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 ongoing review, and research (Oster & Braaten, 2021; Palaganas et al., 2014). The simulator can take a variety of forms. One example is the use of complete full-body manikins. These manikins may also have interactive features such as pulse, breathing sounds, and/ or audio voice. These anatomical simulators may also allow for intubation practice with an airway or torso access for placing chest tubes. Highlighting the patient safety benefits of the experience, Oster and Braaten (2021) emphasize that this is “more than just play-acting or role-playing, an effectively designed and conducted simulation experience allows participants to suspend disbelief, immersing themselves in realistic sights, sounds, smells, feelings, emotions, stressors and human dynamics—all of which are consistent with the situation being simulated and the goals of the simulation” (p. 335). Simulation practice and research has experienced a significant evolution in recent years, and evidence is clear that it is an effective tool, when properly designed with the optimal criteria. Simulation is another tool that is supported by current research and that enhances the quality and safety of patient care. Researchers point out that consulting with content experts and simulation professionals is critical for the success of this type of programming. Moreover, healthcare professionals can expect that simulations can be improved, according to Watts and colleagues (2021), by reviewing the relevant literature and research from the field, joining professional simulation healthcare organizations, participating in mentorship opportunities, and attending workshops and national conferences for advanced training. have different features than acute care hospitals (D’Lima et al., 2017; Thibaut et al., 2019), namely: ● A greater emphasis on outpatient or community-based care, including telehealth care ● The expansion of behavioral healthcare via the Affordable Care Act, especially within primary and pediatric care settings ● The increased risk of self-harm and suicide ● Greater emphasis from managed care insurers to provide patient care via partial hospitalization and intensive outpatient programming Two important regulatory initiatives target safety issues specific to behavioral health settings: The Joint Commission’s 2014 National Patient Safety Goals for Behavioral Health and
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. 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 Okuyama, Wagner, and Bijnen (2014) identify the following important factors that influence healthcare professionals’ 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 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, Client Safety in Behavioral Health Settings Although behavioral health and medical settings share many vulnerable care delivery processes, behavioral healthcare presents unique challenges. One challenge is that the symptoms associated with many mental conditions render clients vulnerable because of diminished ability to communicate effectively with providers. Also challenging are several at-risk groups: certain age groups (such as older adults suffering from dementia and children with ADHD), patients falling within certain diagnostic categories (such as severe mental disorders with psychotic features and co-occurring mental illness and substance abuse), and patients having certain procedures (such as electroconvulsive therapy). Moreover, behavioral health settings
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