Preconceptions of disease can impact the medical and social response to patients with chronic conditions. This article discusses patients with COVID-19 who survive the virus and describes ineffective support due to lack of understanding and empathy regarding the long-term debilitation survivors experience.
Cullen A. Uitgeverij van Brug: The Hague, The Netherlands; 2019. ISBN: 9789065232236.
Patient stories offer important insights regarding the impact medical errors have on patients and their families. This book shares the author's experience with medical error and spotlights how lack of transparency in European health care can contribute to avoidable process failures that result in patient harm.
Clarkson MD, Haskell H, Hemmelgarn C, et al. BMJ. 2019;364:l1233.
The term "second victim," coined by Dr. Albert Wu, has engendered mixed responses from patients and health care professionals. This commentary raises concerns that the term negates the sense of responsibility for errors that result in harm and advocates for abandoning it.
Despite years of investment and government support, electronic health records (EHR) continue to face challenges as a patient safety strategy. This news article outlines the unintended consequences of EHR implementation, including patient harm linked to software glitches and user errors, fraudulent behavior (upcoding), interoperability problems, clinician burnout due to poorly designed digital health records, and lack of industry transparency.
Organizational culture influences how comfortable individuals are with raising awareness of conditions that diminish patient safety. This independent inquiry report provides case studies and a detailed analysis of conditions that hindered nurses and families from acquiring answers about care concerns. The analysis determined factors such as hierarchy and poor physician regard for nursing expertise as persistent challenges to safety in health care.
Hemmelgarn C. Health Aff (Millwood). 2018;37:1332-1334.
Lack of transparency regarding errors in patient care contributes to harm, mistrust, and inclination toward legal action. This commentary offers insights from a parent whose daughter died from medical error and the resistance she faced when trying to understand what happened. The author encourages health care to embrace strategies that improve dialogue and explanation regarding errors including communication-and-resolution programs.
Schenk EC, Bryant RA, Van Son CR, et al. J Nurs Care Qual. 2019;34(1):73-79.
Patients and families enhance safety when invited to express concerns and provide feedback about their care. Qualitative interviews of hospital staff, patients, and families highlighted both patients' and families' unique skills as safety advocates as well as barriers to speaking up. An Annual Perspective delineates tools to promote patient engagement in safety.
Bell SK, Roche SD, Mueller A, et al. BMJ Qual Saf. 2018;27(11):928-936.
A critical component of strong safety culture is that patients and families feel empowered to speak up about safety concerns. Patients and families are often the first to notice changes in their well-being and consistently identify unique adverse events that are not detected through provider-driven means. This cross-sectional survey asked patients currently hospitalized in an intensive care unit (ICU) and their families about their comfort discussing safety concerns with their health care team, then validated those responses with an Internet-recruited nationwide cohort of patients and families who had been previously cared for in ICUs. Many current ICU patients and families expressed some reticence to speak up. Common reasons cited were concern that the health care team was too busy, fear of being labeled a troublemaker, and worry that the team would judge them for not understanding the medical details of their care.
Bell SK, Etchegaray JM, Gaufberg E, et al. Jt Comm J Qual Patient Saf. 2018;44(7):424-435.
Preventable harm can inflict lasting emotional damage on patients and families. Although many safety experts have examined how adverse events affect health care workers (second victims), patients' emotional experience of these events has garnered less scientific attention. The Agency for Healthcare Research and Quality convened diverse stakeholders, including patients, to identify research priorities to better elucidate how adverse events emotionally impact patients and families. They identified 4 priorities and delineated 20 steps organizations can take immediately to support those who experience adverse events, such as involving patients and families in developing solutions, incorporating emotional harm in organizational approaches to safety, and engaging patient advocates and leaders in improvement work. An Annual Perspective examined the shift toward a just culture in patient safety, which requires reckoning with the impact of errors on patients and families.
Bhise V, Meyer AND, Menon S, et al. Int J Qual Health Care. 2018;30(1):2-8.
Reducing diagnostic error is an area of increasing focus within patient safety. However, little is known about how patients perceive physician communication regarding diagnostic uncertainty. In this study, participants (parents of pediatric patients) were assigned to read one of three clinical vignettes each describing a different approach to a physician communicating diagnostic uncertainty; they were then asked to answer a questionnaire. Researchers found that explicit expression of diagnostic uncertainty by a physician was associated with negative perceptions of physician competence as well as diminished trust and satisfaction with care, whereas more implicit language was not. A past Annual Perspective highlighted some of the challenges associated with diagnostic error.
Lyndon A, Wisner K, Holschuh C, et al. J Obstet Gynecol Neonatal Nurs. 2017;46:716-726.
Parents and families are crucial partners in pediatric patient safety. This qualitative study of parents whose infants were hospitalized in the neonatal intensive care unit developed a conceptual model for how and when parents articulate safety concerns.
Health care workers face high levels of stress and production pressures, which can contribute to clinician burnout and diminish the safety of care delivery. This commentary describes stressors that affect the psychological health of clinicians, the importance of establishing an organizational culture that supports clinicians, and proactive ways to build clinician resilience in various stressful circumstances.
Bsharat S, Drach-Zahavy A. J Adv Nurs. 2017;73:2118-2128.
Patients can play an important role in improving patient safety. Although efforts to engage patients in safety work are becoming more widespread, some have criticized the idea that patients should bear any responsibility for safety. Prior research has shown that parents may help identify safety incidents affecting hospitalized children that might otherwise go undetected, but little is known about how nurses react to parental involvement in safety. This study used attribution theory to better understand how nurses respond to safety issues raised by parents. The authors also discuss the implications of their findings on promoting parental engagement in safety. A past PSNet perspective reviewed the opportunities and limitations when engaging patients in safety.
Rosenberg RE, Rosenfeld P, Williams E, et al. J Nurs Care Qual. 2016;31(4):318-326.
Engaging patients and families as partners in safety is increasingly recognized as an important strategy in health care. This qualitative study examined parents' perspectives regarding their role in maintaining the safety of their children in the hospital setting. Investigators uncovered components of hospital culture and practice that affect parent engagement and recommend staff training to enhance clinician–parent partnerships.
Narrative elements of care failures can help motivate commitment to patient safety work by placing the incident in context. Exploring the value of patient perspectives associated with adverse events, this commentary suggests that improvement leaders consider the patient experience when designing harm reduction efforts.
Lang A, Toon L, Cohen SR, et al. Safety Health. 2015;1(1):3.
This qualitative study of palliative care recipients, family caregivers, and paid home health staff found that they conceive of safety as encompassing emotional as well as functional safety, and they accept some risk in order to remain in the home environment. This work emphasizes the need for setting-specific patient engagement to tailor safety efforts.
Herrin J, Harris KG, Kenward K, et al. BMJ Qual Saf. 2016;25:182-9.
This survey of acute care hospitals found significant variation for patient and family engagement activities. Most hospitals reported unrestricted visitor access, nearly two-thirds had formal error disclosure policies, and less than half had a patient advisory council. These findings demonstrate the gap between patient engagement recommendations and current hospital practice.
Chicago, IL: Health Research & Educational Trust; 2015.
Patient and family advisor programs have been implemented in health care as a way to incorporate the experiences of consumers into safety improvement work. This guide provides a framework to help hospitals develop partnership initiatives that focus on advisor recruitment, education, and teamwork to enhance efforts to engage patients and families in this role.
Stickney CA, Ziniel SI, Brett MS, et al. J Pediatr. 2014;165:1245-1251.e1.
In this study, health care providers and parents of children in a pediatric intensive care unit described their perceptions of family involvement in morning rounds. Although parents were overwhelmingly enthusiastic about being included in rounds, providers expressed some concerns and potential drawbacks, such as the avoidance of discussing uncomfortable topics due to presence of family.
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