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Please be sure to only read, use, and cite the selected required article which has been attached. Here is the citation for it:
Vaismoradi, M., Tella, S., A. Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ Adherence to Patient Safety Principles: A Systematic Review. International Journal of Environmental Research and Public Health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028
Requirements: Minimum 1 Full Page Times New Roman Size 12 Font Double-Spaced APA Format Excluding the Title and Reference Pages | .doc file
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NR103 Transition to the Nursing Profession
Transitions Paper Guidelines
Purpose
The purpose of this assignment is to explore a critical concept in nursing. The student will be able to demonstrate
application of information literacy and ability to utilize resources (library, writing center, Center for Academic Success
[CAS], APA resources, Turnitin, and others) through literature search and writing the paper.
Course outcomes: This assignment enables the student to meet the following course outcomes.
CO 2: Identify characteristics of professional behavior including emotional intelligence, communication, and conflict
resolution.
CO 3: Demonstrate information literacy and the ability to utilize resources.
Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to
this assignment.
Total points possible: 150 points
Preparing the assignment
Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
1) Locating Evidence
a. Using the Chamberlain University library, search for a recent (published within the last five years) evidencebased article from a scholarly journal that addresses one of the topics listed.
• Safety
• Delegation
• Prioritization
• Caring
2) Include the following sections.
a. Introduction – 20 points/13%
• Clearly establishes the purpose of the paper
• Includes key points to be covered
• Captures the reader’s interest
b. Body of Paper – 60 points/40%
• Complete, well-developed discussion of key points
• Supports the purpose or main idea of the paper
• Logical development of ideas with clear and accurate information
• Ideas and statements are supported by three or more examples from personal and/or professional
experiences
• Provides own perspectives on the topic that is reflective, insightful, and original
c. Conclusion – 30 points/20%
• Clear and concise
• Summarizes key points discussed in the paper
• Leaves a strong impression, message, or idea on the reader
d. Writing Style – 15 point/10%
e. Correct use of standard English grammar, paragraph, and sentence structure
f. No spelling or typographical errors
g. Organized around required components
h. Information flows in a logical sequence that is easy for the reader to follow
i. APA Format, and References – 25 points/17%
• There is correct and appropriate use of margins, spacing, font, and headers
• Document setup includes title and reference pages in correct APA format
NR103_Transitions_Paper_Guidelines
© 2022 Chamberlain University. All Rights Reserved.
1
NR103 Transition to the Nursing Profession
Transitions Paper Guidelines
•
•
•
•
Citation of sources included in the body of the paper uses correct APA format for direct and indirect quotes
All elements of each reference are included in the correct order
All information taken from the source, even if summarized, is cited and listed on the Reference page
All sources used are nursing journals published within the last five years
For writing assistance visit The Writing Center located within the Virtual Center for Academic Success.
Please note that your instructor may provide you with additional assessments in any form to determine that you fully
understand the concepts learned.
NR103_Transitions_Paper_Guidelines
© 2022 Chamberlain University. All Rights Reserved.
2
NR103 Transition to the Nursing Profession
Transitions Paper Guidelines
Grading Rubric
Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.
Assignment Section and
Required Criteria
(Points possible/% of total points available)
Highest Level of
Performance
High Level of
Performance
Satisfactory Level
of Performance
Unsatisfactory
Level of
Performance
Section not
present in paper
20 points
19 points
15 points
7 points
0 points
Includes no fewer
than 3 requirements
for section.
Includes no fewer
than 2 requirements
for section.
Includes no less than
1 requirement for
section.
60 points
55 points
46 points
23 points
Includes 5
Required criteria
requirements for
1. Complete, well-developed discussion of key
section.
points
2. Supports the purpose or main idea of the paper
3. Logical development of ideas with clear and
accurate information
4. Ideas and statements are supported by three or
more examples from personal and/or
professional experiences
5. Provides own perspectives on the topic that is
reflective, insightful, and original
Includes 4
requirements for
section.
Includes 3
requirements for
section.
Includes 1-2
requirements for
section.
30 points
27 points
23 points
12 points
0 points
Includes 3
Required criteria
requirements for
1. Clear and concise
section.
2. Summarizes key points discussed in the paper
3. Leaves a strong impression, message, or idea on
the reader
Includes 2
requirements for
section.
Includes 1
requirement for
section.
Section present yet
includes no required
criteria.
No requirements for
this section
presented.
Introduction
(20 points/13%)
Required criteria
1. Clearly establishes the purpose of the paper
2. Includes key points to be covered
3. Captures the reader’s interest
Body of Paper – 60 points/40%
(60 points/40%)
Conclusion
(30 points/20%)
NR103_Transitions_Paper_Guidelines
© 2022 Chamberlain University. All Rights Reserved.
Present, yet includes No requirements for
no required criteria. this section
presented.
0 points
No requirements for
this section
presented.
3
NR103 Transition to the Nursing Profession
Transitions Paper Guidelines
Assignment Section and
Required Criteria
(Points possible/% of total points available)
Highest Level of
Performance
High Level of
Performance
Satisfactory Level
of Performance
Unsatisfactory
Level of
Performance
Section not
present in paper
15 points
14 points
11 points
6 points
0 points
Includes 4
requirements for
section.
Includes 3
requirements for
section.
Includes 2
requirements for
section.
Includes 1
requirement for
section.
25 points
23 points
19 points
9 Points
Includes 6
Required criteria
There is correct and appropriate use of margins, requirements for
section.
spacing, font, and headers.
Document setup includes title and reference
pages in correct APA format.
Citation of sources included in the body of the
paper uses correct APA format for direct and
indirect quotes.
Sources are cited correctly on the Reference
page. All elements of each reference are
included in the correct order.
All information taken from the source, even if
summarized, must be cited, and listed on the
Reference page.
All sources used are nursing journals published
within the last five years.
Includes 5
requirements for
section.
Includes 3-4
requirements for
section.
Includes 1-2
requirements for
section.
Writing Style
(15 points/10%)
Required criteria
1. Correct use of standard English grammar,
paragraph, and sentence structure
2. No spelling or typographical errors
3. Organized around required components
4. Information flows in a logical sequence that is
easy for the reader to follow
APA Style and Organization
(25 points/10%)
1.
2.
3.
4.
5.
6.
No requirements for
this section
presented.
0 points
No requirements for
this section
presented.
Total Points Possible = 150 points
NR103_Transitions_Paper_Guidelines
© 2022 Chamberlain University. All Rights Reserved.
4
International Journal of
Environmental Research
and Public Health
Review
Nurses’ Adherence to Patient Safety Principles:
A Systematic Review
Mojtaba Vaismoradi 1, * , Susanna Tella 2 , Patricia A. Logan 3 , Jayden Khakurel 4
Flores Vizcaya-Moreno 5
1
2
3
4
5
*
and
Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway
Faculty of Health and Social Care, LAB University of Applied Sciences, 53850 Lappeenranta, Finland;
susanna.tella@saimia.fi
Faculty of Science, Charles Sturt University, 2795 Bathurst, Australia; plogan@csu.edu.au
Research Centre for Child Psychiatry, Department of Child Psychiatry, Faculty of Medicine, University of
Turku, 20014 Turku, Finland; jayden.khakurel@utu.fi
Nursing Department, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain;
flores.vizcaya@ua.es
Correspondence: mojtaba.vaismoradi@nord.no; Tel.: +47-75517813
Received: 23 February 2020; Accepted: 16 March 2020; Published: 19 March 2020
Abstract: Background: Quality-of-care improvement and prevention of practice errors is dependent
on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic
review of the international literature, to synthesise knowledge and explore factors that influence
nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian,
and Finnish languages were searched, using appropriate keywords to retrieve empirical articles
published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing
risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare
provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were
found that focused on adherence to patient-safety principles during clinical nursing interventions.
They focused on the management of peripheral venous catheters, surgical hand rubbing instructions,
double-checking policies of medicines management, nursing handover between wards, cardiac
monitoring and surveillance, and care-associated infection precautions. Patients’ participation,
healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and
electronic systems, education and regular feedback, and standardization of the care process influenced
nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic
factors has implications for nursing care practice, as both influence adherence to patient-safety
principles. More studies using qualitative and quantitative methods are required to enhance our
knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their
effects on patient-safety outcomes.
Keywords: adherence; quality of care; patient-safety principles; nursing intervention; practice errors;
safe care
1. Introduction
The World Health Organization defines patient safety as the absence of preventable harm to
patients and prevention of unnecessary harm by healthcare professionals [1]. It has been reported
that unsafe care is responsible for the loss of 64 million disability-adjusted life years each year
across the globe. Patient harm during the provision of healthcare is recognized as one of the top 10
causes of disability and death in the world [2]. Regarding the financial consequence of patient harm,
a retrospective analysis of inpatient harm based on data collected from 24 hospitals in the USA showed
Int. J. Environ. Res. Public Health 2020, 17, 2028; doi:10.3390/ijerph17062028
www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2020, 17, 2028
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that harm-reduction strategies could reduce total healthcare costs by $108 million U.S. and generate a
saving of 60,000 inpatient care days [3]. Additionally, the loss of income and productivity due to other
associated costs of patient harm are estimated to be trillions of dollars annually [4]. The burden of
practice errors on patients, their family members, and the healthcare system can be reduced through
implementing patient-safety principles based on preventive and quality-improvement strategies [5].
Patient-safety principles are scientific methods for achieving a reliable healthcare system that minimizes
the incidence rate and impact of adverse events and maximizes recovery from such incidents [6].
These principles can be categorized as risk management, infection control, medicines management,
safe environment and equipment [7], patient education and participation in own care, prevention of
pressure ulcers, nutrition improvement [8], leadership, teamwork, knowledge development through
research [9], feeling of responsibility and accountability, and reporting practice errors [10].
The nurses’ role is to preserve patient safety and prevent harm during the provision of care in
both short-term and long-term care settings [11,12]. Nurses are expected to adhere to organizational
strategies for identifying harms and risks through assessing the patient, planning for care, monitoring
and surveillance activities, double-checking, offering assistance, and communicating with other
healthcare providers [13,14]. In addition to clear policies, leadership, research driven safety initiatives,
training of healthcare staff, and patient participation [1,15], nurses’ adherence to the principles of
patient safety [16,17] is required for the success of interventions aimed at the prevention of practice
errors and to achieve sustainable and safer healthcare systems.
Background
Adherence to and compliance with guidelines and recommendations are influenced by personal
willingness, culture, economic and social conditions, and levels of knowledge [18,19]. On the other
hand, lack of adherence and compliance contravenes professional beliefs, norms, and expectations of
the healthcare professional’s role [20].
Institutional systemic factors influencing nurses’ adherence to and compliance with patient-safety
principles are as follows: the organizational patient-safety climate [21], workload, time pressure,
encouragement by leaders and colleagues [22–24], level of ward performance [25], provision of
education for the improvement of knowledge and skills [11,18], institutional procedures or protocols,
and also communication between healthcare staff and patients [11]. In addition, personal motivation,
resistance to change, feelings of autonomy, attitude toward innovation, and empowerment are personal
factors that impact on the nurses’ adherence to patient-safety principles [26].
A theoretical framework for analysing risk and safety in healthcare practice has been devised by
Vincent et al. (1998) [27] based on the Reason’s model of organizational accidents [28]. It combines
‘person-centred’ approaches, where the focus is on individual responsibility for the preservation of
patients’ safety and prevention of their harm, and the ‘system-centred’ approach, which considers
organizational factors as precursors for endangering patient safety [29]. According to this theoretical
framework, initiatives aimed at the improvement of patient safety require systematic assessments
and integrative interventions to target different elements in the hierarchy of the healthcare system,
including patient, healthcare provider, task, work environment, and organization and management.
This framework, and similar models for risk and safety management, can help with the analysis of
patient harm, to identify probable pitfalls, as well as explore how to prevent future similar incidents [30].
Adherence to the principles of patient safety and the prevention and reduction of practice errors
have been facilitated by technological solutions in recent years [31,32]; however, suboptimal quality
and safety of care remain evident, indicating the need for improved understandings of the various
factors and conditions that increase adherence in daily nursing practice [33]. Consequently, this review
aimed to retrieve, explore, and synthesise factors evident in the international literature that influenced
nurses’ adherence to patient-safety principles. Vincent’s framework was used for the classification of
findings, in order to systematically present the findings and inform clinical practice.
Int. J. Environ. Res. Public Health 2020, 17, 2028
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2. Materials and Methods
2.1. Design
A systematic review was conducted. It is an explicit and clear method of data collection, systematic
description, and synthesis of findings, to reach the study goal [34–36]. The review findings are presented
narratively since heterogeneities in the methods, objectives, and results of studies that met the inclusion
criteria did not lend themselves to meta-analysis. The Preferred Reporting Items Systematic Reviews
and Meta-analysis (PRISMA) Statement (2009) was applied to inform this systematic review [36].
2.2. Search Methods
Search keywords were determined after team discussions, performing a pilot search in general
and specialized databases, and consultation with a librarian. Key search terms relating to adherence to
patient-safety principles by nurses were used to conduct a Boolean search. For operationalising the
study concept, the definition of adherence as a behaviour carried out actively by people according to
orders or advice was used [37]. The word adherence is used interchangeably with, and sometimes
at the same time as, the word compliance, since both can indicate the outcome of care interactions
between the healthcare provider and the caregiver [38–42]. However, adherence indicates responsibility
and empowerment on the healthcare professional’s part to actively perform the expected behaviour
compared to compliance that shows responsibility on the patient’s part to follow up the therapeutic
regimen [43,44].
The search was limited to the time period of January 2010 to August 2019, in English scientific
journals available through the following online databases: PubMed (including Medline), CINAHL,
Scopus, Web of Science, PsycINFO, ProQuest, and EBSCO. In addition, the authors performed searches
in Nordic and Finnish databases to improve the search coverage. To find relevant studies for inclusion
in the data analysis and synthesis, inclusion criteria for selection were articles with a focus on adherence
to patient-safety principles in clinical nursing interventions published in online peer-reviewed scientific
journals. Articles on patients and other healthcare providers, or on non-clinical initiatives, or that had
no exact relevance to adherence to patient-safety principles were excluded.
2.3. Search Outcome and Data Extraction
The authors (M.V., S.T., J.K., and F.V.M.) independently performed each step of the systematic
review, holding frequent online discussions and making collective agreements on how to proceed
through the review steps. Gray literature, such as unpublished dissertations and policy documents
and cross-referencing from bibliographies, were assessed, to improve the search coverage. Guidance
and support with the search process were obtained from the librarian, when needed. All authors
independently screened the titles, abstracts, and full texts of the studies retrieved during the search
process. In the cases where disagreements about the inclusion of selected studies occurred, discussions
were held until a consensus was reached.
A data extraction table was used to collect data on the characteristics of studies. The table included
the lead author’s name, publication year, country, design, sample size and setting, and information
relating to adherence to patient-safety principles. Prior to the full data extraction, this table was
pilot-tested with a few selected studies, to ensure that data relevant to the review aim and analysis
would be appropriately gathered.
2.4. Quality Appraisal
The selected articles were appraised based on the appropriateness of the research structure using
the evaluation tools provided by the Enhancing the QUAlity and Transparency of health Research
(EQUATOR) website [45] and criteria outlined by Hawker et al. (2002) [46], addressing the study aim,
research structure, theoretical/conceptual research framework, conclusion, and references. The appraisal
tool appropriate to cross-sectional, observational and cohort studies such as the Strengthening the
Int. J. Environ. Res. Public Health 2020, 17, 2028
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Reporting of Observational Studies in Epidemiology (STROBE) was used to evaluate the suitability of
selected studies for inclusion in the final data synthesis and analysis. The researchers believed that the
quality appraisal items for determining the inclusion of a study in the final dataset did not align to a
scoring system; therefore, they used a yes/no system to answer the appraisal-tool items during the
quality appraisal and held frequent discussions on the importance and quality of each article before
making the final decision on the selection of studies for data analysis and synthesis.
2.5. Data Abstraction and Synthesis
The Vincent’s framework for analysing risk and safety in clinical practice [27,47] was used
to organize and connect the review findings to the wider theoretical perspective of patient safety.
This framework was developed based on the Reason’s organisational accident model [28]. Accordingly,
issues in patient safety originate in various systemic features at different categories of patient, healthcare
provider, task, work environment, and organisation and management [27,47]. The use of this framework
helped with the description and categorisation of data retrieved and accommodated heterogeneities in
the studies retrieved, with respect to method, samples, settings, and findings, facilitating the integrative
presentation of the review findings. The authors (M.V., S.T., P.A.L., J.K., and F.V.M.) reviewed the
included studies, to allocate the studies’ findings to each category, and used frequent discussions to
reach a consensus.
3. Results
3.1. Search Results and Study Selections
The thorough literature search using the key terms led to the retrieval of 10,855 articles.
After deleting irrelevant and duplicate titles, 382 entered the abstract-reading phase. Each abstract
was assessed by using the inclusion criteria, resulting in 84 possibly relevant articles. The full texts
were obtained from Finnish and Norwegian libraries and were carefully read to select only those
articles that had a precise focus on adherence to patient-safety principles during clinical nursing
interventions by nurses. This resulted in the final six articles chosen for data analysis. Excluded studies
were on adherence by other healthcare providers, rather than nurses, or had no exact relevance to
patient-safety principles. The methodological quality of the selected articles was assessed during the
full-text appraisal, and no article was excluded. In general, they had acceptable qualities with respect
to study research structure, theoretical and conceptual research frameworks, and relevant findings to
the review aim. Grey literature and the manual search in the reference lists of the selected studies led
to no more articles being discovered for inclusion. Appendix A presents the search results, giving the
number of articles located in each database. The Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) flowchart is shown in Figure 1.
3.2. General Characteristics of the Selected Studies
The general characteristics of the selected studies (n = 6) are presented in Table 1. The studies
were published from 2014 to 2019 and were conducted in Australia [48], Finland [49], Norway [50],
South Korea [51], Sweden [52], and the UK [53].
Three studies used a survey design [50–52]; one study used an observational method [53];
one applied an observational intervention design [49]; and another one was a three-stage pre-post
time-series study [48]. Except for one study [49] that was published in the Finnish language, all other
articles were written in English.
Diverse foci were evident in the studies: adherence to patient-safety principles on the management
of peripheral venous catheters [52], surgical hand rubbing instructions [49], double-checking policies
of medicines’ preparation and administration [53], handover from the intensive care unit (ICU) to the
cardiac ward [48], cardiac monitoring and surveillance standards [50], and care-associated infection
precautions [51].
ron. Res. Public Health 2020, 17, x
Int. J. Environ. Res. Public Health 2020, 17, 2028
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Figure 1. The study flow diagram according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA).
ure 1. The study flow diagram according to the Preferred Reporting Items for Systematic Revie
Meta-Analyses (PRISMA).
eral Characteristics of the Selected Studies
e general characteristics of the selected studies (n = 6) are presented in Table 1. The
ublished from 2014 to 2019 and were conducted in Australia [48], Finland [49], Norw
orea [51], Sweden [52], and the UK [53].
ree studies used a survey design [50–52]; one study used an observational method [5
an observational intervention design [49]; and another one was a three-stage pre-po
udy [48]. Except for one study [49] that was published in the Finnish language, a
were written in English.
verse foci were evident in the studies: adherence to patient-safety principles
Int. J. Environ. Res. Public Health 2020, 17, 2028
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Table 1. Characteristics of selected studies for data analysis and synthesis.
Authors, Year, Country
Aim
Förberg et al., 2014, Sweden [52]
To investigate nurses’ adherence to
the clinical practice guidelines
regarding peripheral venous
catheters and investigate their
understandings of work context
influencing it.
Rintala et al., 2014, Finland [49]
To evaluate adherence to surgical
hand rubbing directives among
operating room personnel, in public
hospitals in Southwest Finland.
Alsulami et al., 2014, UK [53]
To explore the follow-up of
double-checking policies by nurses
and assess the identity of
medication-administration errors
despite double-checking.
Method
Sample and Setting
Main Finding
Conclusion
Survey
A children’s hospital with 245 beds,
373 nurses from 23 medical and
surgical inpatient, intensive care, the
operating, anaesthetic, advanced
homecare, and outpatient wards.
The importance of the
workplace condition in
terms of information
sharing and feedback.
The need for various
strategies for improving
adherence among nurses.
Observational before-after
intervention
11 surgical settings of four hospitals,
190 and 73 nurses in the first and
second observation rounds,
respectively.
The relative impact of the
feedback intervention on
adherence by nurses.
Necessity of effective
educational methods and
role models.
Prospective observational
Medical and surgical wards, the
PICU and NICU, observation of
preparation and administration of
2000 drug doses to 876 children.
Deviations from the
policies of medication
administration.
Encouragement of
double-checking steps
during medication
administration, and
prevention of
interruptions.
Graan et al., 2016, Australia [48]
To investigate the adoption of
standardised nursing handover
guidelines from the ICU to the
cardiac ward in regard to
understanding risks to patient
safety before and after the
implementation.
Three-stage, pre–post time
series, and focus group
interviews pre-and/or
post-implementation.
A metropolitan private hospital with
a 15-bed ICU and a 46-bed cardiac
surgical ward; 20 consecutive
episodes of ICU-to-ward handover
and a further 20 post-implementation
episodes; A purposive sample of 19
senior nurse managers and clinicians.
Unsafe practice of
handover interventions
and information gap.
The need for the adoption
of standardised handover
tools for reducing
handover variabilities.
Fålun et al., 2019, Norway [50]
To study cardiovascular nurses’
knowledge of, and adherence to,
practice standards for cardiac
surveillance and their knowledge
improvements over time, in years
2011 and 2017.
Survey
363 nurses from 44 hospitals in 2011
and 38 hospitals in 2017.
Failure to fully adhere to
cardiac telemetry
monitoring standards.
Developing educational
programmes regarding
the safe practice of cardiac
monitoring.
Lim et al., 2019, South Korea [51]
To investigate nurses’ adherence to
standard precautions and its
association with their perceptions
of safe care.
Cross-sectional
329 nurses working in a teaching
hospital.
Intermediate adherence to
standard precautions.
Devising integrative
curricula to improve
nurses’ transition to
professional practice.
PICU: paediatric intensive care unit; NICU: neonatal intensive care unit; ICU: intensive care unit.
Int. J. Environ. Res. Public Health 2020, 17, 2028
Int. J. Environ. Res. Public Health 2020, 17, x FOR PEER REVIEW
7 of 15
7 of 15
3.3. Findings of Studies with Connection to the Vincent’s Framework
3.3. Findings of Studies with Connection to the Vincent’s Framework
The findings were classified based on the theoretical framework for analysing risk and safety in
The
findings
were classified
based
on the
theoretical
framework
forfactors
analysing
riskto
and
in
clinical
practice
developed
by Vincent
(1998,
2010)
[27,47] and
grouped by
related
thesafety
patient,
clinical practice
developed
by Vincent
(1998,and
2010)
[27,47] andand
grouped
by factors
related in
to the
the
healthcare
provider,
task, work
environment,
organisation
management.
Variations
patient,
healthcare
provider,
task,
work
environment,
and
organisation
and
management.
Variations
findings within the selected studies related to the type of patient-safety principles or different clinical
in the findings
within
selected and
studies
relatedoftofindings
the typeunder
of patient-safety
principles or
different
settings
facilitated
the the
description
synthesis
the above-mentioned
categories
clinical
settings
facilitated
the
description
and
synthesis
of
findings
under
the
above-mentioned
(Figure 2).
categories (Figure 2).
Figure 2.
model
of nurses’
adherence
to patient-safety
principles
based onbased
the Vincent’s
Figure
2. Schematic
Schematic
model
of nurses’
adherence
to patient-safety
principles
on the
framework.
Vincent’s
framework.
3.3.1.
3.3.1. Patient
Patient
This
This category
category was
was about
about the
the role
role of
of patients
patients and
and how
how they
they could
could impact
impact nurses’
nurses’ adherence
adherence to
to
patient-safety
For For
instance,
errors made
administration,
patient-safetyprinciples.
principles.
instance,
errorsduring
mademedicines’
during preparation
medicines’ and
preparation
and
and
a deviation from
bysafety
nursesprinciples
were reported.
The deviation
with a high
administration,
and medication
a deviationsafety
from principles
medication
by nurses
were reported.
The
possibility
of
endangering
patient
safety
happened
where
the
parents
of
patients
or
their
companions
deviation with a high possibility of endangering patient safety happened where the parents of
were
left unobserved
and unsupervised
nurses to administer
medicinesby
to patients.
patients
or their companions
were leftbyunobserved
and unsupervised
nurses toUnobserved
administer
or
unsupervised
administration
contravenes
the
medicines
management
principle,
which
a
medicines to patients. Unobserved or unsupervised administration contravenes the requires
medicines
nurse’s
direct
supervision;
a
crucial
consideration
for
the
prevention
of
abuse
and
patient
avoidance
of
management principle, which requires a nurse’s direct supervision; a crucial consideration for the
taking
medicines
as and
prescribed
Moreover,
in spite
of the emphasis
on patient
participation
in
prevention
of abuse
patient[53].
avoidance
of taking
medicines
as prescribed
[53]. Moreover,
in spite
patient-safety
activities,
nursing
handovers
were
delivered
mainly
outside
the
patient’s
room
[48],
or
no
of the emphasis on patient participation in patient-safety activities, nursing handovers were
information
was provided
patients
regarding
the purpose
and process of
cardiac
monitoring
[50].
delivered mainly
outside to
the
patient’s
room [48],
or no information
was
provided
to patients
These
deviations
could
hinder
patients’
active
involvement
in
their
own
safe
care.
Additionally,
the
only
regarding the purpose and process of cardiac monitoring [50]. These deviations could hinder
communication
between patients
and nurses
wasAdditionally,
the call bell, and
nurses
rarely questioned
patients’ active line
involvement
in their own
safe care.
the only
communication
line
patients
their
pain
or comfort.
identified
issues
represent
missed
opportunities
forpain
the
betweenabout
patients
and
nurses
was the These
call bell,
and nurses
rarely
questioned
patients
about their
nurses’
continuous
observation
role
for
early
detection
and
prevention
of
harm
during
handovers
from
or comfort. These identified issues represent missed opportunities for the nurses’ continuous
the
ICU to the
cardiac
warddetection
[48].
observation
role
for early
and prevention of harm during handovers from the ICU to the
cardiac ward [48].
3.3.2. Healthcare Provider
3.3.2.This
Healthcare
categoryProvider
described how nurses’ knowledge and attitudes were associated with their adherence
to patient-safety principles. Variations in nurses’ adherence to patient-safety principles could be
This category described how nurses’ knowledge and attitudes were associated with their
attr
