10
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Clinicians’ Perspectives on Proactive Patient Safety Behaviors in the Perioperative Environment

      research-article
      , MD, MSc 1 , 2 , , MD 3 , , BS 4 , , MD, MBA 5 , 6 , , MD 3 , , BSN, RN, CCRN 2 , , MSN, CRNP 5 , , MSN, CRNP 7 , , MD, MSEd 2 , 3 , 8 ,
      JAMA Network Open
      American Medical Association

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Key Points

          Question

          What are the behavioral categories that support perioperative staff adaptability and resilience to deliver individual and team-based safe care in the perioperative environment?

          Findings

          This qualitative thematic analysis of self-reported proactive safety behaviors included a convenience sample of perioperative staff from a tertiary care academic medical center who participated in a facilitated activity during a 6-month period in 2021. A total of 147 unique behaviors were identified, which were categorized into 8 non–mutually exclusive themes.

          Meaning

          The set of behavioral themes identified in this analysis may serve as the basis for individual and team-based practices of resilience and adaptability that promote patient safety.

          Abstract

          This qualitative study uses thematic analysis to describe clinician perspectives on proactive safety behaviors in the perioperative environment at a US tertiary care center.

          Abstract

          Importance

          The perioperative environment is hazardous, but patients remain safe with a successful outcome during their care due to staff adaptability and resiliency. The behaviors that support this adaptability and resilience have yet to be defined or analyzed. One Safe Act (OSA), a tool and activity developed to capture self-reported proactive safety behaviors that staff use in their daily practice to promote individual and team-based safe patient care, may allow for improved definition and analysis of these behaviors.

          Objective

          To thematically analyze staff behaviors using OSA to understand what may serve as the basis for proactive safety in the perioperative environment.

          Design, Setting, and Participants

          This qualitative thematic analysis included a convenience sample of perioperative staff at a single-center, tertiary care academic medical center who participated in an OSA activity during a 6-month period in 2021. All perioperative staff were eligible for inclusion. A combined deductive approach, based on a human factor analysis and classification framework, as well as an inductive approach was used to develop themes and analyze the self-reported staff safety behaviors.

          Exposures

          Those selected to participate were asked to join an OSA activity, which was conducted in-person by a facilitator. Participants were to self-reflect about their OSA (proactive safety behavior) and record their experience as free text in an online survey tool.

          Main Outcome and Measures

          The primary outcome was the development and application of a set of themes to describe proactive safety behaviors in the perioperative environment.

          Results

          A total of 140 participants (33 nurses [23.6%] and 18 trainee physicians [12.9%]), which represented 21.3% of the 657 total perioperative department full-time staff, described 147 behaviors. A total of 8 non–mutually exclusive themes emerged with the following categories and frequency of behaviors: (1) routine-based adaptations (46 responses [31%]); (2) resource availability and assessment adaptations (31 responses [21%]); (3) communication and coordination adaptation (23 responses [16%]); (4) environmental ergonomics adaptation (17 responses [12%]); (5) situational awareness adaptation (12 responses [8%]); (6) personal or team readiness adaptation (8 responses [5%]); (7) education adaptation (5 responses [3%]); and (8) social awareness adaptation (5 responses [3%]).

          Conclusions and Relevance

          The OSA activity elicited and captured proactive safety behaviors performed by staff. A set of behavioral themes were identified that may serve as the basis for individual practices of resilience and adaptability that promote patient safety.

          Related collections

          Most cited references19

          • Record: found
          • Abstract: not found
          • Article: not found

          Using thematic analysis in psychology

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review.

            This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses. Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity. The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords 'resilience', 'resilience in nursing', and 'workplace adversity' together with 'nursing'. Papers in English were included. Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective. Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses' immediate working environments.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Diffusion theory and knowledge dissemination, utilization, and integration in public health.

              Legislators and their scientific beneficiaries express growing concerns that the fruits of their investment in health research are not reaching the public, policy makers, and practitioners with evidence-based practices. Practitioners and the public lament the lack of relevance and fit of evidence that reaches them and barriers to their implementation of it. Much has been written about this gap in medicine, much less in public health. We review the concepts that have guided or misguided public health in their attempts to bridge science and practice through dissemination and implementation. Beginning with diffusion theory, which inspired much of public health's work on dissemination, we compare diffusion, dissemination, and implementation with related notions that have served other fields in bridging science and practice. Finally, we suggest ways to blend diffusion with other theory and evidence in guiding a more decentralized approach to dissemination and implementation in public health, including changes in the ways we produce the science itself.
                Bookmark

                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                11 April 2023
                April 2023
                11 April 2023
                : 6
                : 4
                : e237621
                Affiliations
                [1 ]Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
                [2 ]Department of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA
                [3 ]Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
                [4 ]Department of Biological Sciences, University of Delaware, Newark
                [5 ]Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
                [6 ]Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
                [7 ]Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia
                [8 ]Department of Clinical Effectiveness and Quality Improvement, Hospital of the University of Pennsylvania, Philadelphia
                Author notes
                Article Information
                Accepted for Publication: February 24, 2023.
                Published: April 11, 2023. doi:10.1001/jamanetworkopen.2023.7621
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2023 Duffy C et al. JAMA Network Open.
                Corresponding Author: Justin B. Ziemba, MD, MSEd, Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, 3rd Floor W, 3400 Civic Center Blvd, Philadelphia, PA 19104 ( justin.ziemba@ 123456pennmedicine.upenn.edu ).
                Author Contributions: Dr Ziemba had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Duffy, Bass, Talwar, Lorenzi, Taing Vo, Chiang, Ziemba.
                Acquisition, analysis, or interpretation of data: Duffy, Menon, Horak, Bass, Chiang, Ziemba.
                Drafting of the manuscript: Duffy, Menon, Horak, Bass, Lorenzi, Ziemba.
                Critical revision of the manuscript for important intellectual content: Duffy, Menon, Bass, Talwar, Taing Vo, Chiang, Ziemba.
                Statistical analysis: Duffy.
                Administrative, technical, or material support: Duffy, Menon, Bass, Chiang, Ziemba.
                Supervision: Duffy, Bass, Talwar.
                Conflict of Interest Disclosures: None reported.
                Data Sharing Statement: See Supplement 2.
                Additional Contributions: We would like to thank all the staff within the Hospital of the University of Pennsylvania’s Department of Perioperative Services for their willingness to participate in the One Safe Act activity and to Dr Jennifer Myers, MD, for her mentorship throughout the project.
                Article
                zoi230251
                10.1001/jamanetworkopen.2023.7621
                10091176
                37040109
                f11c11e8-71b7-43f2-9eff-03e3063d6d42
                Copyright 2023 Duffy C et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 22 November 2022
                : 24 February 2023
                Categories
                Research
                Original Investigation
                Online Only
                Surgery

                Comments

                Comment on this article