident reporting, feedback and communication about errors and organizational learning. The RNs evaluated the simulation-based team training programme in a positive way. The assessments of nurses’ team performance with respect to communication, leadership and decision-making in a simulation-based emergency situation showed a variation in competencies from advanced novice to competent. There were differences between expert raters’ assessments and nurses’ self-assessments. The nurses perceived that simulation-based team training on a regular basis increases the awareness of clinical practice and acknowledges the importance of structured teamwork.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2013. , 91 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2013:46
Keyword [en]
intensive care, nursing, patient safety, safety culture, simulation, team performance, team training
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-29870ISBN: 978-91-7063-524-3 (print)OAI: oai:DiVA.org:kau-29870DiVA: diva2:658289
Public defence
2013-12-06, Lagerlöfsalen, 1A 305, Karlstads universitet, Karlstad, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2013-11-08 Created: 2013-10-21 Last updated: 2017-08-08Bibliographically approved
List of papers
1. Nurses’ perceptions of patient safety climate in intensive care units: A cross-sectional study
Open this publication in new window or tab >>Nurses’ perceptions of patient safety climate in intensive care units: A cross-sectional study
2012 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 28, no 6, 344-354 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:To investigate registered nurses' perceptions of the patient safety climate in intensive care units and to explore potential predictors for overall perception of safety and frequency of incident reporting. RESEARCH METHODOLOGY/DESIGN: A cross-sectional design was conducted, using the questionnaire Hospital Survey on Patient Safety Culture, measuring 12 patient safety climate dimensions: seven at unit and three at hospital level, two outcomes and in addition two outcome items.

SETTING:Ten intensive care units (ICUs) in six hospitals in one hospital trust in Norway.

RESULTS:In total, 220 registered nurses (RNs) responded (72%). Seven of 12 dimensions achieved a RN proportion of positive scores over 55%. Five achieved a lower proportion. Significant differences in RNs' perceptions of patient safety were found between types of units and between the four hospitals. The total variance in the outcome measure explained by the model as a whole was for the outcome dimensions "overall perception of safety" 32%, and "frequency of incident reporting" 32%. The variables at the unit level made a significant contribution to the outcome.

CONCLUSION:RNs in ICU are most positive to patient safety climate at unit level, hence improvements are needed concerning incident reporting, feedback and communication about errors and organisational learning and continuous improvement.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
Intensive care, Medical errors, patient safety climate, Registered nurses perceptions
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-14570 (URN)10.1016/j.iccn.2012.01.001 (DOI)
Available from: 2012-08-27 Created: 2012-08-27 Last updated: 2017-12-07Bibliographically approved
2. Intensive care unit nurses' evaluation of simulation used for team training
Open this publication in new window or tab >>Intensive care unit nurses' evaluation of simulation used for team training
2014 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 19, no 4, 175-184 p.Article in journal (Refereed) Published
Abstract [en]

Aim

To implement a simulation-based team training programme and to investigate intensive care nurses' evaluations of simulation used for team training.

Background

Simulation-based training is recommended to make health care professionals aware of and understand the importance of teamwork related to patient safety.

Design

The study was based on a questionnaire evaluation design.

Methods

A total of 63 registered nurses were recruited: 53 from seven intensive care units in four hospitals in one hospital trust and 10 from an intensive care postgraduate education programme. After conducting a simulation-based team training programme with two scenarios related to emergency situations in the intensive care, the participants evaluated each simulation activity with regard to: (i) outcome of satisfaction and self-confidence in learning, (ii) implementation of educational practice and (iii) simulation design/development.

Result

Intensive care nurses were highly satisfied with their simulation-based learning, and they were mostly in agreement with the statements about self-confidence in learning. They were generally positive in their evaluation of the implementation of the educational practice and the simulation design/development. Significant differences were found with regard to scenario roles, prior simulation experience and area of intensive care practice.

Conclusion

The study indicates a positive reception of a simulation-based programme with regard to team training in emergency situations in an intensive care unit.

Relevance to clinical practice

The findings may motivate and facilitate the use of simulation for team training to promote patient safety in intensive care and provide educators with support to develop and improve simulation-based training programmes.

Keyword
simulation, team training, nurses, intensive care, patient safety
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-28671 (URN)10.1111/nicc.12031 (DOI)000337959400005 ()24750224 (PubMedID)000337959400005 (Scopus ID)
Available from: 2013-08-20 Created: 2013-08-20 Last updated: 2017-12-06Bibliographically approved
3. Exploring intensive care nurses' team performance in a simulation-based emergency situation, − expert raters' assessments versus self-assessments: an explorative study
Open this publication in new window or tab >>Exploring intensive care nurses' team performance in a simulation-based emergency situation, − expert raters' assessments versus self-assessments: an explorative study
2014 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 13, no 47Article in journal (Refereed) Published
Abstract [en]

Background

Effective teamwork has proven to be crucial for providing safe care. The performance of emergencies in general and cardiac arrest situations in particular, has been criticized for primarily focusing on the individual's technical skills and too little on the teams' performance of non-technical skills. The aim of the study was to explore intensive care nurses' team performance in a simulation-based emergency situation by using expert raters' assessments and nurses' self-assessments in relation to different intensive care specialties.

Methods

The study used an explorative design based on laboratory high-fidelity simulation. Fifty-three registered nurses, who were allocated into 11 teams representing two intensive care specialties, participated in a videotaped simulation-based cardiac arrest setting. The expert raters used the Ottawa Crisis Resource Management Global Rating Scale and the first part of the Mayo High Performance Teamwork Scale to assess the teams' performance. The registered nurses used the first part of the Mayo High Performance Teamwork Scale for their self-assessments, and the analyses used were Chi-square tests, Mann–Whitney U tests, Spearman's rho and Intraclass Correlation Coefficient Type III.

Results

The expert raters assessed the teams' performance as either advanced novice or competent, with significant differences being found between the teams from different specialties. Significant differences were found between the expert raters' assessments and the registered nurses' self-assessments.

Conclusions

Teams of registered nurses representing specialties with coronary patients exhibit a higher competence in non-technical skills compared to team performance regarding a simulated cardiac arrest. The use of expert raters' assessments and registered nurses' self-assessments are useful in raising awareness of team performance with regard to patient safety.

Place, publisher, year, edition, pages
England: BioMed Central, 2014
Keyword
Assessment; Emergency; Intensive care; Non-technical skills; Nursing; Patient safety; Simulation-based training; Team performance
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-29984 (URN)10.1186/s12912-014-0047-5 (DOI)25606023 (PubMedID)
Note

This paper was publish as manuscript in R. Ballangruds thesis.

Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved
4. Intensive care nurses' perceptions of simulation-based team training for building pation safety in intensive care: A descriptive qualittaive study
Open this publication in new window or tab >>Intensive care nurses' perceptions of simulation-based team training for building pation safety in intensive care: A descriptive qualittaive study
2014 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 4, 179-187 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Background: Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. Design: The study uses a qualitative descriptive design. Methods: Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. Results: One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Conclusions: Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
ntensive care; Nursing; Patient safety; Simulation-based training; Team performance
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-29985 (URN)10.1016/j.iccn.2014.03.002 (DOI)000349929800001 ()
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved

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