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The relationship between organizational culture and family satisfaction in critical care

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Abstract

Family satisfaction with critical care is influenced by a variety of factors. We investigated the relationship between measures of organizational and safety culture, and family satisfaction in critical care. We further explored differences in this relationship depending on intensive care unit survival status and length of intensive care unit stay of the patient. Cross-sectional surveys. Twenty-three tertiary and community intensive care units within three provinces in Canada. One thousand two-hundred eighty-five respondents from 2374 intensive care unit clinical staff, and 880 respondents from 1381 family members of intensive care unit patients. None. Intensive care unit staff completed the Organization and Management of Intensive Care Units survey and the Hospital Survey on Patient Safety Culture. Family members completed the Family Satisfaction in the Intensive Care Unit 24, a validated survey of family satisfaction. A priori, we analyzed adjusted relationships between each domain score from the culture surveys and either satisfaction with care or satisfaction with decision-making for each of four subgroups of family members according to patient descriptors: intensive care unit survivors who had length of intensive care unit stay <14 days or >14 days, and intensive care unit nonsurvivors who had length of stay <14 days or ≥14 days. We found strong positive relationships between most domains of organizational and safety culture, and satisfaction with care or decision-making for family members of intensive care unit nonsurvivors who spent at least 14 days in the intensive care unit. For the other three groups, there were only a few weak relationships between domains of organizational and safety culture and family satisfaction. Our findings suggest that the effect of organizational culture on care delivery is most easily detectable by family members of the most seriously ill patients who interact frequently with intensive care unit staff, who are intensive care unit nonsurvivors, and who spend a longer time in the intensive care unit. Positive relationships between measures of organizational and safety culture and family satisfaction suggest that by improving organizational culture, we may also improve family satisfaction.

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... Following full-text screening, 15 articles remained that met the inclusion criteria. The included studies were conducted in different countries, including Australia (one study) [19], Canada (two studies) [8,20], Germany (one study) [4], Indonesia (one study) [21], Iran (one study) [22], Israel (two studies) [10,23], Nigeria (one study) [24], United Kingdom (one study) [2] and United States (five studies) [16,[25][26][27][28]. A summary of the characteristics of the included studies is presented in Table 2. ...
... Patient safety culture has been identified within the included studies as being central to the behaviour of the individuals, and influences staff proficiency, attitudes and behaviours concerning their safety performance [8,10,27]. The reviewed literature also identified patient safety culture as one element of a broader organisational culture, related to preventing and detecting shortfalls in patient safety, and managing patient safety in healthcare settings [16,20,21]. The concept of 'safety climate' was also prevalent in the literature, and was often used in studies that also described 'safety culture' [10,16,19,26,27] without distinguishing between the two concepts. ...
... Included studies also presented assessments of the validity of deployed instruments. The most common patient safety culture tool used in the reviewed studies was the Hospital Survey on Patient Safety Culture (HSOPS) [2,16,20,22,24,25,27,28]. The next most common tool used was the Safety Attitudes Questionnaire (SAQ) [19,26]. ...
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Background Measures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings. Methods This study was performed using the five stages of Arksey and O’Malley’s Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria. Results 4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients’ and families’ perspectives. Conclusion The findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience.
... The first result was that we found significant positive, strong associations between the safety and quality climate of the ward, empowerment of the family member, and family members' satisfaction with the provided care among both family members and nurses. These results agree with those of other studies that also reported significant correlations between these variables (Dodek et al., 2012;Ferrando et al., 2019;Jahangiri et al., 2016;Kagan et al., 2019), although in those cases, the correlation was between patients and healthcare providers (nurses and physicians) (Kagan et al., 2019) or among patients' families only (Dodek et al., 2012;Ferrando et al., 2019;Jahangiri et al., 2016). Hence, our results provide new information about these associations among both nurses and patients' families, who are highly relevant for patients in a critical condition. ...
... The first result was that we found significant positive, strong associations between the safety and quality climate of the ward, empowerment of the family member, and family members' satisfaction with the provided care among both family members and nurses. These results agree with those of other studies that also reported significant correlations between these variables (Dodek et al., 2012;Ferrando et al., 2019;Jahangiri et al., 2016;Kagan et al., 2019), although in those cases, the correlation was between patients and healthcare providers (nurses and physicians) (Kagan et al., 2019) or among patients' families only (Dodek et al., 2012;Ferrando et al., 2019;Jahangiri et al., 2016). Hence, our results provide new information about these associations among both nurses and patients' families, who are highly relevant for patients in a critical condition. ...
... In addition, perceptions of the quality and safety climate at the ward were found to be positively correlated with satisfaction with delivery care (Dodek et al., 2012), although open and positive communication with patients and resources for quality care were not significant in this study. These findings emphasize that family members' satisfaction is not a simple consequence of the ward resources (physical environment) and organizational arrangements, but are also strongly influenced by the quality and safety care and how the healthcare providers communicate with patients' families. ...
Article
Purpose: This study was designed to examine the perceptions of ward quality and safety held by family members and nurses, and investigate its impact on family members' empowerment, and satisfaction with patient hospitalization. Design: A cross-sectional study on two study groups was conducted at a large public hospital in Israel. The first group comprised 86 family members of patients hospitalized for more than 72 hours in acute critical condition in intensive care units (ICU) or general wards (GW). The second group included 101 registered nurses who treated the patients in the ICU or GW. Methods: Data were collected by a validated self-administered structured questionnaire. All participants voluntarily signed an informed consent and answered questions related to their demographic characteristics, perceptions, and attitudes toward quality and safety climate, empowerment, and satisfaction with the patients' hospitalization. Pearson correlations coefficient, t-test for independent samples, and a multiple regression model were performed to analyze the data. Findings: The mean age of family members was 51.4 ± 14.1 years and of nurses was 40.9 ± 9.9 years. A significant positive association was found between ward quality and safety climate and empowerment of the family member (r = .716; p < .001); empowerment of the family member and family members' satisfaction with the patients' hospitalization (r = .695; p < .001); and ward safety and quality climate and family members' satisfaction with the patients' hospitalization (r = .763; p <.001). Family members ranked ward quality and safety climate (M = 4.20 ± 0.60 vs. M = 3.61 ± 0.40), and their satisfaction with the patients' hospitalization (M = 4.49 ± 0.69 vs. M = 4.07± 0.54), which were significantly (p < .001) higher than the nurses' estimate. The significant predictors for family members' satisfaction with patients' hospitalization were commitment to quality leadership (b = .210; p = .027); implementing a quality improvement (b = .547; p < .001); and hand-off communication (b = .299; p = .001). Conclusions: Positive relationships between quality and safety climate, empowerment, and satisfaction with patients' hospitalization suggest that by improving the ward quality and safety climate, and family empowerment, we may also improve family satisfaction. Although family members reported being satisfied with hospitalization in the ICU and GW, quality leadership and implementing a quality improvement among the nurses and hand-off communication between nurses and patients' families, will be targeted to improve family satisfaction with the patients' hospitalization. Clinical relevance: Nurses who provide care for patients in a critical condition should maintain high levels of safety and quality care in order to improve the patients' family empowerment and satisfaction. Specifically, their efforts should target a commitment to quality leadership, implementing quality improvement, and hand-off communication.
... They want to participate in patient care [7,10] and be included in decision-making processes [12,15]. Dodek et al. [16] and Wall et al. [17] claim that there is a potential for improvement in respect of the family's perceptions of receiving support in the decision-making processes. Information exchanges where the ICU nurse is not present can make further communication between them and the family members more difficult [15,18,19]. ...
... Our data suggests that family member's satisfaction, as measured by the FS-DM subscale, was lower than that reported in earlier research using the same questionnaire in Canada [16], Norway [42], Germany [47] and the USA [53,54].Family members assessed their satisfaction with the frequency of conversations with physicians as low. They expected to receive accurate and unfiltered information, even in the event of bad news [12,13]. ...
... They expected to receive accurate and unfiltered information, even in the event of bad news [12,13]. Dodek et al. [16], Lind et al. [15] and Wall et al. [17] suggested that family members had a low level of satisfaction with the frequency of conversations with physicians. However, the structure of the FS-DM subscale does not provide information as to the actual content of the conversation or, whether family members felt the need to talk to physicians more often than was the case. ...
Article
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Background Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient’s closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family’s level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction. Method The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot. Results The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables – relation to the patient and patient survival – significantly affected family satisfaction. Conclusion Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses’ knowledge when meeting the family of the intensive care patient.
... One basic principle of patient safety is patient safety culture, which refers to ranking patient safety as the highest priority during all healthcare and medical procedures at all healthcare facilities [8]. Research on this culture is consistently increasing [9][10][11][12][13][14]. Some studies suggest significant relationships exist between the extent of a patient safety culture, number of in-hospital deaths, medication administration errors, and rehospitalizations, and that a patient safety culture positively relates to satisfaction among patients and their families [10][11][12][13][14]. ...
... Research on this culture is consistently increasing [9][10][11][12][13][14]. Some studies suggest significant relationships exist between the extent of a patient safety culture, number of in-hospital deaths, medication administration errors, and rehospitalizations, and that a patient safety culture positively relates to satisfaction among patients and their families [10][11][12][13][14]. ...
... Although the need for research on patient safety cultures to lower the risk of accidents and potential risk factors is emphasized in medicine [9], previous research on patient safety cultures in dentistry mostly have focused on reporting patients' safety problems [17][18][19][20][21][22][23]. A patient safety culture is vital to increasing patient safety, it relates to the quality of medical services, and it might lower the risks of accidents [10][11][12][13][14]. Therefore, dental professionals' patient safety cultures should be assessed and factors expected to improve patient safety should be analyzed. ...
Article
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Background: Patient safety culture is a core factor in increasing patient safety, is related to the quality of medical service, and can lower the risk of patient safety accidents. However, in dentistry, research has previously focused mostly on reporting of patient safety accidents. Dental professionals' patient safety culture must therefore first be assessed, and related factors analyzed to improve patient safety. Methods: This cross-sectional study completed a survey on 377 dental hygienists working in dental settings. To assess patient safety culture, we used a survey with proven validity and reliability by translating the Hospital Survey on Patient Safety Culture (HSOPS) developed by Agency for Healthcare Research and Quality (AHRQ) into Korean. Response options on all of the items were on 5-point Likert-type scales. SPSS v21 was used for statistical analysis. The relationships between workplace factors and patient safety culture were examined using t-tests and one-way analysis of variance (ANOVA) tests(p < 0.05). Results: The work environment of dental hygienists has a close relationship with patient safety. Dental hygienists working ≥40 h/week in Korea had a significantly lower for patient safety grade than those working < 40 h/week. When the number of patients per day was less than 8, the safety level of patients was significantly higher. And significant differences were found depending on institution type, institution size. Conclusions: In order to establish high-quality care and patient safety system practical policies must be enacted. In particular, assurance in the quality of work environment such as sufficient staffing, appropriate work hours, and enough rest must first be realized before patient safety culture can easily be formed.
... Anket soruları oluşturulurken hem yurtdışında hem de Türkiye'de yapılan bu konu ile ilgili literatür taraması ve bu çalışmalarda bulunan anket soruları gözden geçirildi (1,6,7). Ülkemiz için sosyokültürel ve medikal işleyiş açısından uygun olan ve mevcut çalışmanın hedeflerine yönelik olan sorular seçilerek ankete dahil edildi (6,8). ...
... Bu çalışmada ankete davet edilen tüm hasta yakınları katılmayı kabul ettiler. Bu sonuç diğer sonuçlar ile karşılaştırıldığında oldukça büyük bir katılım yüzdesini göstermektedir (1,4,(8)(9)(10)(11). Bu oranın yüksek olmasının en önemli nedeni anketin doğrudan hastanın tedavisi ve hasta ziyaret saatlerinde bilgi verilmesinde rol oynayan primer yoğun bakım doktorları tarafından yapılması nedeni ile olabilir. ...
... Hastanın tanısının doğru bilinmesi ile hasta yakınının yakınlık derecesi arasında bir ilişki olmadığı saptanmıştır (p>0,05). Doğru bilenlerin bilmeyenlere göre daha genç yaşta oldukları görüldü, doğru bilen hasta yakınlarının yaş ortancası 48,5 (29,8) iken, bilmeyenlerin yaş ortalaması 59,0 (41,8-63,0) yıl olarak saptandı (p=0,04). Tüm hastalar kritik hasta olarak YBÜ'ye kabul edildiği halde hasta yakınlarına hastaları-%82'si YBÜ'de ağır hastaların yattığını bilmişlerdir. ...
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Objective: Evaluation of needs and satisfaction of families of patients admitted to intensive care unit (ICU) is an important concern. The aim of this study was to determine relatives’ perception and satisfaction about ICU in our hospital. Material and Methods: For evaluation, a questionnaire study was conducted in medical ICU. During study period, families of ICU patients were included into the study and a face-to-face survey was administered by the ICU physician to those who wish to participate. Results: A total of 50 family members were included into the study. Of them all reported to know the exact diagnosis for ICU admission however only 32% of them had the correct diagnosis, whereas others stated previous comorbidities as the main admission reason. Even though all the patients admitted to the ICU were critically ill, 23% of relatives classified their patient’s status as mild or moderate. Seventy two percent of study participants stated that the information given about their patients was adequate, and 70% of them reported that the content of the procedures described sufficiently. The overall satisfaction was good or very good in 88% of participants. It was observed that longer stay in the ICU was associated with better satisfaction (p<0.05). Conclusion: Detailed information about patient’s status, including admission diagnosis, and all interventions should be given to ICU patients’ relatives continuously from the first day of ICU admission. © 2016 by Turkish Society of Medical and Surgical Intensive Care Medicine.
... In recent years, patient and family perspectives on received health care quality and safety have been increasingly valued across the world; however, current efforts to capture these perspectives from severely injured patients in ICU settings have been limited. [3][4][5] In ICUs, a family member is often required to act as a surrogate decision maker and may spend a considerable amount of time in the unit. At times, surrogate decision makers are required to make difficult choices for the patient because of the severity of a patient's condition, varying levels of patient consciousness, numerous complications, or the patient being unable to fully comprehend care-related decisions. ...
... 10 A recent study using a family satisfaction survey found that higher satisfaction in families of seriously injured or ill patients in the ICU was associated with better organizational and safety culture. 5 Although patient and family satisfaction may not correlate with all dimensions of health care quality, it remains an important component of how health care systems are evaluated and improved. 10,11 The Critical Care Family Satisfaction Survey (CCFSS), a tool developed by Wasser and colleagues, can assist health care systems in the evaluation of patient care by measuring the fulfilment of family member's psychological and informational needs using both quantitative and qualitative data. ...
Article
Objective The purpose of this quality improvement initiative was to evaluate satisfaction of family members of patients in a neuro trauma ICU (NTICU). Methods Adult patients (age 18+) admitted to the NTICU for at least 24 hours between June 2017 and November 2018 were identified. Near or at the time of discharge from the NTICU, the health unit coordinator or registered nurse identified the family member who was either the next‐of‐kin, surrogate decision‐maker, or person who had been most frequently present at the patient's bedside. This person was provided a packet containing a letter of consent and the Critical Care Family Satisfaction Survey (CCFSS). Results Surveys were completed by 78 family members, the majority of whom were the wife of the patient (n = 35, 44%), 60 years and older (n = 48, 60.8%). Fifty‐seven percent of patients (n = 45) were in the ICU less than 3 days and 59% (n = 47) of medical events were injury‐related. Total CCFSS scores ranged from 69 to 100 (median 95). The item with the largest number of dissatisfied responses was “Noise level in the critical care unit” (n = 4, 5.3% not satisfied). Open‐ended question comments were primarily positive (n = 60, 66%), with 32% (n = 29) representing areas for improvement. Conclusions Results of this satisfaction survey have been disseminated to leadership and have been taken into consideration in the planning of a new hospital building currently being built, including ICU patient rooms that allow for more privacy and reduced noise, and more comfortable family rooms. Relevance to Clinical Practice Family members are a very useful source of feedback for ICU care. Several concerns identified by family members in this study are likely to be relevant to other sites. These included: communication between health care providers and family about patient status, noise in the ICU, peaceful waiting areas for family, and slow transfers.
... For this reason. satisfaction and quality assessment of the health service provided to the patient by their relatives have gained importance. 7, [8][9][10][11][12][13][14] There were no previous studies evaluating the satisfaction of patients and their relatives in intensive care units in our hospital. With the questionnaire form we prepared. ...
Article
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Aims: There has been no previous study on the satisfaction of relatives of patients receiving treatment in the intensive care unit of our hospital. Our study was conducted to improve quality and service in our intensive care unit. A survey was conducted to evaluate the satisfaction of the relatives of patients receiving treatment. Methods: The satisfaction of the relatives of the patients who were treated for at least 3 days in the 3rd Step general intensive care unit at Mardin Training and Research Hospital between 01. February 2023 and 01. June 2023 was evaluated in line with the surveys. A questionnaire was given to each patient’s relative by the attending physician to be filled out. Results: 114 patient relatives participated in the study. 12 patient relatives did not agree to fill out the survey. 102 patient relatives filled out the satisfaction survey. Conclusion: Waiting room in intensive care unit conditions need to be improved. In our study, we think that patient relatives have confidence in the treatments applied to their patients and are satisfied with the skills and abilities of doctors and nurses.
... By assessing the existing safety culture, organizations will be allowed to obtain a clear view of PS details requiring urgent attention, determine the strengths and weaknesses of their safety culture, and enhance continuous quality management [9]. ...
Article
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Introduction: Patient safety is a fundamental element in healthcare quality and a major challenge in achieving universal health coverage, especially in low- and middle-income countries. The first step to improve patient safety is to evaluate the safety culture in hospitals. This study aimed to investigate the patient safety culture among nurses and determine the factors affecting it. Methods: This cross-sectional study was conducted among 423 nurses working at tertiary care hospitals in the Al-Jouf region in Saudi Arabia. Results: The highest score for patient safety among nurses was for teamwork within units (16.41 ± 2.44). The lowest score was for nonpunitive response to errors (5.87 ± 1.92). In addition, 83% of the participants did not report any events in the past 12 months. More perception of patient safety was significantly higher among females than males in dimensions of teamwork within units, frequency of events reported, and staffing. Furthermore, teamwork within units, management support for patient safety, staffing, non-punitive response to errors, and handoffs and transitions were significantly higher among participants in direct contact with patients. The Hospital Survey on Patient Safety Culture (HSOPSC) scale is significantly higher among non-Saudi nurses, nurses with bachelor's education, nurses with less working hours per week, and those who had training on patient safety. Conclusion: The current study showed that the majority of the participants did not report any events in the past 12 months. The highest score for patient safety culture dimensions among nurses was for teamwork within units while the lowest score was for nonpunitive response to errors.
... [58] However, studies suggested that patient or family ratings correlated with other quality domains (organization and safety) in some settings. [59] In general, high ratings may reflect low expectations, and rising expectations might lower satisfaction. As the public increasingly adopts patient-and family-centered care, satisfaction ratings may drop further. ...
Article
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Quality indicators are increasingly used in the intensive care unit (ICU) to compare and improve the quality of delivered healthcare. Numerous indicators have been developed and are related to multiple domains, most importantly patient safety, care timeliness and effectiveness, staff well-being, and patient/family-centered outcomes and satisfaction. In this review, we describe pertinent ICU quality indicators that are related to organizational structure (such as the availability of an intensivist 24/7 and the nurse-to-patient ratio), processes of care (such as ventilator care bundle), and outcomes (such as ICU-acquired infections and standardized mortality rate). We also present an example of a quality improvement project in an ICU indicating the steps taken to attain the desired changes in quality measures.
... Al finalizar la encuesta dentro de las observaciones realizadas por los encuestados pudimos encontrar inconformidades en cuanto al tiempo de espera para asignación de camas, mayor control en los horarios de visita e información compartida con familiares. Y una de las observaciones de mayor relevancia es la solicitud de que los oncólogos realicen visitas periódicas a los pacientes hospitalizados para sentir el apoyo de su médico tratante [8][9][10]. ...
Article
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Introducción: La calidad asistencial es la relación entre los servicios prestados y la obtención de los resultados deseados, enfocándose en las necesidades de los pacientes y optimización de recursos, siendo oportuno conocer el nivel de satisfacción de los usuarios que consiste en el resultado de la evaluación de la atención recibida. El objetivo de este trabajo fue describir el nivel de satisfacción obtenido en el área de Hospitalización Clínica de un hospital oncológico de Guayaquil. Métodos: El presente estudio observacional se realizó en el Hospital de SOLCA Guayaquil-Ecuador de marzo del 2021 a marzo 2022. Se incluyeron pacientes o familiares en el área de hospitalización clínica. Las variables fueron sexo, tipo de cuidador, nivel de satisfacción (variable dependiente a escala Likert). La muestra fue probabilística. Se presenta un análisis de la calidad del cuestionario con el coeficiente alfa de Cronbach y la Prueba U de Mann-Whitney. Se utiliza un análisis de asociación entre las preguntas del cuestionario para observar la correlación. Resultados: Participaron 345 encuestados, 19 pacientes, 326 familiares. Mayores a 56 años en familiares (29.1 %) y pacientes (78.9 %). La calidad del cuestionario fue alta , alfa de Cronbach =1. La satisfacción global fue de 4.85 ± 0.41 (sobre 5). La calificación mas baja fue para el tiempo de espera de cama con instancia intrahospitalaria 4.67 ± 0.65. Hubo asociación estadística entre el tiempo de espera para signación de cama y de habitación R: 0.80, P: 0.001. Conclusiones: La atención a los usuarios puede verse afectada por la presencia de nudos críticos los cuales son situaciones que afectan el correcto funcionamiento de procedimientos técnicos, operativos o gerenciales de una organización como el tiempo de espera para hospitalización y el tiempo de espera dentro de la institución para la asignación de cama.
... A cross-sectional survey conducted in Canada showed a positive relationship between safety culture and family satisfaction of nonsurvivor patients in the ICU. 15 Another study in the United States with 73 participating hospitals found that the staff with more positive perceptions of patient safety culture tends to have more positive assessments of care from the patient. 16 Furthermore, a study in the United States on nursing rounds found a significant reduction in patient falls and increased patient satisfaction when the safety protocol of the nursing round was applied. ...
Article
Background and objective A cross-sectional research, the questionnaire-based study aimed to investigate the association between patient safety culture and patient satisfaction through pharmacist performance, between patient safety culture and pharmacist performance, between pharmacist performance and patient satisfaction, and between patient safety culture and patient satisfaction. Methods Pharmacists and pharmacy technicians working in the community pharmacies evaluated the patient safety culture using an online self-administrated questionnaire filled out by participants. The first research questionnaire was adopted from the agency of healthcare research and quality (AHRQ), which was reliable and valid. Pharmacist performance and patient satisfaction were measured by using an online self-completion questionnaire that patients filled out. To measure performance, a previously validated questionnaire was used. For measuring patient satisfaction, The Patient Satisfaction with Pharmacist Clinical Services Questionnaire the final version (PSPSQ 2.0) was used. A total of 204 pharmacists, pharmacy technicians, and 204 patients constitute the research sample. Results The results showed that there is a significant association between the patient safety culture and the pharmacist's performance; an insignificant association between the patient safety culture and patient satisfaction; a significant association between the pharmacist’s performance and patient satisfaction; and a pharmacist’s performance mediates the relationship between patient safety culture and patient satisfaction. Conclusion The pharmacy sector may effectively reinforce patient safety culture in community pharmacies and enhance pharmacists’ performance to improve the quality of care and increase patient satisfaction.
... In approximately two thirds of these studies, means and SD were reported. Only few studies reported findings on construct validity (k=17) 4,8,35,43,56,60,71,83,86,[97][98][99]102,111,115,120,141 , inter-rater or test-retest reliability (k=9) 44,59,73,99,106,133,141,143,168 , measures of central tendency (k=1) 125 , responsiveness (k=11) 36,100,102,119,120,125,153,155,157,169,171 and sensitivity (k=1) 168 (see Appendix B for a detailed overview) (Table 3). ...
... Accordingly, it can reduce fatigue and psychological and work-related stress among employees and can promote their health and job performance. Overall, studies have demonstrated that positive patient safety culture contributes positively to patient satisfaction, family satisfaction, and the wellbeing of hospital staff and can even decrease hospital admissions (17,18). ...
Article
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Background and Aim Patient safety culture attitude is strongly linked to patient safety outcomes. Since the onset of the COVID-19 pandemic in early 2020, pandemic prevention has become the priority of hospital staff. However, few studies have explored the changes in patient safety culture among hospital staff that have occurred during the pandemic. The present study compared the safety attitudes, emotional exhaustion (EE), and work–life balance (WLB) of hospital staff in the early (2020) and late (2021) stages of the COVID-19 pandemic and explored the effects of EE and WLB on patient safety attitudes in Taiwan. Materials and Methods In this cross-sectional study, the Joint Commission of Taiwan Patient Safety Culture Survey, including the six-dimension Safety Attitudes Questionnaire (SAQ) and EE and WLB scales, were used for data collection. Results This study included a total of 706 hospital employees from a district hospital in Taipei City. The respondents' scores in each SAQ sub-dimension (except for stress recognition) increased non-significantly from 2020 to 2021, whereas their EE and WLB scores improved significantly (P < 0.05 and P < 0.01, respectively). The results of hierarchical regression analysis indicated that although a respondent's WLB score could predict their scores in each SAQ sub-dimension (except for stress recognition), EE was the most important factor affecting the respondents' attitudes toward patient safety culture during the later stage of the COVID-19 pandemic. Conclusion In the post-pandemic, employees' attitudes toward safety climate, job satisfaction, and perception of Management changed from negative to positive. Additionally, both EE and WLB are key factors influencing patient safety culture. The present study can be used as a reference for hospital managers to formulate crisis response strategies.
... Assessing the current safety attitudes enables organisations to gain a clear picture of PS issues that require immediate attention, address the strengths and weaknesses of their safety culture, and improve continuous quality management. 4 http://www.phcfm.org Open Access middle-income countries is direr, with approximately 2.6 million deaths occurring because of 134 million adverse events occurring in hospitals each year. ...
Article
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Background: Patient safety (PS) has been identified as a significant healthcare challenge. A good safety attitude helps healthcare workers (HCWs) to decrease medical errors. Aim: This study aimed to assess the PS attitude and identify its determinants among HCWs. Setting: This study was conducted in Sharqia Governorate at different levels of health care. Methods: This was a comparative cross-sectional study that involved240 HCWs selected after using a multistage cluster sampling technique from Sharqia Governorate.In ordertto assess the respondents’ attitudes towards PS, the modified Chinese Safety Attitudes Questionnaire (CSAQ) was used. Results: The scale with the highest percentage of positive responses, on average, was safety climate (49.59%). The study found a statistically significant association between the level of health care and mean scores of ‘teamwork climate, perception of management, job satisfaction, working conditions, and stress recognition’ and the overall CSAQ score. In regression analysis, the highest degree of education and job type were significant predictors of PS attitude among the HCWs under study (p = 0.031 and 0.011, respectively). Conclusion: According to the study’s findings, PS is low among HCWs in both healthcare units and hospitals, with a significantly higher score among hospital workers than among primary care workers. All PS composites need improvement starting with regular assessment of PS culture along with continuous monitoring.
... Therefore the population of many countries has become increasingly diverse, there is an urgent need for the healthcare provider to recognize of background and the particular needs of minority groups, culture develops the method we view our environment and influences the relationship among patients and clinicians (Ali et al., 2019;Dodek et al., 2012). Over the last few decades, studies on patient and families satisfaction of health care services had been increased since those studies act as the quality indicators to better the quality of nursing intervention as well as to assess the outcomes of care provided by health care professionals. ...
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Background family satisfaction care and decision making as important indicator to evaluate the quality of care in intensive care unit. The family satisfaction in the ICU questionnaire (FS-ICU 33 Malay languages) is a well-established tool to assess satisfaction in such settings. ICU admission has many implications, for example, the effects on critically ill patients, the ICU setting, the role of health care staff and family members, communication, psychology of families and physical health. Thus, this study we tested the hypothesis that examined effects of gender, age, relationship, marital status, education level, race and occupation can attribute on family satisfaction care and decision making. Two hundred and eight respondents selected from the Public Hospital Terengganu completed the Family satisfaction ICU Malay languages questionnaire (FS-ICU-M). A quantitative, cross-sectional study and purposive sampling was conducted from 10 October 2018 to January 2020. In this study conclude that the ICU-Care satisfaction score was significantly associated with age, education level, occupation, and the relationship of the respondents (p<0.05), but not associated with the gender, race, and marital status of the respondents. Moreover, the ICU-DM satisfaction score was significantly associated with age, marital status, occupation, and the relationship of the respondents (p<0.05), but not associated with the gender, race, and education level of the respondents.
... Contrary to some prior evidence [29], our study found that family members of patients who died in ICU were more satisfied with the quality of end-of-life care in comparison to patients who died in other units. This finding is consistent with other studies that suggest that family members of ICU decedents are generally more satisfied with the quality and experience of care as a result of more frequent interaction and engagement with healthcare staff over the course of the patient's stay in the ICU [41]. Low satisfaction scores at the end of life, on the other hand, have been shown to be strongly correlated with psychological burden and symptoms of anxiety, depression, post-traumatic stress disorder and complicated grief [42]. ...
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Background Recently immigrated and ethnic minority patients in Ontario, Canada are more likely to receive aggressive life-prolonging treatment at the end of life in comparison to other patients. To explore this finding further, this survey-based observational study aimed to evaluate satisfaction with the quality of end-of-life care for patients from diverse ethnocultural backgrounds. Methods The End-of-Life Satisfaction Survey was used to measure satisfaction with the quality of inpatient end-of-life care from the perspective of next-of-kin of recently deceased patients at Sunnybrook Health Sciences Centre in Toronto, Ontario (between March 2012 to May 2019). The primary outcome was the global rating of satisfaction. Associations with patient ethnicity, patient religion, level of religiosity/spirituality, language/communication barriers, and location of death were assessed using univariable and multivariable modified Poisson regression. Secondary outcomes included differences in satisfaction and rates of dying in intensive care units (ICU) among patient population subgroups, and identification of high priority areas for quality-of-care improvement. Results There were 1,543 respondents. Patient ethnicities included Caucasian (68.2%), Mediterranean (10.5%), East Asian (7.6%), South Asian (3.5%), Southeast Asian (2.1%) and Middle Eastern (2.0%); religious affiliations included Christianity (66.6%), Judaism (12.3%) and Islam (2.1%), among others. Location of death was most commonly in ICU (38.4%), hospital wards (37.0%) or long-term care (20.0%). The mean(SD) rating of satisfaction score was 8.30(2.09) of 10. After adjusting for other covariates, satisfaction with quality of end-of-life care was higher among patients dying in ICU versus other locations (relative risk [RR] 1.51, 95%CI 1.05-2.19, p=0.028), lower among those who experienced language/communication barriers (RR 0.49 95%CI 0.23-1.06, p=0.069), and lower for Muslim patients versus other religious affiliations (RR 0.46, 95%CI 0.21-1.02, p=0.056). Survey items identified as highest priority areas for quality-of-care improvement included communication and information giving; illness management; and healthcare provider characteristics such as emotional support, doctor availability and time spent with patient/family. Conclusion Satisfaction with quality-of-care at the end of life was higher among patients dying in ICU and lower among Muslim patients or when there were communication barriers between families and healthcare providers. These findings highlight the importance of measuring and improving end-of-life care across the ethnocultural spectrum.
... The reasons were as follows: the improvement of the system, the addition of equipment, and the participation of multidisciplinary teams eliminated the hidden dangers for the transfer of critically ill patients and reduced the occurrence rate of adverse events. On the other hand, a positive safety culture [27] improved the safety and team environment in the medical unit. After the application of the CUSP model, doctors focused on the communication with the patients' relatives, explaining the time, economics, and the physical cost while going to and from the hospital. ...
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Background To explore the effect of applying a comprehensive unit-based safety program (CUSP) in the intrahospital transfer of patients with critical diseases. Methods A total of 426 critically ill patients in the first affiliated Hospital of Anhui Medical University from August 2018 to February 2019 were divided into two groups according to the time of admission. Overall, 202 patients in the control group were treated with the routine transfer method, and 224 patients in the observational group were treated with the transfer method based on the CUSP model. The safety culture assessment data of medical staff, the occurrence rate of adverse events and related causes, the time of transfer, and the satisfaction of patients’ relatives to the transfer process were compared before and after implementation of the transfer model between the two groups. Results Before and after the implementation of the CUSP mode transfer program, there were significant differences in the scores of all dimensions of the safety culture assessment of medical staff ( P < 0.05), and the occurrence rate of adverse events and the causes in the observational group were significantly lower than those in the control group (disease-related, staff-related, equipment-related, environment-related) ( P < 0.05). The transfer time for Computed Tomography (CT), Magnetic Resonance Imaging (MRI), operating room, and the interventional room was significantly shorter in the observational group than that in the control group ( P < 0.05), while the satisfaction of relatives to the transfer process was significantly higher than those in the control group ( P < 0.05). Conclusion The implementation of CUSP model for the intrahospital transfer of critically ill patients can significantly shorten the in-hospital transfer time, improve the attitude of medical staff towards safety, reduce the occurrence rate of adverse events, and improve the satisfaction of patients’ relatives to the transfer process.
... Furthermore, a direct correlation has been found between health workers' perception of safety and satisfaction levels of patients' family members [67]. This influence however, is not always positive [68]. ...
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The incidence of adverse events in healthcare is a global problem with negative consequences for all stakeholders including patients, their family members, health professionals and the government. Patient safety and patient safety culture lie at the heart of all adverse events within healthcare settings. The culture of an organization determines its approach to problem solving and determines how individuals within that setting work; this is also true for patient safety culture and the reduction of adverse events within healthcare organizations. The aim of this study was to assess, identify and have a better understanding of the importance of patient safety culture within the healthcare organization and to create insights on the impact of cultural management systems regarding patient safety. The research method of this study is an integrated literature of the patient safety culture and perspectives of healthcare workers, assessed using the Modified Stanford Instrument (MSI) and Manchester Patient Safety Framework (MaPSaF). Analysis of the data revealed that health professionals working in the same organizations have differing opinions on the same topic; therefore, there is need for open communication and a systematic approach to establishing the right safety culture within healthcare organizations. In conclusion, establishing the right culture and having systematic ways of measurement enable improvements and the ability of organizations to learn from their mistakes. There is paucity of data with respect to the use of these tools in the respective countries (Canada and United Kingdom) even though the tools are the national tools established through rigorous research. Therefore, a study of MaPSaF in New Zealand was also analyzed. There is need for further research and publications to enable learning on patient safety, which will reduce the incidence of adverse events and associated consequences in healthcare organizations.
... 5 Weaver et al 6 assert that the terms 'safety culture' and 'safety climate' are frequently employed in an interchangeable manner despite their different meanings. For instance, patient safety culture represents a component of organisational culture 7 that is related to the consonance of behavioural patterns, beliefs and values related to the safety of patients, which are common among representatives of a particular entity, [8][9][10][11] and empowers decision-making. 12 Safety climate, conversely, is considered as the outer layers of safety culture, 13 more often measured at a defined time point. ...
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Introduction Hospitals commonly examine patient safety culture and other quality indicators to evaluate and improve performance in relation to quality and safety. A growing body of research has separately examined relationships between patient safety culture and patient experience on clinical outcomes and other quality indicators. However, there is a knowledge gap regarding the relationship between these two important domains. This article describes the protocol for a scoping review of published literature examining the relationship between patient safety culture and patient experience in hospital settings. The scoping review will provide an overview of research into the relationship between patient safety culture and patient experience in hospital contexts, map key concepts underpinning these domains and identify research gaps for further study. Methods and analysis The scoping review will be conducted using the five stages of Arksey and O’Malley’s framework: identify the research question; identify relevant studies; study selection; chart data; and collate, summarise and report the results. The inclusion criteria will be applied using the Population, Concept and Context Framework. Searches will be conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, Scopus and SciELO databases, without applying date range limits. Hand-searching of grey literature will also be performed to find relevant, non-indexed literature. Data will be extracted using a standardised data extraction form developed by the Joanna Briggs Institute. Both descriptive and thematic analyses will be undertaken to scope key concepts within the body of reviewed literature. Ethics and dissemination This type of study does not require an ethics review. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.
... Findings of this study suggest visitors' experience with the healing garden can lead to overall satisfaction with the hospital and behavioral intentions toward the hospital. These findings should be of key interest because satisfaction is so highly desired among hospital managers (Atkins et al., 1996), and the satisfaction of visitors, particularly family members of patients, has become an increasingly important trend (Dodek et al., 2012;Henrich et al., 2011). This study demonstrates that a healing garden can be a powerful enough space to impact not only visitors' overall satisfaction with the hospital but also their intentions regarding their future behavior toward the hospital, such as revisiting or recommending the hospital. ...
Article
Purpose: To measure hospital visitors' satisfaction with a rooftop atrium and its resultant impact on the visitors' behavioral intentions toward the healing garden, the hospital, and overall satisfaction with the hospital. Background: There is a significant lack of empirical research that links the emotional and behavioral responses toward healing gardens and the hospitals providing them. Methods: A purposeful sample of 96 visitors to the healing garden in the rooftop atrium of a surgery building in a major hospital in the Southeastern United States completed a survey based on Roger Ulrich's Theory of Supportive Gardens and the Stimulus, Organism, Response (S-O-R) paradigm. Results: Findings of this study suggest visitors' experience with the healing garden can lead to overall satisfaction with the hospital and behavioral intentions toward the hospital. Visitors' satisfaction with the healing garden significantly predicted their satisfaction with the hospital, their intend to revisit the hospital, and their intend to recommend it. Conclusions: This study demonstrates that a small healing garden can be a powerful enough space to impact visitors' overall satisfaction with the hospital and their intentions regarding their future behavior toward the hospital, such as revisiting or recommending the hospital.
... Çalışmamız bu alanda yapılmış literatürde ki ülkemizden bildirilen ilk çalışma olma açısından da önem göstermektedir. (5) tarafından hazırlanan, Erdal ve ark.'nın (6) Türkçeye çevirdiği ve geçerlilik güvenirlik çalışması yapılan, FS-ICU 24 başlıklı anket seti kullanıldı. Veriler anket uygulama metodu ile toplanmıştır. ...
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INTRODUCTION: The aim of this study is showing the satisfaction levels of patient’s relatives using pediatric palliative care service, aiming to eliminate the problems of pediatric patients at the end-of-life stage and their relatives thereafter improving quality of life. METHODS: The population of the study consists of 87 relatives of patients who were hospitalized between May and November 2017 in the palliative care unit of İzmir Dr. Behçet Uz Children’s Hospital. In the study, FS-ICU 24 scale which was prepared by Dodek et al. and which was translated into Turkish and tested for validity and reliability by Erdal et al. was used to find out the satisfaction levels of 87 patients relatives. RESULTS: While scores of care and treatment of patients, interest and giving information to the patient’s relatives, perception, affect to emotion situation of patient’s relatives, decision-making process and waiting of environment and logistic support sub-dimensions were favorable. DISCUSSION AND CONCLUSION: Today, the safety and quality of health care services are important as being accessible and widespread. How to evaluate this stuation is merely carried out by the satisfaction of the patient’s relatives. Satisfaction levels of both patients and their relatives deliver us information about the quality and safety of given health care. This study provides us the importance and necessity of the palliative health care units. We believe that more studies in advance will contribute to the quality of services.
... Subsequently, healthy work environments are associated with fewer patient complications (falls, failure to rescue, mortality), as well as lower rates of nurse burnout and greater levels of job satisfaction (Halm, 2019). To a great extent, the nurse's ability to provide family support is enhanced or diminished by the ICU environment and the overall organizational culture of family care (Dodek et al., 2012;Hetland et al., 2017;Mackie et al., 2018;McAndrew et al., 2019;Vandall-Walker & Clark, 2011;Vandall-Walker et al., 2007). These findings further support that family care quality is tied to nurses' work demands and resources. ...
Article
The theory of nurse-promoted engagement with families in the intensive care unit (ICU) was developed to describe the dynamic and complex interplay between factors that support or impair nurses’ efforts to promote family engagement. Theory construction involved theory derivation and theory synthesis. Concepts and relationships from ecological theory, the Resiliency Model of Family Stress, Adjustment and Adaptation, moral distress theory, and the healthy work environment framework informed the initial formation of the emerging theory. The synthesis of findings from the literature further expanded the scope of the relationships and propositions proposed in the theory. This middle-range theory can set direction for theory-informed focused nursing research that can advance the science of family nursing and guide ICU clinicians in overcoming challenges in family nursing practice. Recommendations are provided for applying this new theoretical lens to guide family nursing curriculum development, practice improvements, and policy changes to support nurses in promoting family engagement.
... Quality in hospital services means providing the patient with multidisciplinary care at minimal risk. Therefore, implementing improvements in organizational and safety culture enhances quality [6]. ...
... We had high satisfaction levels in this context. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to Studies have indicated that frequency of communication is one of the parameter that have least satisfaction (1,3,8,15) Increasing the frequency of doctor-patient communication frequency is one of the factors that can improve general level of satisfaction (3,(21)(22)(23). A study showed that meeting with the doctor at least once a day is one of the ten important needs (9). ...
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Objective: This study aims to investigate the validity and reliability of the FS-ICU 24 survey in the Turkish language, to evaluate the satisfaction of ICU patients' relatives, and to determine the factors affecting satisfaction. Materials and Methods: In this study, the Turkish version was prepared based on the FS-ICU 24 survey applied to the relatives of ICU patients (Anesthesiology, Internal Medicine, General Surgery and Neurosurgery) at the Erciyes University in the Faculty of Medicine between April 2015 and June 2015. The Turkish version was tested and proven to be reliable and valid. Relatives of patients that were hospitalized for at least 48 hours, who had visited the patient at least once, were included. In this study, 369 surveys were completed. Results: FS-ICU 24 survey was found reliable and valid in Turkish. Patients' relatives were unsatisfied with physical conditions, waiting room setting and frequency of communication with nurses the most. The relatives were highly satisfied with the skills and competency of ICU doctors/nurses, setting of the ICU, completeness of treatment provided. Among the intensive care unit departments, there were not any statistically significantly different satisfaction results (p>0.05). The satisfaction level was found to decrease with increasing education levels and increasing duration of hospitalization (p<0.05). The satisfaction in the group who knew the diagnosis was higher (p<0.05). Conclusion: Even though the general satisfaction level of the patients' relatives was high, satisfaction level can be increased by improving physical factors, such as the waiting room setting, and by training on the communication skills of all staff that have contact with the patients' relatives on communication skills.
... All these could be achieved through setting up clear policies, having skilled healthcare professionals, all-level leadership, up-to-date data, and patient-centered care in order to maintain healthcare safety sustainability [1]. Assessing the existing safety culture allows organizations to obtain a clear view of patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, and enhance continuous quality management [7]. In most Arab countries, PS is considered a major issue for health policy makers, which necessitates identifying and analyzing its negatively contributed factors [8]. ...
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Background: Healthcare is a high-risk industry that requires regular assessment of patient safety climate within healthcare organizations. This addresses the organizational cultural issues and explores the association between organizational climate and patient outcomes. This study aimed to assess patient safety culture among paramedical health employees at Fayoum general and district hospitals and to determine factors affecting their perception of patient safety. Methods: A descriptive cross-sectional study was conducted at the general hospital and four district hospitals in Fayoum Governorate, Egypt, among 479 paramedical healthcare workers. The standardized Hospital Patient Safety scale (HSOPSC) that composed of 12 safety culture dimensions was used. Results: The mean total safety score varies according to the participant's position and work area. The total patient safety score was 46.56%. No dimension reported score above 75%. The highest mean composite scores were for organizational learning and continuous improvement (65.36%) and teamwork within hospital units (63.09%). The lowest reported score was for communication openness (17.9%). More perception of safety dimensions was seen in females than males, participants in direct contact with patients, and those with work experience less than 10 years. Conclusion and recommendations: Overall, the degree of patient safety is low at Fayoum public hospitals. No dimension scored above 75%, and 7 out of 12 dimensions scored less than 50%. Hence, continuous monitoring and updating of the ways of incident reporting is highly recommended. This may be done through setting up a web-based incident reporting system accessible for 24 h.
... The overall satisfaction score was comparable with other published studies employing similar methods to administer the FS-ICU-24 questionnaire. [14][15][16][17] Our findings are also consistent with a study by Wall et al 6 which identified that families of ICU non-survivors were more satisfied than families of ICU survivors. Similarly, Stricker et al, 7 among a number of patient-level and ICU-level factors studied, found that increasing acute severity of illness of the patient (evaluated using the Simplified Acute Physiology Score (SAPS) II score) was associated with increasing satisfaction on the overall family satisfaction score; however, lower satisfaction was associated with ICU-level characteristics of a written admission/discharge policy and a higher patient:nurse ratio. ...
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Objective To assess family satisfaction with intensive care units (ICUs) in the UK using the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire, and to investigate how characteristics of patients and their family members impact on family satisfaction. Design Prospective cohort study nested within a national clinical audit database. Setting Stratified, random sample of 20 adult general ICUs participating in the Intensive Care National Audit & Research Centre Case Mix Programme. Participants Family members of patients staying at least 24 hours in ICU were recruited between May 2013 and June 2014. Interventions Consenting family members were sent a postal questionnaire 3 weeks after the patient died or was discharged from ICU. Up to four family members were recruited per patient. Main outcome measures Family satisfaction was measured using the FS-ICU-24 questionnaire. Main results A total of 12 346 family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. Overall and domain-specific family satisfaction scores were high (mean overall family satisfaction 80, satisfaction with care 83, satisfaction with information 76 and satisfaction with decision-making 73 out of 100) but varied significantly across adult general ICUs studied and by whether the patient survived ICU. For family members of ICU survivors, characteristics of both the family member (age, ethnicity, relationship to patient (next-of-kin and/or lived with patient) and visit frequency) and the patient (acute severity of illness and receipt of invasive mechanical ventilation) were significant determinants of family satisfaction, whereas, for family members of ICU non-survivors, only patient characteristics (age, acute severity of illness and duration of stay) were significant. Conclusions Overall family satisfaction in UK adult general ICUs was high but varied significantly. Adjustment for differences in family member/patient characteristics is important to avoid falsely identifying ICUs as statistical outliers. Trial registration number ISRCTN47363549
... Sorra et al., 2014). Another study that used the AHRQ HSOPS and family satisfaction indicators concluded that only Teamwork and Feedback and Communication about Errors were positively associated to patient satisfaction (Dodek et al., 2012). These studies were done at a hospital level surveying staff across hospitals and not at a unit level within a hospital. ...
Article
The objective of this research was to analyze the relationship between nursing safety work culture in inpatient nursing units of a specialty academic hospital and their patients’ perception of safety using quantitative and qualitative methods. The aim of the quantitative study was to quantitatively evaluate whether nursing safety culture, as measured on the Hospital Survey on Patient Safety Culture (HSOPS) safety questions of the institutional employee opinion survey, was associated with patients’ perception of safety during their inpatient care, as measured by responses on the inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The aim of the qualitative study was to explore patients’ and nurses’ perceptions of the experiences about safety through individual interviews. The setting of the study was 14 inpatient nursing units. The sample for the quantitative study was these 14 units. The selected HSOPS and HCAHPS question scores were used for selected domains for a regression analysis. For the qualitative study, 4 units were selected from these 14 units based on their HCAHPS score (top, lowest, and two average performers). A total of 14 nurses and 12 patients were interviewed from these selected units. The quantitative results indicated that there was no significant association between any of the domains of the nurses’ safety culture and the domains of patients’ perception of safety. A possible explanation was the limited vii statistical power, given the fixed sample size of 14 units. In the qualitative study, the nursing themes were the following: High workload and insufficient staff, nurses identified safety risks, and safety climate is favorable. The patient themes were the following: Patients identified safety risks, Communication and caring from nurses is appreciated, Patients noticed nurses work as a team, Insufficient staffing not an issue for patients. The conclusions from the study was that nurses are working in a favorable safety climate and teamwork is important because both nurses and patients recognized it as part of safety, patients perceived safe care and felt that nurses genuinely cared for them, and working and staffing are the highest safety priority for nurses.
... Therefore, our study findings cannot be generalized to other ICU settings in different geographic regions. Moreover, Dodek et al [28] found that there was strong positive relationships between some aspects of organizational/safety culture and the satisfaction of family members. ...
... Studies have also reported a lack of information in the rehabilitation phase regarding the content of the rehabilitation and the impact of a severe TBI [14,15]. Dodek et al. pointed to the lack of information and organization as one of the main challenges for family members as patients move from the ICU to the neurosurgical departments or from the neurosurgical department to rehabilitation [33]. Family members may have unrealistic expectations related to both the extent of follow up and improvement of the patients' functional and cognitive improvement. ...
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Background Family member’s experience and satisfaction of health care in the acute care and in-patient rehabilitation are important indicators of the quality of health care services provided to patients with severe traumatic brain injury (TBI). The objective was to assess family members’ experience of the health care provided in-hospital to patients with severe TBI, to relate experiences to family member and patient demographics, patients’ function and rehabilitation pathways. Methods Prospective national multicentre study of 122 family members of patients with severe TBI. The family experience of care questionnaire in severe traumatic brain injury (FECQ-TBI) was applied. Independent sample t-tests or analysis of variance (ANOVA) were used to compare the means between 2 or more groups. Paired samples t-tests were used to investigate differences between experience in the acute and rehabilitation phases. Results Best family members` experience were found regarding information during the acute phase, poorest scores were related to discharge. A significantly better care experience was reported in the acute phase compared with the rehabilitation phase (p < 0.05). Worst family members` experience was related to information about consequences of the injury. Patient’s dependency level (p < 0.05) and transferral to non-specialized rehabilitation were related to a worse family members` experience (p < 0.01). Conclusions This study underscores the need of better information to family members of patients with severe TBI in the rehabilitation as well as the discharge phase. The results may be important to improve the services provided to family members and individuals with severe TBI.
... Safety culture influences the management, control, and minimization of operational failures that can lead to medical errors within healthcare settings (Pronovost et al., 2006). Safety culture is a subset of organizational culture that pertains to the prevention, detection, and management of patient safety events in healthcare and informs the safety climate that captures the perceptions, practices, and procedures employees follow when executing tasks (Dodek et al, 2012(Dodek et al, , p. 1506Hofmann & Mark, 2006;Schneider, 1990). ...
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Patient safety is a significant challenge to United States (U.S.) healthcare settings despite public and private efforts to reduce risk of medical error. Nurses function at the “sharp end” of error; they practice at the point in the clinical process where latent factors such as misaligned organizational process, poor communication, and lack of resources merge to actualize an error event. This article examines the impact of organizational role on perception of safety culture within a multi-state, multi-organization sample of healthcare professionals. The authors offer background information and describe study methods. Data were derived from a national sample of hospitals that administered the 2011 Agency for Healthcare Research and Quality (AHRQ) Safety Culture survey. The sample included registered nurses, physicians, and managers employed within 66 multi-state hospitals. Results demonstrated that managers reported significantly higher mean scores on the Safety Culture survey than registered nurses. Length of hospital employment predicted higher overall mean scores and number of reported adverse events predicted lower overall mean scores. Direct care providers reported significantly lower mean Safety Culture scores. The discussion and conclusion indicate that a primary implication of these findings is the importance of nursing input into patient safety policies.
... Therefore, our study findings cannot be generalized to other ICU settings in different geographic regions. Moreover, Dodek et al [28] found that there was strong positive relationships between some aspects of organizational/safety culture and the satisfaction of family members. ...
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Although family satisfaction is an important indicator for quality improvement of intensive care units (ICUs), few studies have translated family satisfaction data into quality improvement in Asia. A prospective multicenter study was conducted to evaluate family satisfaction regarding the care of patients and their family. The family satisfaction in the ICU (FS-ICU) questionnaire was administered from January 2015 to February 2016 at ICUs of 3 tertiary teaching hospitals in South Korea. Family members of adult patients, staying at an ICU for ≥48 hours, were included. Key factors affecting satisfaction were identified using quantitative and qualitative analyses. In total, 200 family members participated in this survey. The mean score for overall family satisfaction (FS-ICU/total) was 75.4 ± 17.7. The mean score for satisfaction with information/decision-making was greater than that for satisfaction with care (78.2 ± 18.2 vs 73.5 ± 19.4; P ≤ .001). Family members who agreed to not resuscitate and whose patient died at the ICU had lower FS-ICU/total scores. When compared with hospital A, hospital C was an independent predictor with an FS-ICU/total score of <75. Families reported the least satisfaction for the atmosphere of the ICU, including the waiting room atmosphere and management of agitation. We evaluated family satisfaction regarding ICUs for the first time in Asia using a validated tool. The decision to not resuscitate, ICU mortality, and ICU culture were associated with family satisfaction with critical care. Efforts should be targeted for improving factors that cause low family satisfaction when planning quality improvement interventions for ICUs in Asia.
... Quality in hospital services means providing the patient with multidisciplinary care at minimal risk [6]. Therefore, implementing improvements in organizational and safety culture enhances quality [7]. ...
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Objective To assess the culture of patient safety in studies that employed the hospital survey on patient safety culture (HSOPS) in hospitals around the world. Method We searched MEDLINE, EMBASE, SCOPUS, CINAHL, and SciELO. Two researchers selected studies and extracted the following data: year of publication, country, percentage of physicians and nurses, sample size, and results for the 12 HSOPS dimensions. For each dimension, a random effects meta-analysis with double-arcsine transformation was performed, as well as meta-regressions to investigate heterogeneity, and tests for publication bias. Results 59 studies with 755,415 practitioners surveyed were included in the review. 29 studies were conducted in the Asian continent and 11 in the United States. On average studies scored 9 out of 10 methodological quality score. Of the 12 HSOPS dimensions, six scored under 50% of positivity, with “nonpunitive response to errors” the lowest one. In the meta-regression, three dimensions were shown to be influenced by the proportion of physicians and five by the continent where survey was held. Conclusions The HSOPS is widely used in several countries to assess the culture of patient safety in hospital settings. The culture of culpability is the main weakness across studies. Encouraging event reporting and learning from errors should be priorities in hospitals worldwide.
... Todos os estudos analisados utilizaram instrumentos de avaliação de satisfação da família na UTI em diferentes abordagens. Desses, 62,9% 1, [14][15][16][17][19][20]22,[24][25][26][27][29][30][31][32][33] tiveram como objetivo avaliar a satisfação em relação às tomadas de decisão, 25,9% 8-13,28 objetivaram avaliar a satisfação em relação à atenção de pacientes em cuidados paliativos na UTI, e 11,1% 18,21,23 tiveram como objetivo adaptar e validar instrumentos. ...
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Objective: to analyze the scientific production related to the evidence on the satisfaction of family members of ICU patients and the instruments used for the evaluation. Method: An integrative review in which articles published between 2005 and 2015 were analyzed in English, Portuguese or Spanish, in the PUBMED / MEDLINE and LILACS databases and the SciELO library. The following were used as a search strategy: personal satisfaction OR satisfaction AND family. For the purpose of the data collection of articles, an instrument was developed with information such as title, authors, year of publication and journal, study objective, design, participants, research site, main theme and results. Results: 27 studies met the inclusion criteria. Four instruments were used to evaluate the satisfaction of family members of ICU patients: Critical Care Family Satisfaction Survey, Family Satisfaction in the Intensive Care Unit, Critical Care Family Needs Inventory and the Quality of Dying and Death. The studies addressed the satisfaction of family members in relation to their needs and decision making, satisfaction with palliative care, and cross-cultural adaptation studies and the validation of instruments were also evidenced. Regarding the level of evidence, the studies focus on levels II to VI. Conclusion: the analysis of the scientific production on the satisfaction of family members of ICU patients showed that the factor that contributes most to the promotion of family satisfaction was the quality of care.
... A large part of the included studies reported average satisfaction levels near the maximum possible, indicating the probable presence of the ceiling effect. In these cases, family groups with the highest scores cannot be differentiated from one another, thus decreasing result reliability and limiting the ability of the instrument to expose aspects that could be improved or to measure the (8) After discharge (n) 12,5% (2) 25,0% (2) ----10,5% (4) Undefined (n) 43,8% (7) 12,5% (1) 12,5% (1) ---23,7% (9) Not reported (n) 12,5% (2) 25,0% (2) -25,0% (1) --13,2% (5) a Dodek et al. 24 reports family satisfaction in 2 moments. impact of improvement initiatives. ...
Article
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Objectives Family satisfaction in intensive care units (ICU) is of increasing relevance for family-centred cared. The objective of this review was to explore the characteristics of studies that have used questionnaires to measure the satisfaction of family members of ICU patients. Review methods A literature review was performed for studies evaluating family satisfaction in the ICU, independent of design. The following data were obtained for each selected article: publication year, country of origin, design, number of family members, instrument for family satisfaction, instrument score range, response rate, moment at which satisfaction was evaluated, and average level of reported satisfaction. Data sources The following databases were systematically searched: PubMed, CINAHL, ProQuest Nursing, ProQuest Social Science, ProQuest Psychology, Science Direct, PsycINFO, LILACS, and Scielo. Results Thirty-seven articles met inclusion criteria, showing high levels of family satisfaction. Among these, nine different questionnaires were identified. In 31.6% of the studies, family satisfaction was evaluated during the ICU stay, whereas 36.9% did not report the evaluation moment. The mean response rate was 65.5%, and response rates greater than 70% were found only in 28.2% of the studies. Conclusions High satisfaction levels among family members of ICU patients must be contextualised in light of questionnaire heterogeneity, low response rates, and variability in the moment at which family satisfaction is evaluated. The creation of methodological standards for evaluating and reporting family satisfaction could facilitate comparing results between investigations in this field.
... (2,6,13) Other studies have claimed that a higher family satisfaction with an ICU is associated with several domains of a better organizational/safety culture. (15,16) A low satisfaction index among both groups indicates that more work is needed in the ICU units in the city of Al-Madinah Al Munawarah to increase satisfaction by improving the quality of care. However, the relatively high satisfaction index that was obtained for questions 2, 6, and 10, which concerned the level of care of the hospital staff toward patients, the courtesy of ICU staff members, and the satisfaction with the medical care that the patient received, is encouraging. ...
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Objectives:: This study aims to identify the satisfaction levels of the family members of patients in intensive care units. Methods:: This is a cross-sectional analytical study. General intensive care units offer a variety of services to clinical and surgical patients. For the purpose of this study, a trained interviewer communicated with the families of patients, either before or after visiting hours. Results:: The study included 208 participants: 119 (57.2%) males and 89 (42.8%) females. Seventy-three (35.1%) of the patients attended a private hospital, and 135 (64.9%) attended a public hospital in the city of Al Madinah Al- Munawarah. All of the participants were either family members or friends of patients admitted to the intensive care units at the hospitals. The responses of both groups yielded low scores on the satisfaction index. However, a relatively high score was noted in response to questions 2, 6, and 10, which concerned the care that was extended by the hospital staff to their patients, the courteous attitude of intensive care unit staff members towards patients, and patients' satisfaction with the medical care provided, respectively. A very low score was obtained for item 11, which was related to the possibility for improvements to the medical care that the patients received. Overall, greater satisfaction with the services offered by the public intensive care units was reported compared to the satisfaction with the services offered by the private intensive care units. Conclusion:: An overall low score on the satisfaction index was obtained, and further studies are recommended to assess the current situation and improve the satisfaction and quality of care provided by intensive care units.
... Some previous research has shown a connection between patient safety and patient experience. [14][15][16] However, those studies did not aggregate data to the level of the hospital unit/service line (the level at which care is given and errors are made), did not focus on validated measures of staff and patient perceptions, and/or were limited in terms of regional or convenience sampling methods. Furthermore, some prior studies did not include data that would elucidate the specific hospital and unit/service line characteristics that potentially influence the association between nurse perception of safety culture and ability to achieve HCAHPS top box patient experience scores. ...
Article
Objective: The purpose of this study was to better understand the relationship between nurse-reported safety culture and the patient experience in a multistate sample of nurses and patients, matched by hospital unit/service line and timeframe of care delivery. Background: Nurses play a key role in the patient experience and patient safety. A strong safety culture may produce positive spillover effects throughout the nurse caregiving experience, resulting in patient perception of a high-quality experience. Methods: Multivariate mixed-effects regression models were specified using data from a multistate sample of hospital units that administered both the Agency for Healthcare Research and Quality (AHRQ) staff safety culture survey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey over a 12-month period. Survey response variables are measured at the unit (service line) and hospital level. Results: Key variables in the HCAHPS and AHRQ surveys were significantly correlated. Findings highlight the relationship between 3 safety culture domains: teamwork, adequate staffing, and organizational learning on the achievement of a positive patient experience. Conclusion: Modifiable aspects of hospital culture can influence the likelihood of achieving high HCAHPS top box percentages in the nursing and global domains, which directly impact hospital reimbursement.
... In order to assess how well health care providers are doing in this area, data on family satisfaction must first be measured. Findings from recent studies [9][10][11][12][13] suggest that most families are pleased with the care their loved ones received in the ICU. However, interventions that improve communication and interaction between patients' families and health care providers are still needed. ...
Article
Background: In our competitive health care environment, measuring the experience of family members of patients in the intensive care unit to ensure that health care providers are meeting families' needs is critical. Surveys from Press Ganey and the Centers for Medicare and Medicaid Services are unable to capture families' satisfaction with care in this setting. Objective: To implement a sustainable measure for family satisfaction in a 12-bed medical and surgical intensive care unit. To assess the feasibility of the selected tool for measuring family satisfaction and to make recommendations that are based on the results. Method: A descriptive survey design using the Family Satisfaction in the Intensive Care Unit 24-item questionnaire to measure satisfaction with care and decision-making. Results: Forty family members completed the survey. Overall, the mean score for families' satisfaction with care was 72.24% (SD, 14.87%) and the mean score for families' satisfaction with decision-making was 72.03% (SD, 16.61%). Families reported that nurses put them at ease and provided understandable explanations. Collaboration, inclusion of families in clinical discussions, and timely information regarding changes in the patient's condition were the most common points brought up in free-text responses from family members. Written communication, including directions and expectations, would have improved the families' experience. Conclusion: Although patients' family members reported being satisfied with their experience in the intensive care unit, there is room for improvement. Effective communication among the health care team, patients' families, and patients will be targeted for quality improvement initiatives.
... Additionally, instruments on family needs after TBI focus on health information together with support and involvement with care [33,35]: these areas are included in the factor/subscale information in the FECQ-TBI. The second rehabilitation-related factor is organization, which is a significantly important domain for seriously ill patients in the intensive care unit (ICU) and for patients with a long length of stay [36]. Included in the organisation subscale is stability of personnel, in accordance with a qualitative study reporting that sustained connections with professionals are of utmost importance in rehabilitation [37]. ...
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Background Family members are important for support and care of their close relative after severe traumas, and their experiences are vital health care quality indicators. The objective was to describe the development of the Family Experiences of in-hospital Care Questionnaire for family members of patients with severe Traumatic Brain Injury (FECQ-TBI), and to evaluate its psychometric properties and validity. Methods The design of the study is a Norwegian multicentre study inviting 171 family members. The questionnaire developmental process included a literature review, use of an existing instrument (the parent experience of paediatric care questionnaire), focus group with close family members, as well as expert group judgments. Items asking for family care experiences related to acute wards and rehabilitation were included. Several items of the paediatric care questionnaire were removed or the wording of the items was changed to comply with the present purpose. Questions covering experiences with the inpatient rehabilitation period, the discharge phase, the family experiences with hospital facilities, the transfer between departments and the economic needs of the family were added. The developed questionnaire was mailed to the participants. Exploratory factor analyses were used to examine scale structure, in addition to screening for data quality, and analyses of internal consistency and validity. ResultsThe questionnaire was returned by 122 (71%) of family members. Principal component analysis extracted six dimensions (eigenvalues > 1.0): acute organization and information (10 items), rehabilitation organization (13 items), rehabilitation information (6 items), discharge (4 items), hospital facilities-patients (4 items) and hospital facilities-family (2 items). Items related to the acute phase were comparable to items in the two dimensions of rehabilitation: organization and information. All six subscales had high Cronbach’s alpha coefficients >0.80. The construct validity was confirmed. Conclusion The FECQ-TBI assesses important aspects of in-hospital care in the acute and rehabilitation phases, as seen from a family perspective. The psychometric properties and the construct validity of the questionnaire were good, hence supporting the use of the FECQ-TBI to assess quality of care in rehabilitation departments.
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Suboptimal communication with clinicians, fragmented care and failure to align with patients' preferences are determinants of post intensive care unit (ICU) burden in family members. Our aim was to evaluate the impact of a nurse facilitator on family psychological burden. We carried out a randomised controlled trial in five ICUs in France comparing standard communication by ICU clinicians to additional communication and support by nurse facilitators. We included patients > 18 years, with expected ICU length of stay > 2 days, chronic life-limiting illness, and their family members. Facilitators were trained to help families to secure care in line with patient's goals, beginning in ICU and continuing for 3 months. Assessments were made at baseline and 1, 3 and 6 months post-randomisation. Primary outcome was the evolution of family symptoms of depression over 6 months using a linear mixed effects model on the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included HADS-Anxiety, Impact of Event Scale-6, goal-concordant care and experience of serious illness (QUAL-E). 385 patients and family members were enrolled. Follow-up at 1-, 3- and 6-month was completed by 284 (74%), 264 (68.6%) and 260 (67.5%) family members respectively. The intervention was associated with significantly more formal meetings between the ICU team and the family (1 [1–3] vs 2 [1–4]; p < 0.001). There was no significant difference between the intervention and control groups in evolution of symptoms of depression over 6 months (p = 0.91), nor in symptoms of depression at 6 months [0.53 95% CI (− 0.48; 1.55)]. There were no significant differences in secondary outcomes. This study does not support the use of facilitators for family members of ICU patients.
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Introduction: The family has an important role in the recovery of the intensive care patient. Evidence in the literature reveals the importance of family members' satisfaction with patient care. Because of that, it is crucial to evaluate the level of family satisfaction with the services provided to them and their patients. Methodology: A comparative, descriptive multicenter cross- sectional study was carried out in Saudi Arabia, targeting all Intensive Care Units in both Government and Private Hospitals in all regions equally. Result: A total of 2053 responses were analyzed. A 63.4% satisfaction index was reported for communication with ICU staff, the emotional support and support in decision making reported a 62.9% satisfaction index. The patient's and family's overall needs reported a 56.9% satisfaction index. Also, data showed some discrepancies between government and private hospitals. Discussion: A high satisfaction index among families for the services provided to their patients in intensive care units, compared to the satisfaction index among families in the Arab world, and with a relative level compared with research around the world. Conclusion: This study showed a satisfaction level of 56.9% in meeting the patient's and family's overall needs; many families indicated the need for improvement in the ICU's services. That urges to carry out future researches to identify the families' and patients' needs in detail.
Article
Background: Few responses to the Child Hospital Consumer Assessment of Healthcare Providers and Systems and no use of family satisfaction scores indicated the need to implement a program to collect and use family satisfaction data at a pediatric cardiac intensive care unit (ICU) at a southeastern academic medical center. Objectives: To improve response rates for family satisfaction surveys, to identify future quality improvement initiatives, to receive qualitative feedback from key stakeholders, and to better understand nursing staff's satisfaction with the project implementation process. Methods: A quality improvement program using the Pediatric Family Satisfaction in the Intensive Care Unit (pFS-ICU) survey was implemented to evaluate family satisfaction data from a pediatric cardiac ICU. Data were collected for 6 months to identify quality improvement initiatives for continuing excellence. An interprofessional focus group of key stakeholders assessed feedback and perceptions. Results: A 61% response rate (n = 81 responses) was achieved on the pFS-ICU survey. Respondents ranked the pediatric cardiac ICU higher than 90% excellence in all categories in every month but 1 (in 1 category). The focus group revealed the survey's ease of use and indicated that the data allow more focus on patient-centered care. A staff survey showed that 100% of staff understood the new process and 87% agreed that the survey is an effective tool. Conclusion: Researchers should study the pFS-ICU survey in other inpatient pediatric step-down units and ICUs because it fosters a high response rate that provides real-time data, leading to quality improvement initiatives that can increase quality of care and improve outcomes.
Article
Objectives To examine family members’ satisfaction in adult intensive care units. Methodology This is mixed-method research. Family members of critically ill patients responded to a structured questionnaire and then were interviewed using semi-structured interviews. Quantitative and qualitative data were analyzed separately and integrated during the discussion. Settings Six adult intensive care units in university hospitals in Egypt. Main outcome measures Family satisfaction was assessed using the Critical Care Family Satisfaction Survey and field notes of the interviews. Results The mean total satisfaction score was 12.8 ± 3.5, and comfort has the lowest subscale mean score: 2.07 ± 0.96. Multivariate regression analysis showed that family members’ satisfaction was positively associated with their ability to communicate with patients (B [95% confidence interval]: 2.1 [1.19 to 3.02]) and negatively with daily purchasing of medications and supplies (−2.41 [−3.23 to −1.59]), low economic status (−1.57 [−2.47 to −0.67]), and perceiving patient condition to be deteriorating (−0.99 [−1.93 to −0.04]). Content analysis of qualitative data revealed four themes: aspects of family care, aspects of patient care, organizational and administrative issues and environment. Conclusions In Egyptian adult intensive care units, regular family meetings, flexible visiting hours, shared decision-making, increasing staff-to-patient ratio and ensuring comfortable waiting rooms are promising strategies to enhance family satisfaction.
Article
Objectives: Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. Design: Patient-level, randomized trial. Setting: Two university-based, tertiary-care children's hospital PICUs. Participants: Parents of patients requiring more than 24 hours in the PICU. Interventions: PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. Measurements and main results: The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; SE, 4.53; 95% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful. Conclusions: Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.
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Background and objectives: We examined the association between turnover of registered nurses (RNs) and certified nurse assistants (CNAs) and perceived patient safety culture (PSC) in nursing homes (NHs). Research design and methods: In 2017, we conducted PSC survey using the Agency for Healthcare Research and Quality- developed and -validated instrument for NHs. A random sample of 2,254 U.S. NHs was identified. Administrators, directors of nursing (DONs), and nurse unit leaders served as respondents. Responses were obtained for 818 facilities from 1,447 individuals. The instrument contained 42 items relating to 12 PSC domains and turnover rates. PSC domains were based on five-point Likert scale items. A positive response was defined as "agree" or "strongly agree" (4-5 on the Likert scale). For CNAs low turnover was defined as <35%, and for RNs <15%. Facility-level and market-competition characteristics were included. Bivariate comparisons employed analysis of variance and chi-square tests. In multivariable models, we fit separate linear regressions for the average positive PSC score and for each of the 12 PSC domains, including turnover rates, NH, and market factors. Results: In NHs with low turnover, the overall PSC scores were 4.04% (RNs) and 6.28% (CNAs) higher than in NHs with high turnover. Teamwork, staffing, and training/skills were associated with CNA but not RN turnover. Discussion and implications: The effect of turnover on PSC depends on who leaves and to a lesser extent on the organizational characteristics. In NHs, improvements in PSC may depend on the ability to retain a well-trained and skilled nursing staff.
Article
Objective: It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU. Design: Pre- and postimplementation (pre-I and post-I) design. Setting: Single academic neuroscience ICU. Patients: Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission. Intervention: The on-service attending intensivist and a neuroscience ICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week. Measurements and main results: One family member per patient during the pre-I and post-I periods was recruited to complete the Family Satisfaction in the ICU 24 instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite Family Satisfaction in the ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (March 2013 to October 2014; capture rate, 51.6%) and 141 post-I surveys (October 2014 to December 2015; 47.2%) were collected. There was no difference in mean Family Satisfaction in the ICU 24 score between groups (pre-I, 89.2 ± 11.2; post-I, 87.4 ± 14.2; p = 0.6). In a secondary analysis, there was also no difference in mean Family Satisfaction in the ICU 24 score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean Family Satisfaction in the ICU 24 score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%; p = 0.002), coordination of care (82% vs. 68%; p = 0.03), and frequency of communication by physicians (60% vs. 43%; p = 0.03). Conclusions: Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU's overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.
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Susan E Beswick,1 Sandee Westell,1 Sarah Sweetman,1 Charmaine Mothersill,1 Lianne P Jeffs1,21St Michael's Hospital, Toronto, ON, Canada; 2Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada Background: Developing a therapeutic partnership between patient and nurse is key to ensuring the patient's needs and preferences are identified, addressed, and valued as a key patient safety goal. There is growing recognition that patients living with chronic lung diseases often experience increased levels of stress, anxiety, and depression compared to their healthy counterparts. Creating strategies for early identification and management of patients' fears and anxieties is a strategy to minimize anxiety and depressive symptoms.Methods: This article provides an overview of a qualitative study which explored nurses' perceptions and experiences associated with the implementation of the Registered Nurses' Association of Ontario's Establishing Therapeutic Relationships Best Practice Guideline that focused on strategies to alleviate patients' fears and anxieties on one respirology unit.Results: Study findings suggest that involvement in Best Practice Guideline implementation enabled nurses to address patients' fears and anxieties in a focused, conscientious manner and to be more collaborative and confident in their care.Conclusion: Providing opportunities for nurses to learn and apply evidence-based practice around therapeutic patient-centered care is a key step in ensuring a quality patient experience.Keywords: evidence-based practice, best practice guideline, therapeutic relationship, fear and anxiety, collaborative practice
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To improve care it is necessary to feed back experiences of those receiving care. Of patients admitted to intensive care units (ICUs), approximately one-quarter die, and few survivors recollect their experiences, so family members have a vital role. The most widely validated tool to seek their views is the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU). Objectives To test face and content validity and comprehensibility of the FS-ICU (phase 1). To establish internal consistency, construct validity and reliability of the FS-ICU; to describe family satisfaction and explore how it varies by family member, patient, unit/hospital and other contextual factors and by country; and to model approaches to sampling for future use in quality improvement (phase 2). Design Mixed methods: qualitative study (phase 1) and cohort study (phase 2). Setting NHS ICUs ( n = 2, phase 1; n = 20, phase 2). Participants Health-care professionals, ex-patients, family members of ICU patients ( n = 41, phase 1). Family members of ICU patients ( n = 12,303, phase 2). Interventions None. Main outcome measures Key themes regarding each item of the 24-item FS-ICU (FS-ICU-24) (phase 1). Overall family satisfaction and domain scores of the FS-ICU-24 (phase 2). Results In phase 1, face validity, content validity and comprehensibility were good. Adaptation to the UK required only minor edits. In phase 2, one to four family members were recruited for 60.6% of 10,530 patients (staying in ICU for 24 hours or more). Of 12,303 family members, 7173 (58.3%) completed the questionnaire. Psychometric assessment of the questionnaire established high internal consistency and criterion validity. Exploratory factor analysis indicated new domains: satisfaction with care , satisfaction with information and satisfaction with the decision-making process . All scores were high with skewed distributions towards more positive scores. For family members of ICU survivors, factors associated with increased/decreased satisfaction were age, ethnicity, relationship to patient, and visit frequency, and patient factors were acute severity of illness and invasive ventilation. For family members of ICU non-survivors, average satisfaction was higher but no family member factors were associated with increased/decreased satisfaction; patient factors were age, acute severity of illness and duration of stay. Neither ICU/hospital factors nor seasonality were associated. Funnel plots confirmed significant variation in family satisfaction across ICUs. Adjusting for family member and patient characteristics reduced variation, resulting in fewer ICUs identified as potential outliers. Simulations suggested that family satisfaction surveys using short recruitment windows can produce relatively unbiased estimates of average family satisfaction. Conclusions The Family-Reported Experiences Evaluation study has provided a UK-adapted, psychometrically valid questionnaire for overall family satisfaction and three domains. The large sample size allowed for robust multilevel multivariable modelling of factors associated with family satisfaction to inform important adjustment of any future evaluation. Limitations Responses to three free-text questions indicate the questionnaire may not be sensitive to all aspects of family satisfaction. Future work Reservations remain about the current questionnaire. While formal analysis of the free-text questions did not form part of this proposal, brief analysis suggested considerable scope for improvement of the FS-ICU-24. Study registration Current Controlled Trials ISRCTN47363549. Funding details The National Institute for Health Research Health Services and Delivery Research programme.
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The objective of this study is to describe the characteristics of scientific literature on patient safety related to security management and organizational culture, the type of publication, year, and vehicle of publication, country, language and theme. Data collection was conducted in June 2012, the Virtual Health Library (VHL) using the keywords patient safety, safety management and organizational culture. The results show 106 indications in seven years (2006 to 2012). 50.9% of the publications were articles from the United States, 84.9% publications were in English, 74% were original articles and the main theme was the malpractice. We conclude that the scientific production was higher and continuous in the last 3 years. The authorship was predominantly American and published in scientific journals in the United States, which indicated the need to develop research on the subject in Brazil.
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Intensive care unit (ICU) caregivers should seek to develop collab- orative relationships with their patients' family members, based on an open exchange of information and aimed at helping family members cope with their distress and allowing them to speak for the patient if necessary. We conducted a prospective multicenter study of family member satisfaction evaluated using the Critical Care Family Needs Inventory. Forty-three French ICUs participated in the study. ICU characteristics, patient and family member de- mographics, and data on satisfaction were collected. Factors asso- ciated with satisfaction were identified using a Poisson regression model. A total of 637 patients were included in the study, and 920 family members completed the questionnaire. Seven predictors of family satisfaction were found: one family-related factor, namely, fam- ily of French descent and six caregiver-related factors, namely, no perceived contradictions in information given by caregivers; infor- mation provided by a junior physician; patient to nurse ratio < 3; knowledge of the specific role of each caregiver; help from the family's own doctor; and sufficient time spent giving information. Predictors of satisfaction are amenable to intervention and de- serve to be investigated further with the goal of improving the satisfaction of ICU patients' family members.
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The goal was to examine nursing team structure and its relationship with family satisfaction. We used electronic health records to create patient-based, 1-mode networks of nursing handoffs. In these networks, nurses were represented as nodes and handoffs as edges. For each patient, we calculated network statistics including team size and diameter, network centrality index, proportion of newcomers to care teams according to day of hospitalization, and a novel measure of the average number of shifts between repeat caregivers, which was meant to quantify nursing continuity. We assessed parental satisfaction by using a standardized survey. Team size increased with increasing length of stay. At 2 weeks of age, 50% of shifts were staffed by a newcomer nurse who had not previously cared for the index patient. The patterns of newcomers to teams did not differ according to birth weight. When the population was dichotomized according to median mean repeat caregiver interval value, increased reports of problems with nursing care were seen with less-consistent staffing by familiar nurses. This relationship persisted after controlling for factors including birth weight, length of stay, and team size. Family perceptions of nursing care quality are more strongly associated with team structure and the sequence of nursing participation than with team size. Objective measures of health care team structure and function can be examined by applying network analytic techniques to information contained in electronic health records.
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Safety culture may influence patient outcomes, but evidence is limited. We sought to determine if intensive care unit (ICU) safety culture is independently associated with outcomes. Cohort study combining safety culture survey data with the Project IMPACT Critical Care Medicine (PICCM) clinical database. Thirty ICUs participating in the PICCM database. A total of 65 978 patients admitted January 2001-March 2005. None. Hospital mortality and length of stay (LOS). From December 2003 to April 2004, we surveyed study ICUs using the Safety Attitudes Questionnaire-ICU version, a validated instrument that assesses safety culture across six factors. We calculated factor mean and percent-positive scores (% respondents with mean score > or =75 on a 0-100 scale) for each ICU, and generated case-mix adjusted, patient-level, ICU-clustered regression analyses to determine the independent association of safety culture and outcome. We achieved a 47.9% response (2103 of 4373 ICU personnel). Culture scores were mostly low to moderate and varied across ICUs (range: 13-88, percent-positive scores). After adjustment for patient, hospital and ICU characteristics, for every 10% decrease in ICU perceptions of management percent-positive score, the odds ratio for hospital mortality was 1.24 (95% CI: 1.07-1.44; P = 0.005). For every 10% decrease in ICU safety climate percent-positive score, LOS increased 15% (95% CI: 1-30%; P = 0.03). Sensitivity analyses for non-response bias consistently associated safety climate with outcome, but also yielded some counterintuitive results. In a multicenter study conducted in the USA, perceptions of management and safety climate were moderately associated with outcomes. Future work should further develop methods of assessing safety culture and association with outcomes.
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This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.
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Because most critically ill patients lack decision-making capacity, physicians often ask family members to act as surrogates for the patient in discussions about the goals of care. Therefore, clinician-family communication is a central component of medical decision making in the ICU, and the quality of this communication has direct bearing on decisions made regarding care for critically ill patients. In addition, studies suggest that clinician-family communication can also have profound effects on the experiences and long-term mental health of family members. The purpose of this narrative review is to provide a context and rationale for improving the quality of communication with family members and to provide practical, evidence-based guidance on how to conduct this communication in the ICU setting. We emphasize the importance of discussing prognosis effectively, the key role of the integrated interdisciplinary team in this communication, and the importance of assessing spiritual needs and addressing barriers that can be raised by cross-cultural communication. We also discuss the potential value of protocols to encourage communication and the potential role of quality improvement for enhancing communication with family members. Last, we review issues regarding physician reimbursement for communication with family members within the context of the US health-care system. Communication with family members in the ICU setting is complex, and high-quality communication requires training and collaboration of a well-functioning interdisciplinary team. This communication also requires a balance between adhering to processes of care that are associated with improved outcomes and individualizing communication to the unique needs of the family.
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Intensive care unit (ICU) caregivers should seek to develop collaborative relationships with their patients' family members, based on an open exchange of information and aimed at helping family members cope with their distress and allowing them to speak for the patient if necessary. We conducted a prospective multicenter study of family member satisfaction evaluated using the Critical Care Family Needs Inventory. Forty-three French ICUs participated in the study. ICU characteristics, patient and family member demographics, and data on satisfaction were collected. Factors associated with satisfaction were identified using a Poisson regression model. A total of 637 patients were included in the study, and 920 family members completed the questionnaire. Seven predictors of family satisfaction were found: one family-related factor, namely, family of French descent and six caregiver-related factors, namely, no perceived contradictions in information given by caregivers; information provided by a junior physician; patient to nurse ratio </= 3; knowledge of the specific role of each caregiver; help from the family's own doctor; and sufficient time spent giving information. Predictors of satisfaction are amenable to intervention and deserve to be investigated further with the goal of improving the satisfaction of ICU patients' family members.
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Links between teamwork and outcomes have been established in a number of fields. Investigations into this link in healthcare have yielded equivocal results. To examine the relationship between the level of self-identified teamwork in the intensive care unit and patients' outcomes. A total of 394 staff members of 17 intensive care units completed the Group Development Questionnaire and a demographic survey. The questionnaire is a reliable and valid measure of team development and effectiveness. Each unit's predicted and actual mortality rates for the month in which data were collected were obtained. Pearson product moment correlations and analyses of variance were used to analyze the data. Staff members of units with mortality rates that were lower than predicted perceived their teams as functioning at higher stages of group development. They perceived their team members as less dependent and more trusting than did staff members of units with mortality rates that were higher than predicted. Staff members of high-performing units also perceived their teams as more structured and organized than did staff members of lower-performing units. The results of this study and other establish a link between teamwork and patients' outcomes in intensive care units. The evidence is sufficient to warrant the implementation of strategies designed to improve the level of teamwork and collaboration among staff members in intensive care units.
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The potential role of organizational factors in enhanced patient safety and medical error prevention is highlighted in the systems approach advocated for by the Institute of Medicine and others. However, little is known about the extent to which these factors have been shown empirically to be associated with these favorable outcomes. The present study conducted an intensive review of the clinical and health services literatures in order to explore this issue. The results of this review support the general conclusion that there is little evidence for asserting the importance of any individual, group, or structural variable in error prevention or enhanced patient safety at the present time. Two major issues bearing on the development of future research in this area involve strengthening the theoretical foundations of organizational research on patient safety and overcoming definitional and observability problems associated with error-focused dependent variables.
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Objective To describe the perspectives of family members to the care provided to critically ill patients who died in the ICU. Design Multicenter, prospective, observational study. Setting Six university-affiliated ICUs across Canada. Methods Patients who received mechanical ventilation for > 48 h and who died in the ICU were eligible for this study. Three to four weeks after the patient’s death, we mailed a validated questionnaire to one selected family member who made at least one visit to the patient in the ICU. We obtained self-rated levels of satisfaction with key aspects of end-of-life care, communication, and decision making, and the overall ICU experience. Main results Questionnaires were mailed to 413 family members; 256 completed surveys were returned (response rate, 62.0%). In the final hours before the death of the patient, family members reported that patients were “totally comfortable” (34.8%), “very comfortable” (23.8%), or “mostly comfortable” (32.0%). Family members felt “very supported” (57.0%) and “supported” (30.7%) by the health-care team. Most (82.0%) believed that the patient’s life was neither prolonged nor shortened unnecessarily. Most family members (90.4%) preferred some form of shared decision making. Overall, 52% of families rated their satisfaction with care as “excellent,” 31% rated care as “very good,” 10% as “good,” 4% as “fair,” and 2% as “poor.” Overall satisfaction with end-of-life care was significantly associated with completeness of information received by the family member, respect and compassion shown to patient and family member, and satisfaction with amount or level of health care received. Conclusions The majority of families of patients who died in participating ICUs were satisfied with the end-of-life care provided. Adequate communication, good decision making, and respect and compassion shown to both the dying patient and their family are key determinants to family satisfaction.
Article
Objective: To describe the reasons for eventual dissatisfaction among the families of patients who died in the intensive care unit (ICU), regarding both the assistance offered during the patient's stay in the hospital and the information received from the medical staff. Design: Cross-sectional descriptive study, which was conducted after a survey using a questionnaire. Setting: Interdisciplinary ICU (n = 8 beds) at San Giovanni Hospital in Bellinzona (CH). Subjects: Three-hundred ninety families of patients who died in the ICU. Interventions: None. Measurements and Main Results: A postal questionnaire (n = 43 questions) was sent to the families of 390 patients who died in the ICU during 8 yrs (1981 to 1989). The results referred to 123 replies: a) 82.6% of the respondents expressed no criticism of the patient's hospital stay; b) 90% considered the patient's treatment was adequate; c) 17% felt that the information received concerning diagnosis was insufficient or unclear; and d) 30% (particularly close relatives and those relatives who were informed of the death by telephone and not in person) expressed dissatisfaction regarding the information received on the cause of death. Conclusions: Our survey found that the relatives of patients who died were most dissatisfied with the care received according to: a) the type of death (e.g., sudden death vs. death preceded by a gradual deterloration in the patient's condition); and b) the manner in which the relatives were notified of the death (in person vs. by telephone). The personal characteristics of the people interviewed, such as gender and the closeness of their relationship to the deceased, also seem to have some bearing on the opinions expressed. A high percentage of respondents were satisfied with the treatment received by their dying relative and the information conveyed by caregivers. Nevertheless, the dissatisfaction expressed by some respondents indicates a need for improvement, especially in communicating information to the relatives of these patients. (Crit Care Med 1998; 26:1187-1193)
Article
The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture. In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture. Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P < .01), relative technical quality of care (r = 0.66; P < .01), and medical director budgeting authority (r = 0.46; P = .03), and moderately strong negative correlations with frequency of events reported (r = -0.46; P = .03), and teamwork across hospital units (r = -0.51; P = .01). There were similar patterns for relationships with intensivist management. For most pairs of domains, there were weak correlations between organizational and safety culture. Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs.
Article
To provide critical care clinicians with information on validated instruments for assessing burden in families of critical care patients. PubMed (1979-2009). We included all quantitative studies that used a validated instrument to evaluate the prevalence of, and risk factors for, burden on families. We extracted the descriptions of the instruments used and the main results. Family burden after critical illness can be detected reliably and requires preventive strategies and specific treatments. Using simple face-to-face interviews, intensivists can learn to detect poor comprehension and its determinants. Instruments for detecting symptoms of anxiety, depression, or stress can be used reliably even by physicians with no psychiatric training. For some symptoms, the evaluation should take place at a distance from intensive care unit discharge or death. Experience with families of patients who died in the intensive care unit and data from the literature have prompted studies of bereaved family members and the development of interventions aimed at decreasing guilt and preventing complicated grief. We believe that burden on families should be assessed routinely. In clinical studies, using markers for burden measured by validated tools may provide further evidence that effective communication and efforts to detect and to prevent symptoms of stress, anxiety, or depression provide valuable benefits to families.
Article
To define the relationship between hospital patient safety climate (a measure of hospitals' organizational culture as related to patient safety) and hospitals' rates of rehospitalization within 30 days of discharge. A safety climate survey administered to a random sample of hospital employees (n=36,375) in 2006-2007 and risk-standardized hospital readmission rates from 2008. Cross-sectional study of 67 hospitals. Robust multiple regressions used 30-day risk-standardized readmission rates as dependent variables in separate disease-specific models (acute myocardial infarction [AMI], heart failure [HF], pneumonia), and measures of safety climate as independent variables. We estimated separate models for all hospital staff as well as physicians, nurses, hospital senior managers, and frontline staff. There was a significant positive association between lower safety climate and higher readmission rates for AMI and HF (p ≤ .05 for both models). Frontline staff perceptions of safety climate were associated with readmission rates (p ≤ .01), but senior management perceptions were not. Physician and nurse perceptions related to AMI and HF readmissions, respectively. Our findings indicate that hospital patient safety climate is associated with readmission outcomes for AMI and HF and those associations were management level and discipline specific.
Article
Purpose of review: It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. Recent findings: Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. Summary: Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.
Article
Purpose of review: Family satisfaction in the ICU reflects the extent to which perceived needs and expectations of family members of critically ill patients are met by healthcare professionals. Here, we present recently developed tools to assess family satisfaction, with a special focus on their psychometric properties. Assessing family satisfaction, however, is not of much use if it is not followed by interpretation of the results and, if needed, consecutive measures to improve care of the patients and their families, or improvement in communication and decision-making. Accordingly, this review will outline recent findings in this field. Finally, possible areas of future research are addressed. Recent findings: To assess family satisfaction in the ICU, several domains deserve attention. They include, among others, care of the patient, counseling and emotional support of family members, information and decision-making. Overall, communication between physicians or nurses and members of the family remains a key topic, and there are many opportunities to improve. They include not only communication style, timing and appropriate wording but also, for example, assessments to see if information was adequately received and also understood. Whether unfulfilled needs of individual members of the family or of the family as a social system result in negative long-term sequels remains an open question. Summary: Assessing and analyzing family satisfaction in the ICU ultimately will support healthcare professionals in their continuing effort to improve care of critically ill patients and their families.
Article
This project analyzed the psychometric properties of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (HSOPSC) including factor structure, interitem reliability and intraclass correlations, usefulness for assessment, predictive validity, and sensitivity. The survey was administered to 454 health care staff in 3 hospitals before and after a series of multidisciplinary interventions designed to improve safety culture. Respondents (before, 434; after, 368) included nurses, physicians, pharmacists, and other hospital staff members. Factor analysis partially confirmed the validity of the HSOPSC subscales. Interitem consistency reliability was above 0.7 for 5 subscales; the staffing subscale had the lowest reliability coefficients. The intraclass correlation coefficients, agreement among the members of each unit, were within recommended ranges. The pattern of high and low scores across the subscales of the HSOPSC in the study hospitals were similar to the sample of Pacific region hospitals reported by the Agency for Healthcare Research and Quality and corresponded to the proportion of items in each subscale that are worded negatively (reverse scored). Most of the unit and hospital dimensions were correlated with the Safety Grade outcome measure in the tool. Overall, the tool was shown to have moderate-to-strong validity and reliability, with the exception of the staffing subscale. The usefulness in assessing areas of strength and weakness for hospitals or units among the culture subscales is questionable. The culture subscales were shown to correlate with the perceived outcomes, but further study is needed to determine true predictive validity.
Article
Safety climate refers to shared perceptions of what an organization is like with regard to safety, whereas safety culture refers to employees' fundamental ideology and orientation and explains why safety is pursued in the manner exhibited within a particular organization. Although research has sought to identify opportunities for improving safety outcomes by studying patterns of variation in safety climate, few empirical studies have examined the impact of organizational characteristics such as culture on hospital safety climate. This study explored how aspects of general organizational culture relate to hospital patient safety climate. In a stratified sample of 92 U.S. hospitals, we sampled 100% of senior managers and physicians and 10% of other hospital workers. The Patient Safety Climate in Healthcare Organizations and the Zammuto and Krakower organizational culture surveys measured safety climate and group, entrepreneurial, hierarchical, and production orientation of hospitals' culture, respectively. We administered safety climate surveys to 18,361 personnel and organizational culture surveys to a 5,894 random subsample between March 2004 and May 2005. Secondary data came from the 2004 American Hospital Association Annual Hospital Survey and Dun & Bradstreet. Hierarchical linear regressions assessed relationships between organizational culture and safety climate measures. Aspects of general organizational culture were strongly related to safety climate. A higher level of group culture correlated with a higher level of safety climate, but more hierarchical culture was associated with lower safety climate. Aspects of organizational culture accounted for more than threefold improvement in measures of model fit compared with models with controls alone. A mix of culture types, emphasizing group culture, seemed optimal for safety climate. Safety climate and organizational culture are positively related. Results support strategies that promote group orientation and reduced hierarchy, including use of multidisciplinary team training, continuous quality improvement tools, and human resource practices and policies.
Article
To examine the relationship between measures of hospital safety climate and hospital performance on selected Patient Safety Indicators (PSIs). Primary data from a 2004 survey of hospital personnel. Secondary data from the 2005 Medicare Provider Analysis and Review File and 2004 American Hospital Association's Annual Survey of Hospitals. A cross-sectional study of 91 hospitals. Negative binomial regressions used an unweighted, risk-adjusted PSI composite as dependent variable and safety climate scores and controls as independent variables. Some specifications included interpersonal, work unit, and organizational safety climate dimensions. Others included separate measures for senior managers and frontline personnel's safety climate perceptions. Hospitals with better safety climate overall had lower relative incidence of PSIs, as did hospitals with better scores on safety climate dimensions measuring interpersonal beliefs regarding shame and blame. Frontline personnel's perceptions of better safety climate predicted lower risk of experiencing PSIs, but senior manager perceptions did not. The results link hospital safety climate to indicators of potential safety events. Some aspects of safety climate are more closely related to safety events than others. Perceptions about safety climate among some groups, such as frontline staff, are more closely related than perceptions in other groups.
Article
Health Services Research has a growing need for reliable and valid measures of managerial practices and organizational processes. A national study of 42 intensive care units involving over 1,700 respondents provides evidence for the reliability and validity of a comprehensive set of measures related to leadership, organizational culture, communication, coordination, problem solving-conflict management and team cohesiveness. The data also support the appropriateness of aggregating individual respondent data to the unit level. Implications for further research are discussed.
Article
A significant portion of health care resources are spent in intensive care units with, historically, up to two-fold variation in risk-adjusted mortality. Technological, demographic, and social forces are likely to lead to an increased volume of intensive care in the future. Thus, it is important to identify ways of more efficiently managing intensive care units and reducing the variation in patient outcomes. Based on data collected from 17,440 patients across 42 ICUs, the present study examines the factors associated with risk-adjusted mortality, risk-adjusted average length of stay, nurse turnover, evaluated technical quality of care, and evaluated ability to meet family member needs. Using the Apache III methodology for risk-adjustment, findings reveal that: 1) technological availability is significantly associated with lower risk-adjusted mortality (beta = -.42); 2) diagnostic diversity is significantly associated with greater risk-adjusted mortality (beta = .46); and 3) caregiver interaction comprising the culture, leadership, coordination, communication, and conflict management abilities of the unit is significantly associated with lower risk-adjusted length of stay (beta = .34), lower nurse turnover (beta = -.36), higher evaluated technical quality of care (beta = .81), and greater evaluated ability to meet family member needs (beta = .74). Furthermore, units with greater technological availability are significantly more likely to be associated with hospitals that are more profitable, involved in teaching activities, and have unit leaders actively participating in hospital-wide quality improvement activities. The findings hold a number of important managerial and policy implications regarding technological adoption, specialization, and the quality of interaction among ICU team members. They suggest intervention "leverage points" for care givers, managers, and external policy makers in efforts to continuously improve the outcomes of intensive care.
Article
To measure the ability to meet family needs in an intensive care unit (ICU). Descriptive survey. University hospital ICU. Ninety-nine next of kin respondents and 16 secondary family respondents were recruited. A modified Society of Critical Care Medicine Family Needs Assessment instrument was used. Demographic variables included patient age, gender, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission, Therapeutic Intervention Scoring System (TISS) score on the date of interview, cumulative TISS of the ICU on the day of interview, number of patients in the ICU at time of interview, nurse/patient ratio for the patient, average nurse/patient ratio of the entire unit, day of the week of the interview, timing of the interview, number of ICU attending physicians who cared for this patient (scheduled for a period of seven consecutive days), number of nurses who cared for the patient, if a nurse was assigned the same patient on two consecutive days worked, length of stay in the ICU, and length of hospital stay. Demographic information concerning the family member included gender, age, commuting time to the hospital, visiting time in the hospital per day, number in family group, relationship to the patient, ethnic background, and education level. The additive score of all questions in the needs assessment instrument was calculated and used as the dependent variable. The independent variables were demographic information concerning patients, ICU, and respondents. The model coefficient of determination (R2adj) was 0.20 with a p = .0079. Greater family dissatisfaction (i.e., higher score) was present if there were more than two ICU attendings per patient (p = .048), or if the same nurse was not assigned on two consecutive days (p = .044). Family satisfaction increased if the respondent was female (p = .006), if the patient had a higher APACHE II score (p = .007), and if the patient's relationship with the most significant family member was brother/sister (p = .012). The family needs instrument was reliable and demonstrated a high degree of concordance with a second respondent in the same family surveyed. Communication by the same provider was important when measuring the ability of an ICU to meet family needs. Instrument scores and the ability to meet family needs differed depending on the gender and the relationship to the patient of the most significant family member. We speculate that this instrument may be a useful adjunct in assessing quality of critical care services provided.
Article
To describe the reasons for eventual dissatisfaction among the families of patients who died in the intensive care unit (ICU), regarding both the assistance offered during the patient's stay in the hospital and the information received from the medical staff. Cross-sectional descriptive study, which was conducted after a survey using a questionnaire. Interdisciplinary ICU (n = 8 beds) at San Giovanni Hospital in Bellinzona (CH). Three-hundred ninety families of patients who died in the ICU. None. A postal questionnaire (n = 43 questions) was sent to the families of 390 patients who died in the ICU during 8 yrs (1981 to 1989). The results referred to 123 replies: a) 82.6% of the respondents expressed no criticism of the patient's hospital stay; b) 90% considered the patient's treatment was adequate; c) 17% felt that the information received concerning diagnosis was insufficient or unclear; and d) 30% (particularly close relatives and those relatives who were informed of the death by telephone and not in person) expressed dissatisfaction regarding the information received on the cause of death. Our survey found that the relatives of patients who died were most dissatisfied with the care received according to: a) the type of death (e.g., sudden death vs. death preceded by a gradual deterioration in the patient's condition); and b) the manner in which the relatives were notified of the death (in person vs. by telephone). The personal characteristics of the people interviewed, such as gender and the closeness of their relationship to the deceased, also seem to have some bearing on the opinions expressed. A high percentage of respondents were satisfied with the treatment received by their dying relative and the information conveyed by caregivers. Nevertheless, the dissatisfaction expressed by some respondents indicates a need for improvement, especially in communicating information to the relatives of these patients.
Article
The objectives of this study were to develop an instrument to assess the satisfaction of family members with withdrawal of life support (WLS), and to determine which factors are associated with greater levels of satisfaction. To do this, we developed a self-administered questionnaire that was sent to the next-of-kin of intensive care unit (ICU) patients dying following WLS. Over a six-month period, 69 patients died following WLS in the ICU. Three letters were returned "address unknown", 33 did not respond, and 33 responded, of whom 29 agreed to participate (29/66 = 44% of those contacted). Of these, 24 (83%) strongly agreed with the patient's death being compassionate and dignified, one moderately agreed, one mildly agreed, one was neutral and two strongly disagreed. Items associated with greater satisfaction included: the process of WLS being well explained, WLS proceeding as expected, patient appearing comfortable, family/friends prepared for the decision, appropriate person initiating discussion, adequate privacy during WLS, chance to voice concerns. The study suggests factors that are important to consider in ensuring family comfort with the process of withdrawing life support.
Article
To identify critical psychosocial supports and areas of conflict for families of intensive care unit (ICU) patients during decisions to withdraw or withhold life-sustaining treatment. Cross-sectional survey. Six intensive care units in a tertiary care academic medical center. Forty-eight family members, one per case, of patients previously hospitalized in the ICU who had been considered for withdrawal or withholding of life-sustaining treatment. None. Two raters coded transcripts of audiotaped interviews with family members about their experiences in the ICU and the decision-making process for withdrawing or withholding life-sustaining treatment. Codes identified sources of conflict and personal, institutional, and staff supports on which families relied during the decision-making process. Forty-six percent of respondents perceived conflict during their family member's ICU stay; the vast majority of conflicts were between themselves and the medical staff and involved communication or perceived unprofessional behavior (such as disregarding the primary caregiver in treatment discussions). Sixty-three percent of family members previously had spoken with the patient about his or her end-of-life treatment preferences, which helped to lessen the burden of the treatment decision. Forty-eight percent of family members reported the reassuring presence of clergy, and 27% commented on the need for improved physical space to have family discussion and conferences with physicians. Forty-eight percent of family members singled out their attending physician as the preferred source of information and reassurance. Many families perceived conflict during end-of-life treatment discussions in the ICU. Conflicts centered on communication and behavior of staff. Families identified pastoral care and prior discussion of treatment preferences as sources of psychosocial support during these discussions. Families sought comfort in the identification and contact of a "doctor-in-charge." ICU policies such as family conference rooms and lenient visitation accommodate families during end-of-life decision-making.
Article
To develop and validate the Critical Care Family Satisfaction Survey as a proxy for patient satisfaction. Instrument validation study. SETTING AND TIME FRAME: The Medical Intensive Care, Shock Trauma, Acute Coronary Care, Central Nervous System, Surgical Intensive Care, and Special Care units of Lehigh Valley Hospital (Allentown, PA), for the period December 1997 through September 1998. One family member for each of 237 critical care patients. Content and construct validity were examined on 37 items and 6 constructs thought to measure family satisfaction with the quality of critical care in hospitals. Initially, 14 items and 1 construct were removed from the questionnaire based on this analysis. It was then administered to 237 family members. Factor analysis and confirmatory factor analysis using path models were performed. Internal consistency using Pearson correlations and Cronbach's alpha, and discriminant validation were also calculated. Factor analysis yielded a single eigenvalue >1 (3.712), whereas confirmatory factor analysis led to the final instrument being reduced to 20 items and 5 subscale constructs. One subscale ("Comfort") performed poorly, indicating the possible need for a four-factor model. Subsequently, internal consistency assessed by Cronbach's alpha was 0.9101 for the five-factor model and 0.9327 for the four-factor model. Subscale correlations were no lower than 0.750 for the five-factor model and 0.856 for the four-factor model. This study provides support that the Critical Care Family Satisfaction Survey-which yields five subscales, "Assurance," "Information," "Proximity," "Support," and "Comfort"--is reliable and valid. Using five constructs rather than four is recommended because of the following: a) the internal consistency loss of 0.0226 for the "Comfort" subscale is not enough to warrant its removal, b) a four-factor questionnaire can be administered and totaled independently of this subscale, c) the need for the fifth construct is indicated by this study's results, and d) including the extra data may allow for more detailed analysis.
Article
To develop and test the feasibility of administering a questionnaire to measure family members' level of satisfaction with care provided to them and their critically ill relative. To develop the questionnaire, existing conceptual frameworks of patient satisfaction, decision making, and quality of end-of-life care were used to identify important domains and items. We pretested the questionnaire for readability, clarity, and sensibility in 21 family members and 16 professionals. To assess validity, we measured the correlation between satisfaction with overall care and satisfaction with decision making. To assess the reliability of the questionnaire, we administered the questionnaire to next of kin of surviving patients on discharge and 7 to 10 days later. Questionnaires were mailed out to 33 family members of nonsurvivors; 24 were returned completed but only 22 (66%) were usable.Twenty-five family members of eligible surviving critically ill patients participated in the test-retest part of this study. Of the 47 respondents, 84% were very satisfied with overall care and 77% were very satisfied with their role in the decision making. There was good correlation between satisfaction with overall care and satisfaction with decision making (correlation coefficient =.64). The assessment of overall satisfaction with care was shown to be reliable (correlation coefficient =.85). This questionnaire has some measure of reliability and validity and is feasible to administer to next of kin of critically ill patients.
Article
Despite the growing body of knowledge on the theory of organization, the application of such theory to the organization of intensive care units is in its infancy. Our knowledge about the influence of ICU organization on patient outcomes is limited. Development of instruments to measure ICU organization, and their implementation in studies of new therapies and technologies, will assist in demonstrating the effect of various models of ICU organization on the provision of clinical care.
Article
To determine the level of satisfaction of family members with the care that they and their critically ill relative received. Prospective cohort study. Six university-affiliated intensive care units across Canada. We administered a validated questionnaire to family members who made at least one visit to intensive care unit patients who received mechanical ventilation for >48 hrs. We obtained self-rated levels of satisfaction with 25 key aspects of care related to the overall intensive care unit experience, communication, and decision making. For family members of survivors, the questionnaire was administered while the patient was still in the hospital. For family members of nonsurvivors, the questionnaire was mailed out to the family member 3-4 wks after the patient's death. A total of 891 family members received questionnaires; 624 were returned (70% response rate). The majority of respondents were satisfied with overall care and with overall decision making (mean +/- sd item score, 84.3 +/- 15.7 and 75.9 +/- 26.4, respectively). Families reported the greatest satisfaction with nursing skill and competence (92.4 +/- 14.0), the compassion and respect given to the patient (91.8 +/- 15.4), and pain management (89.1 +/- 16.7). They were least satisfied with the waiting room atmosphere (65.0 +/- 30.6) and frequency of physician communication (70.7 +/- 29.0). The variables significantly associated with overall satisfaction in a regression analysis were completeness of information received, respect and compassion shown to the patient and family member, and the amount of health care received. Satisfaction varied significantly across sites. Most family members were highly satisfied with the care provided to them and their critically ill relative in the intensive care unit. Efforts to improve the nature of interactions and communication with families are likely to lead to improvements in satisfaction.