Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions

Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA 19102, USA.
BMJ quality & safety (Impact Factor: 3.99). 02/2012; 21(2):101-11. DOI: 10.1136/bmjqs-2011-000082
Source: PubMed


Safety climate and nurses' working conditions may have an impact on both patient outcomes and nurse occupational health, but these outcomes have rarely been examined concurrently.
To examine the association of unit-level safety climate and specific nurse working conditions with injury outcomes for both nurses and patients in a single hospital.
A cross-sectional study was conducted using nursing-unit level and individual-level data at an urban, level-one trauma centre in the USA. Multilevel logistic regressions were used to examine associations among injury outcomes, safety climate and working conditions on 29 nursing units, including a total of 723 nurses and 28 876 discharges.
Safety climate was measured in 2004 using the Safety Attitudes Questionnaire (SAQ). Working conditions included registered nursing hours per patient day (RNHPPD) and unit turnover. Patient injuries included 290 falls, 167 pulmonary embolism/deep vein thrombosis (PE/DVT), and 105 decubitus ulcers. Nurse injury was defined as a reported needle-stick, splash, slip, trip, or fall (n=78). Working conditions and outcomes were measured in 2005.
The study found a negative association between two SAQ domains, Safety and Teamwork, with the odds of both decubitus ulcers and nurse injury. RNHPPD showed a negative association with patient falls and decubitus ulcers. Unit turnover was positively associated with nurse injury and PE/DVT, but negatively associated with falls and decubitus ulcers.
Safety climate was associated with both patient and nurse injuries, suggesting that patient and nurse safety may actually be linked outcomes. The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries.

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Available from: Jennifer Taylor, Nov 20, 2014
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    • "Finally, there was no differentiation between the near-accidents of patients and those that occurred to nurses. There is, however, good evidence that interruption is valid to predict both (Taylor et al., 2012). "
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    ABSTRACT: Errors are frequent in health care. A specific model was tested that affirms failure in cognitive action regulation to mediate the influence of nurses' workflow interruptions and safety conscientiousness on near-accidents in health care. One hundred and sixty-five nurses from seven Swiss hospitals participated in a questionnaire survey. Structural equation modelling confirmed the hypothesised mediation model. Cognitive failure in action regulation significantly mediated the influence of workflow interruptions on near-accidents (p < .05). An indirect path from conscientiousness to near-accidents via cognitive failure in action regulation was also significant (p < .05). Compliance with safety regulations was significantly related to cognitive failure and near-accidents; moreover, cognitive failure mediated the association between compliance and near-accidents (p < .05). Contrary to expectations, compliance with safety regulations was not related to workflow interruptions. Workflow interruptions caused by colleagues, patients and organisational constraints are likely to trigger errors in nursing. Work redesign is recommended to reduce cognitive failure and improve safety of nurses and patients.
    Psychology Health and Medicine 04/2014; 20(2):1-9. DOI:10.1080/13548506.2014.913796 · 1.26 Impact Factor
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    • "There is, however, good evidence that the model is valid for both. Recent evidence shows working conditions to be a common antecedent in both nurses' and patients' injuries [38]. "
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    ABSTRACT: Background Workflow interruptions during surgery may cause a threat to patient's safety. Workflow interruptions were tested to predict failure in action regulation that in turn predicts near-accidents in surgery and related health care. Methods One-hundred-and-thirty-three theater nurses and physicians from eight Swiss hospitals participated in a cross-sectional questionnaire survey. The study participation rate was 43%. Results Structural equation modeling confirmed an indirect path from workflow interruptions through cognitive failure in action regulation on near-accidents (p < 0.05). The indirect path was stronger for workflow interruptions by malfunctions and task organizational blockages compared with workflow interruptions that were caused by persons. The indirect path remained meaningful when individual differences in conscientiousness and compliance with safety regulations were controlled. Conclusion Task interruptions caused by malfunction and organizational constraints are likely to trigger errors in surgery. Work redesign is recommended to reduce workflow interruptions by malfunction and regulatory constraints.
    Safety and Health at Work 03/2014; 5(1):1-6. DOI:10.1016/
    • "Physicians who experience high burnout are more likely to perceive problems with quality of care (Shanafelt et al., 2010, 2012; Thomas, 2004). Taylor et al. (2012) found a negative association between two dimensions of safety climate (i.e., perceptions of organizational commitment to safety and quality of collaboration) and a patient outcome (i.e., decubitus ulcer) and nurse injury. Worker outcomes may mediate the impact of working conditions on patient outcomes (Hickam et al., 2003; Laschinger & Leiter, 2006; Lundstrom, Pugliese, Bartley, Cox, & Guither, 2002; Williams et al., 2012). "
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    ABSTRACT: The U.S. Institute of Medicine and health care experts have called for new approaches to manage health care quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to health care quality and patient safety are described, such as the SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety and the model of health care professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health information technology and medical devices, violations, and care coordination provide examples of macroergonomics contributions to health care quality and patient safety. Health care systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles, and methods for health care system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety) and macroergonomics of patient-centered care and care coordination.
    Reviews of Human Factors and Ergonomics 10/2013; 8(1):4-54. DOI:10.1177/1557234X13492976
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