vidio bokep

LR22 / Human factor for the work of RN practices

Romania




Type of Patient Safety Practice
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Other
Patient safety theme the SCP/clinical risk management practice is aimed at
An innovative research approach to explore factors affecting registered nurse performance during real work on acute care medical-surgical units with the intention to suggest interventions to improve patient safety, as well as recruitment and retention for registered nurses .
Objective of the CRM practice
Redesign efforts in healthcare services delivery during the last 10 years were well intentioned but reflect the weakness of implementing change without understanding how healthcare providers organize and structure information cognitively, how they respond appropriately in complex situations, and what environmental conditions support or hinder decision making in actual situations. Increased understanding of the work complexity in acute care environments and the cognitive factors that contribute to RN work management activities will be critical to the successful redesign of environments to improve patient safety and recruit and retain RNs. However, there has been little research exploring the details of actual RN work from a human performance framework [p.631,1].
Short description of the CRM practice, including any references for further information
Understanding RN work in the context of patient assignments in the midst of complex system characteristics, such as unpredictability, missing information, and unreliable access to resources and processes, provides a different picture from the role descriptions, nursing process, and strict policy and procedural guidelines that have been used in the past to design systems of care delivery. This study addressed 3 areas that have had insufficient attention in the nursing literature: (a) human and environmental issues affecting RN work in acute care settings during actual work situations, (b) specific cognitive factors driving RN performance and decision making during actual care situations, and (c) strategies used by experienced RNs to manage work successfully [p.631,1]. Five goal patterns that represented areas for potential goal conflicts included maintaining patient safety, preventing getting behind, avoiding increasing complexity, appearing competent and efficient to patients/families and coworkers, and maintaining patient/family satisfaction. Eight patterns were identified that related to complexity of work, including disjointed supply sources, missing or nonfunctioning supplies and equipment, repetitive travel, interruptions, waiting for systems/processes, difficulty in accessing resources to continue care, breakdown in communication, and breakdowns in communication processes or mediums. Findings from this study suggest multiple ways to redesign systems to decrease work complexity, obviously starting with the relatively simple redesign of units so that, for example, water, ice, and cups would be kept in the same area[p.637,1].
Innovator of the SCP, country of origin
USA. Indianapolis, 1 Midwest healthcare network, that included 4 general medical-surgical, 2 medical,1 post procedural, and 1 orthopedic unit. 8 RNs, were observed continuously for 3 hours during actual work in the role of staff nurse on 2 different days between 8 AM and 3 PM by a single researcher. Two sessions were scheduled for each RN, to decrease observer influence on the participant’s work at the second observation. Each RN was interviewed individually using Critical Decision Method (CDM). The CDM interview is a technique based on the recognition-primed decision-making model developed by Klein [5]. The technique enables users to elicit information from an expert about situations that may be difficult to articulate. Decision cases were selected that represented the research phenomenon of interest: work complexity [p.632,1].
Involved health care staff
8 expert RNs, recruited from 2 separate facilities, working on 7 different units belonging to 1 Midwest healthcare network. Nurses were eligible for participation if they had at least 5 years of medical-surgical experience and were identified as expert clinical nurses by their respective unit supervisors. The sample included 2 diploma-, 1 associate-, and 5 baccalaureate-prepared nurses. RN experience ranged from 5.5 to 39 years. Length of time worked by the RNs on their respective units ranged from 8 months to 24 years[p.631,1].
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
In USA, in a Midwest healthcare network, that included 4 general medical-surgical, 2 medical,1 post procedural, and 1 orthopedic unit [p631,1].
Summary of evidence for effectiveness, including references
The patterns of knowledge factors driving RN activities in this study were particularly interesting, given the shortage of RNs and the search for the ideal RN-patient ratio. Interview data revealed the use of specific and sometimes subtle cues regarding individual patients that resulted in important decisions about next steps with patients who were clinically unstable. Knowing specific information about patients and typical profiles enabled RNs to anticipate likely outcomes, which, in turn, guided decision making[7,8]. Findings from this small study support the future use of research approaches not used traditionally in healthcare to understand factors related to the work complexity of healthcare environments, cognitive factors driving performance and decision making, strategies used by healthcare workers to manage care in demanding environments, and potential areas for redesign and education[p.638,1].
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Making progress in both patient safety and RN recruitment and retention may depend on redesign of environments to support care providers in work situations. Using a human performance framework and innovative data collection techniques, multiple patterns characterizing RN work during work situations on medical surgical acute units were identified[2,6]. Findings from this study cannot be generalized because of the small and nonrandomized sample. Although data were collected from 8 RNs on 7 different units, all were part of 1 healthcare network. Data collection was limited to only expert RNs and during the day shift. The care delivery models on the study units were either total patient care or an RN with nursing technician support. Patterns with larger and more varied samples and settings will be identified with future research [p.637,1].
Summary of available information on feasibility, including references
The expert RNs in this study demonstrated effective strategies to cope and adapt in work situations to manage workload demands. Although nursing school curricula have a great deal of content related to disease processes, procedural techniques, and critical-thinking processes, little time is devoted to managing workload complexities in care situations, and students must be taught these skills. Using a human performance framework and innovative data collection techniques, multiple patterns characterizing RN work during work situations on medical surgical acute care units were identified [3,6]. Findings from this small study support the future use of research approaches not used traditionally in healthcare to understand factors related to the work complexity of healthcare environments, cognitive factors driving performance and decision making, strategies used by healthcare workers to manage care in demanding environments, and potential areas for redesign and education[p.638,1].
Existing implementation tools, including references
Guided by a “start list” of codes (16 codes) based on the Sharp End and Blunt End framework, content analysis was used to sort and categorize individual interview and observation data and then identify common meanings and patterns across participants[5]. On this micro ethnographic study, the researchers used the human performance framework “Sharp End and Blunt End”10 and a mixed method approach. The quantitative and qualitative data collection included field observations, followed by semi structured interviews[p.631,1].
Potential for/description of patient involvement in the CRM practice, including references
No direct patient involvement.
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] Ebright, Patricia, DNS, RN; Patterson, Emily, PhD; Chalko, Barbara , MSN, RN; Render, Marta, MD(2003): Understanding the Complexity of Registered Nurse Work in Acute Care Settings. JONA Volume 33, Number 12, Lippincott Williams & Wilkins, Inc. References [2]. Buerhaus P, Staiger D, Auerbach D. Implications of an aging registered nurse workforce. JAMA. 2000;283:2948-2954. [3]. Klein G. Sources of Power: How People Make Decisions. Cambridge, Mass: Massachusetts Institute of Technology; 1998. [4]. Woods DD, Johannesen LJ, Cook RI, Sarter NB. Behind Human Error: Cognitive Systems, Computers, and Hindsight. Wright-Patterson AFB, Ohio: Crew Systems Ergonomic Information and Analysis Center (CSERIAC); 1994. [5]. Miles MB, Huberman, AM. Qualitative Data Analysis. 2nd ed. Thousand Oaks, Calif: Sage; 1994. [6]. Cook RI, Woods DD. Operating at the ‘sharp end:’ The complexity of human error. In: Bogner MS, ed. Human Error in Medicine. Hillsdale, NJ: Lawrence Erlbaum; 1994:255-310. [7]. Leape LL. Error in medicine. JAMA. 1994;272:1851-1857. [8]. Reason J. Human Error. Cambridge, Mass: Cambridge University Press; 1990.
Reviewer
Dr Teodora Ciolompea, National School of Public Health and Management, Romania
Organisation
National School of Public Health and Management, Romania
Any additional information on the CRM (e.g. implementation barriers and drivers)
description of concrete national or regional experience in practice
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