Speaking Up Organizational behavior and culture promote or inhibit workers’ ability to speak up when they observe problems (Weiss & Morrison, 2018). For healthcare professionals, “speaking up” is communicating patient safety concerns and quality of care through information, questions, or opinions where immediate action is needed to avoid patient harm. Researchers found that the organizational climate, particularly a climate of healthcare worker resignation, contributed to a milieu of workplace silence. This silence fed the dynamic of nonreporting of safety concerns and related issues. Speaking up—asserting one’s opinion, questions, or observations about unsafe patient practices—is often difficult for healthcare workers. Unsafe acts that can place a patient in immediate harm complicate this organizational dynamic considerably. Bearing in mind that obstacles to speaking up, many of which have been identified in this course, must be understood so that training and education can address barriers to improvement, researchers (Schwappach & Richard, 2018) identified the following obstacles that perpetuate a culture of silence regarding unsafe patient acts. ● The presence of an audience, namely patients, relatives, or coworkers ● Power hierarchies and related dynamics ● Fears of harming relationships with coworkers and superiors ● Helpless feelings of resignation
Self-Assessment Question 3 Janet is a newly hired licensed vocational nurse working a large inpatient psychiatric unit for acute care. It is a Friday afternoon, and the unit is fully occupied. Her director of nursing, Mark, is anxious to leave for the day and is finishing final medication rounds for the patients. Several patients are receiving an antipsychotic medication that is clearly segregated from other medications, which in this case are antidepressants. Mark becomes distracted and accidently directs Janet to dispense the antipsychotic medications to the wrong patients. Janet does not follow this directive and corrects the mistake herself. Going forward, Janet is unclear if she should say something to Mark about his mistake. What is the best course of action? a. Say nothing because Mark is her superior. b. Address the matter privately with Mark. c. Try to ignore when medications are dispensed on the unit because it’s too stressful. d. Advise patients to carefully check that they have received the correct medications. Okuyama, Wagner, and Bijnen (2014) identify the following important factors that influence healthcare professionals’ reporting behavior and suggest that organizations assess these factors when designing speaking-up training programs. The factors are: ● The professional’s motivation to speak up to help the patient, such as the perceived risk for patients (e.g., immediate harm), and the ambiguity or clarity of the clinical situation ● Contextual factors, such as hospital administrative support, interdisciplinary policymaking, teamwork and a person’s relationship with other team members, and attitude of leaders/superiors ● Individual factors, such as satisfaction with the job, a sense of responsibility toward patients, responsibility as professionals, confidence based on experience, communication skills, and educational background ● The professional’s perceived safety in speaking up, such as fear of the responses of others and conflict and concerns over appearing incompetent ● The professional’s perceived efficacy of speaking up, such as being ignored, lack of changes, or the professional’s control of the issues ● Tactics and targets such as the ways of collecting facts, showing positive intent, and selecting the person to whom they will speak patient safety” (p. 334). In the most basic terms, healthcare simulations are composed of three distinct parts: the scenario, the simulator, and the experience. The scenario is predesigned to replicate a clinical situation as realistically as possible to fully immerse participants. In an effort to create realism for participants, these multifaceted plans include expected and unexpected events. The scenario will often include staging elements, namely a realistic setting or space, specific equipment, and props that create an appropriate environment. Participants will be assigned specific roles and responsibilities in advance, and scenario confederates will have rehearsed with scripts and simulations of their own to create a clinically accurate experience. At the conclusion of a scenario event, a video recording of the event will be used for debriefing, ongoing review, and research (Oster & Braaten, 2021; Palaganas et al., 2014).
Enhancing Patient Safety through Simulation Traditionally, simulation has been used as an educational approach for prepractice learning, aiding students in medical schools, nursing schools, graduate behavioral programs, and other allied health programs. Widely used as an educational tool, this rapidly expanding approach is now being researched and implemented as an emerging tool to improve the quality and safety of patient care. Researchers and experts are defining systems, best practices, and ethical guidelines to establish this growing framework of practice. According to Oster and Braaten (2021), the Society for Simulation in Healthcare defines healthcare simulation as a technique “that uses a situation or environment created to allow persons to experience a representation of a real healthcare event for the purpose of practice, learning, evaluation, testing, or to gain an understanding of systems or human actions; the application of a simulator to training, assessment, research, or systems integration toward
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Book Code: PCUS1525
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