The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Lyndon A, Simpson KR, Spetz J, et al. Appl Nurs Res. 2022;63:151516.
Missed nursing care appears to be associated with higher rates of adverse events. More than 3,600 registered nurses (RNs) were surveyed about missed care during labor and birth in the United States. Three aspects of nursing care were reported missing by respondents: thorough review of prenatal records, missed timely documentation of maternal-fetal assessments, and failure to monitor input and output.
Finney RE, Torbenson VE, Riggan KA, et al. J Nurs Manag. 2021;29:642-652.
Healthcare professionals who experience emotional consequences after adverse events are referred to as ‘second victims’. Nearly half of nurses responding to this survey reported ‘second victim’ events during their career and experienced psychological distress, greater turnover intention, decreased professional self-efficacy, and lack of institutional support. Nurse respondents expressed desires for more peer support interventions for ‘second victim’ experiences.
Avesar M, Erez A, Essakow J, et al. Diagnosis (Berl). 2021;8:358-367.
Disruptive and rude behavior can hinder teamwork and diminish patient safety. This randomized, simulation-based study including attendings, fellows, and residents explored whether rudeness during handoff affects the likelihood for challenging a diagnostic error. The authors found that rudeness may disproportionally hinder diagnostic performance among less experienced physicians.
Nydoo P, Pillay BJ, Naicker T, et al. Scand J Public Health. 2020;48:629-637.
Maternity care can be a high-risk environment. This literature review summarizes the prevalence, risk factors, coping strategies, and recovery processes for ‘second victims’, with an emphasis on obstetric care.
Over 1,000 nurses across 40 medical/surgical or telemetry units throughout seven hospitals were surveyed about perceptions on safety culture, patient advocacy, patient experience, and fall and pressure ulcer rates. Survey results indicated a positive correlation between safety culture and advocacy; however, this relationship was moderated by nursing experience, with newer nurses being more positive about safety culture and advocacy compared to experienced nurses.