a Nurse Is Reviewing Practice Guidelines With a Group of Newly
Int J Environ Res Public Health. 2020 Mar; 17(six): 2028.
Nurses' Adherence to Patient Safety Principles: A Systematic Review
Mojtaba Vaismoradi
aneFaculty of Nursing and Health Sciences, Nord Academy, 8049 Bodø, Norway
Susanna Tella
twoFaculty of Health and Social Care, LAB University of Practical Sciences, 53850 Lappeenranta, Finland; if.aimias@allet.annasus
Patricia A. Logan
3Faculty of Science, Charles Sturt University, 2795 Bathurst, Australia; ua.ude.usc@nagolp
Jayden Khakurel
4Research Centre for Child Psychiatry, Department of Child Psychiatry, Kinesthesia of Medicine, University of Turku, 20014 Turku, Finland; if.utu@lerukahk.nedyaj
Flores Vizcaya-Moreno
5Nursing Department, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain; se.au@ayacziv.serolf
Received 2020 February 23; Accustomed 2020 Mar xvi.
Abstract
Background: Quality-of-intendance 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-rubber principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using advisable keywords to think empirical articles published from 2010–2019. Using the theoretical domains of the Vincent's framework for analysing risk and rubber in clinical practice, we synthesized our findings co-ordinate to 'patient', 'healthcare provider', 'task', 'work environs', and 'organisation and direction'. Findings: Six manufactures 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 intendance-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 procedure influenced nurses' adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing intendance practice, as both influence adherence to patient-rubber 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 furnishings on patient-safety outcomes.
Keywords: adherence, quality of intendance, patient-prophylactic principles, nursing intervention, practice errors, safe care
1. Introduction
The Earth Health Organization defines patient safety equally the absenteeism of preventable impairment to patients and prevention of unnecessary harm past healthcare professionals [1]. It has been reported that dangerous care is responsible for the loss of 64 million disability-adjusted life years each twelvemonth across the globe. Patient harm during the provision of healthcare is recognized as 1 of the summit ten causes of disability and death in the earth [2]. Regarding the financial outcome of patient harm, a retrospective analysis of inpatient harm based on data collected from 24 hospitals in the Us showed that harm-reduction strategies could reduce full healthcare costs by $108 1000000 U.S. and generate a saving of 60,000 inpatient care days [three]. 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 exist reduced through implementing patient-condom principles based on preventive and quality-improvement strategies [five]. Patient-safety principles are scientific methods for achieving a reliable healthcare system that minimizes the incidence charge per unit and affect of adverse events and maximizes recovery from such incidents [half-dozen]. These principles can be categorized as risk direction, infection control, medicines management, prophylactic environment and equipment [7], patient teaching and participation in own care, prevention of pressure ulcers, nutrition improvement [viii], leadership, teamwork, knowledge development through inquiry [ix], feeling of responsibleness and accountability, and reporting practice errors [10].
The nurses' role is to preserve patient rubber and prevent impairment during the provision of care in both brusk-term and long-term care settings [xi,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, offer help, and communicating with other healthcare providers [xiii,14]. In add-on to clear policies, leadership, research driven safety initiatives, training of healthcare staff, and patient participation [1,fifteen], nurses' adherence to the principles of patient prophylactic [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, civilisation, economic and social conditions, and levels of knowledge [18,nineteen]. On the other hand, lack of adherence and compliance contravenes professional person beliefs, norms, and expectations of the healthcare professional's role [xx].
Institutional systemic factors influencing nurses' adherence to and compliance with patient-safety principles are as follows: the organizational patient-rubber climate [21], workload, time pressure, encouragement by leaders and colleagues [22,23,24], level of ward performance [25], provision of instruction for the improvement of knowledge and skills [11,eighteen], institutional procedures or protocols, and also advice between healthcare staff and patients [xi]. 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-prophylactic 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]. Information technology 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' arroyo, which considers organizational factors every bit precursors for endangering patient safety [29]. Co-ordinate to this theoretical framework, initiatives aimed at the improvement of patient safety require systematic assessments and integrative interventions to target dissimilar elements in the hierarchy of the healthcare system, including patient, healthcare provider, task, work environment, and system and direction. This framework, and similar models for risk and safety management, tin can help with the assay of patient harm, to place likely pitfalls, as well equally 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]; withal, suboptimal quality and safety of care remain evident, indicating the need for improved understandings of the diverse factors and conditions that increase adherence in daily nursing exercise [33]. Consequently, this review aimed to retrieve, explore, and synthesise factors axiomatic 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 practise.
ii. Materials and Methods
2.i. Design
A systematic review was conducted. Information technology is an explicit and clear method of data collection, systematic clarification, and synthesis of findings, to attain the written report goal [34,35,36]. 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.two. Search Methods
Search keywords were determined after team discussions, performing a pilot search in full general and specialized databases, and consultation with a librarian. Key search terms relating to adherence to patient-safety principles by nurses were used to deport a Boolean search. For operationalising the study concept, the definition of adherence as a behaviour carried out actively past people according to orders or advice was used [37]. The word adherence is used interchangeably with, and sometimes at the same fourth dimension as, the discussion compliance, since both tin can point the outcome of intendance interactions between the healthcare provider and the caregiver [38,39,xl,41,42]. Nonetheless, adherence indicates responsibility and empowerment on the healthcare professional's function to actively perform the expected behaviour compared to compliance that shows responsibility on the patient'due south function to follow upward the therapeutic regimen [43,44].
The search was limited to the time period of January 2010 to August 2019, in English scientific journals bachelor through the following online databases: PubMed (including Medline), CINAHL, Scopus, Spider web of Science, PsycINFO, ProQuest, and EBSCO. In add-on, the authors performed searches in Nordic and Finnish databases to improve the search coverage. To find relevant studies for inclusion in the information analysis and synthesis, inclusion criteria for selection were manufactures with a focus on adherence to patient-prophylactic principles in clinical nursing interventions published in online peer-reviewed scientific journals. Articles on patients and other healthcare providers, or on not-clinical initiatives, or that had no exact relevance to adherence to patient-safety principles were excluded.
ii.3. Search Upshot and Data Extraction
The authors (K.V., S.T., J.K., and F.V.M.) independently performed each footstep of the systematic review, property frequent online discussions and making commonage agreements on how to go along through the review steps. Gray literature, such equally unpublished dissertations and policy documents and cantankerous-referencing from bibliographies, were assessed, to better 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 information extraction tabular array was used to collect information on the characteristics of studies. The table included the lead author's name, publication year, land, design, sample size and setting, and information relating to adherence to patient-safety principles. Prior to the total 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 accordingly gathered.
two.iv. Quality Appraisal
The selected articles were appraised based on the ceremoniousness of the research structure using the evaluation tools provided past the Enhancing the QUAlity and Transparency of health Enquiry (EQUATOR) website [45] and criteria outlined by Hawker et al. (2002) [46], addressing the study aim, research construction, theoretical/conceptual research framework, conclusion, and references. The appraisement tool appropriate to cross-sectional, observational and cohort studies such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to evaluate the suitability of selected studies for inclusion in the concluding data synthesis and assay. 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 yep/no system to answer the appraisal-tool items during the quality appraisement and held frequent discussions on the importance and quality of each article before making the concluding decision on the selection of studies for information analysis and synthesis.
2.v. Data Brainchild and Synthesis
The Vincent's framework for analysing adventure 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 adult based on the Reason's organisational accident model [28]. Accordingly, bug 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.Five., South.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.ane. Search Results and Written report Selections
The thorough literature search using the key terms led to the retrieval of 10,855 articles. Afterward deleting irrelevant and duplicate titles, 382 entered the abstract-reading phase. Each abstract was assessed past using the inclusion criteria, resulting in 84 peradventure 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 terminal six articles called for information analysis. Excluded studies were on adherence past 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 appraisement, and no article was excluded. In general, they had acceptable qualities with respect to study enquiry 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.
The study flow diagram according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
3.2. General Characteristics of the Selected Studies
The general characteristics of the selected studies (n = 6) are presented in Tabular array 1. The studies were published from 2014 to 2019 and were conducted in Commonwealth of australia [48], Finland [49], Norway [l], Due south Korea [51], Sweden [52], and the UK [53].
Tabular array 1
Characteristics of selected studies for data analysis and synthesis.
| Authors, Year, Land | Aim | Method | Sample and Setting | Main Finding | Determination |
|---|---|---|---|---|---|
| Förberg et al., 2014, Sweden [52] | To investigate nurses' adherence to the clinical exercise guidelines regarding peripheral venous catheters and investigate their understandings of piece of work context influencing it. | Survey | A children's infirmary 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. |
| Rintala et al., 2014, Finland [49] | To evaluate adherence to surgical hand rubbing directives among operating room personnel, in public hospitals in Southwest Finland. | Observational before-afterward intervention | 11 surgical settings of four hospitals, 190 and 73 nurses in the offset and second observation rounds, respectively. | The relative touch on of the feedback intervention on adherence by nurses. | Necessity of constructive educational methods and office models. |
| Alsulami et al., 2014, United kingdom of great britain and northern ireland [53] | To explore the follow-up of double-checking policies past nurses and appraise the identity of medication-administration errors despite double-checking. | Prospective observational | Medical and surgical wards, the PICU and NICU, ascertainment 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 assistants, 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–postal service fourth dimension series, and focus grouping interviews pre-and/or postal service-implementation. | A metropolitan private infirmary with a 15-bed ICU and a 46-bed cardiac surgical ward; 20 consecutive episodes of ICU-to-ward handover and a farther 20 post-implementation episodes; A purposive sample of 19 senior nurse managers and clinicians. | Dangerous 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 report cardiovascular nurses' knowledge of, and adherence to, practice standards for cardiac surveillance and their noesis 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 do of cardiac monitoring. |
| Lim et al., 2019, South korea [51] | To investigate nurses' adherence to standard precautions and its clan 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 do. |
Three studies used a survey blueprint [50,51,52]; one study used an observational method [53]; one practical an observational intervention design [49]; and another one was a 3-phase pre-post time-series study [48]. Except for one study [49] that was published in the Finnish linguistic communication, all other articles were written in English.
Diverse foci were evident in the studies: adherence to patient-rubber principles on the direction of peripheral venous catheters [52], surgical hand rubbing instructions [49], double-checking policies of medicines' grooming and administration [53], handover from the intensive care unit (ICU) to the cardiac ward [48], cardiac monitoring and surveillance standards [50], and intendance-associated infection precautions [51].
3.iii. Findings of Studies with Connection to the Vincent'south Framework
The findings were classified based on the theoretical framework for analysing gamble and safety in clinical practice developed by Vincent (1998, 2010) [27,47] and grouped past factors related to the patient, healthcare provider, task, work environment, and organization and management. Variations in the findings inside the selected studies related to the type of patient-safety principles or different clinical settings facilitated the description and synthesis of findings under the higher up-mentioned categories (Effigy two).
Schematic model of nurses' adherence to patient-safety principles based on the Vincent's framework.
3.3.1. Patient
This category was near the function of patients and how they could touch nurses' adherence to patient-safety principles. For case, errors made during medicines' preparation and administration, and a divergence from medication condom principles by nurses were reported. The deviation with a high possibility of endangering patient prophylactic happened where the parents of patients or their companions were left unobserved and unsupervised by nurses to administer medicines to patients. Unobserved or unsupervised administration contravenes the medicines direction principle, which requires a nurse'south direct supervision; a crucial consideration for the prevention of abuse and patient avoidance of taking medicines equally prescribed [53]. Moreover, in spite of the accent on patient participation in patient-condom activities, nursing handovers were delivered mainly outside the patient's room [48], or no data was provided to patients regarding the purpose and procedure of cardiac monitoring [50]. These deviations could hinder patients' agile interest in their own prophylactic care. Additionally, the only communication line betwixt patients and nurses was the telephone call bell, and nurses rarely questioned patients well-nigh their hurting or comfort. These identified issues stand for missed opportunities for the nurses' continuous observation function for early detection and prevention of harm during handovers from the ICU to the cardiac ward [48].
3.3.ii. Healthcare Provider
This category described how nurses' cognition and attitudes were associated with their adherence to patient-prophylactic principles. Variations in nurses' adherence to patient-rubber principles could exist attributed to their varied levels of cognition and attitudes. Examples included nurses' incomplete adherence to infection-control principles, which encompassed the daily inspection of peripheral venous catheter sites, surgical hand rubbing, disinfection of hands, and the use of disposable gloves and aprons when exposed to patient excretions [49,51,52]. Other examples were related to the principles of medicines' management: inappropriate speed of intravenous bolus, incorrect medicines' preparation, administration at incorrect times, problematic labelling of flush syringes and administration of intravenous antibiotics without flushing, non receiving the medicines' complete dose by patients, and wrong mixing of medicines with diluent [53]. Lack of sufficient knowledge and skills regarding cardiac monitoring and surveillance standards were also axiomatic, with wrong placement of cardiac electrodes and/or skin preparation before the procedure leading to inconsistent monitoring, which could endanger patient safety [50]. Interestingly, being a newly graduated nurse with less time having passed since obtaining the nursing certificate was associated with improve adherence to the peripheral venous catheter-care principles, possibly due to having more informatics skills and updated knowledge of nursing care and post-obit upwards of rules set by senior nurses [52]. Additionally, negative attitudes and perceptions toward the significance of care standards, individual aesthetic manicure preferences, and the presence of eczema and pare wounds hindered adherence to the surgical hand rubbing protocol, thus having negative implications for patient safe [49].
3.3.3. Chore
In this category, the clan between the identity and blazon of nursing task and adherence to patient-safety principles by nurses was considered. The lowest adherence rates were evident in 'independent' medicine management tasks such as dose calculation, charge per unit of administering intravenous bolus drugs, and labelling of flush syringes. On the other paw, a higher charge per unit of adherence was reported for 'cooperative' tasks with college levels of complexity, such as the double-checking of drugs for the actual administration of medicine to the patient [53]. Similarly, a higher number of nurses working and collaborating together in the ward was associated with a higher rate of adherence to infection-control precautions, including putting precipitous manufactures into appropriate boxes, roofing both the mouth and nose, and disinfection of hands later on glove removal [51].
three.3.4. Work Surround
The effect of equipment and the workplace condition on adherence to patient-safety principles was reported in this category. The availability of equipment and electronic resources and digitalization increased the likelihood of adherence to patient prophylactic principles related to medicine management [53], peripheral venous catheter intendance [52], and cardiac monitoring and surveillance [50]. Appropriately, a telemetry cover on cardiac telemetry and monitoring units helped with the prevention of nosocomial infection by preventing contamination of shared equipment [50]. Electronic resources and digitalization helped with reminding the daily inspection and information-sharing between nurses regarding peripheral venous catheter insertion sites [52]. The beingness of an environmental infinite for preparation of medicines without interruptions helped nurses attach more closely to double-checking instructions of preparation and administration on weekends, as compared with weekdays [53].
3.3.5. Organization and Direction
This category focused on collaboration between nurses and the leadership role in motivating nurses' adherence to patient-safety principles. Equally an example, adherence to the surgical hand rubbing principles, including properly drying hands after alcohol hand rubbing and washing with water and soap, and booze paw rubbing up to elbows, was improved after the provision of feedback past nurse leaders [49]. Regular practical feedback processes, interaction opportunities and ascertainment of peers and senior colleagues, and leadership motivated nurses' adherence to daily inspection of the peripheral venous catheter site and the employ of disposable gloves when handling peripheral venous catheters insertion sites [52]. Adherence to patient-rubber principles by cardiac nurses was improved through feedback provision and informing nurses in the ICU of the type of nursing interventions conducted in cases of serious dysrhythmias and their outcomes [50].
The provision of a standard process for handover, such as the introduction of a validated handover tool, improved nurses' readiness to receive patients from the ICU. It informed the preparation of the required equipment for care, enabled operation of handovers at the patient bedside, and involved patients in their care, while also assisting with attending patients' needs, checking patients' identity, and collecting data of their medical history and allergies. Further, the standardising of the handover process helped with the continuity of intendance plan past formalising discussions betwixt nurses and profitable with removal of any ambiguities, and then increasing awareness of risks to patient safety [48]. The college adherence rate to standard precautions for infection control were found when at that place was a higher nurse-to-patient ratio indicating the association between workload and patient-safety management [51]. Similarly, the development of a local practise standard for cardiac monitoring and surveillance, as well as for assessing the eligibility of patients for admission to critical and non-critical telemetry sections, would improve adherence to patient-rubber principles for the cardiac patient [50].
4. Discussion
This systematic review integrated current international knowledge through the categorization of factors affecting adherence to patient-prophylactic principles by nurses to the elements of the Vincent's framework (1998 and 2010) for analysing hazard and safety in clinical practice [27,47].
In this review, leaving patients' companions unsupervised during medicines' administration, performing handovers exterior patients' rooms, and lack of the provision of information and advisable communication with patients hindered patient participation in their understandings of their own care. Lack of engagement of patients in safe-intendance initiatives contravenes nurses' adherence to patient-safety principles. Benefiting from patients' participation requires understanding of how to amend the patient'southward willingness to deed as an active member of the healthcare team, development of practical guidelines for such an engagement with the consideration of patients and their relatives' knowledge and skills of the care process, too equally definition of the role and provision of supervision and guidance by nurses. The assigned participation task should exist communicated appropriately to the patient, have congruity with patients' knowledge of nursing routines and their ain implementation chapters, likewise as be incorporated into routine care with the consideration of infrastructures and healthcare missions [fourteen,54,55]. It has been suggested that planning and performing nursing care at the patient's bedside tin meliorate patient participation, reduce work interruptions [56], and consequently improve nurses' adherence to safe care guidelines [11].
The findings of this review highlighted that nurses' knowledge, perceptions, and attitudes influenced their adherence to patient-safety principles. Nurses have multiple roles and central responsibleness to continue patients safe in the complex healthcare environment [57,58]. The upshot of personal and professional values and attitudes on the consistency of adherence to patient safety by nurses has been shown to be more important than the event of their workloads [22]. Information technology is believed that individual factors such as nurses' attitudes, perceptions, cognition, and data seeking tin can facilitate or hinder the employ of clinical exercise guidelines by nurses and consequently endanger patient safety [11,26] through inconsistent adherence to patient-safety principles [59].
It was evident that collaborative tasks fostered nurses' adherence to patient-safety principles. Improving nurses' cognition of tasks improves nurses' adherence [60]. Moreover, the coordinated direction arroyo and collaboration with team members raise the effectiveness of patient-safe interventions due to the creation of a shared understanding of changes that should exist made past all healthcare staff to improve the quality of care [61,62].
With regard to the work environment, the findings of this review highlighted how equipment and electronic systems could assist with sharing data between healthcare providers and heighten adherence to patient-safe principles. 1 office of the healthcare arrangement'southward commitment to patient prophylactic is the training of appropriate work equipment [63,64]. Technology can support data security and facilitate nursing care through the provision of real-time and ubiquitous documentation, which is needed for professional interactions and collaboration [65]. Digital systems tin reduce the fourth dimension needed to perform nursing care and limit errors in drug administration, likewise as ameliorate nurses' and patients' satisfaction with care [66,67].
An appropriate work surround was characterised as one where nurses were less interrupted, and lower workloads improved adherence to patient-safety principles. An appropriate work environment is associated with better patient safety and less burnout. Workload and burnout act equally negative mediators of safe care [68,69]. A work environs characterised by a heavy workload and mental pressure [23,24,70] and frequent disruptions [71] has been implicated in reducing nurses' adherence to safety-related principles. There is an association between patient safety and the nurses' work environment [39,72,73] and implementation of patient-safe principles to foreclose errors and adverse events [26,74].
The findings of this review emphasized the role of regular education and provision of feedback to nurses. Taking responsibility for actions and behaviours through educational activity and feedback is a crucial aspect of professional practice [75]. The empowerment of nurses to intervene based on intendance standards is an expectation of healthcare leaders which tin can be achieved through the development of the culture of patient safe [33,76,77,78], the implementation of educational programs, and timely feedback and reminders [79,eighty,81]. Farther, the utilise of standard processes, supported past validated tools, guided nurses and facilitated their adherence to patient-safety principles. Usability, format, easy access of the contents of guidelines, and consideration of fourth dimension, staffing, concatenation of communication, accurateness of practice, supplies of equipment, and logistics are the main advantages of guidelines that facilitate the implementation of condom intendance [26,82].
Limitations and Suggestions for Futurity Studies
In spite of the accent on adherence to patient-safety principles and patient-intendance outcomes, this study has directly focused on nurses' adherence to patient-safety principles, which can impact our understandings of the variation of factors influencing this of import concept. However, the wide nature of the search in the electronic databases and in diverse languages convinced the researchers that the study topic has been addressed appropriately and an answer based on the electric current cognition can exist provided. However, the limited number of studies that met the inclusion criteria for this review hinders the full exploration of the relationship betwixt individual and systemic factors that impact on nurses' adherence to patient-safety principles in inpatient and outpatient settings.
5. Conclusions
This review has shown that adherence to patient-safety principles was affected by numerous intersecting and complex factors. Variations in the studies' aims, methods, and results hinder the formation of a determinant decision on how adherence to patient-safety principles can be improved. However, based on the review results, general indications are that comeback of nurses' noesis well-nigh patient safe, collaboration in performing tasks, reduction of workloads, provision of appropriate equipment and electronic systems for advice and sharing information, regular feedback in the workplace, and standardization of the care processes can help with enhancing nurses' adherence to patient-safety principles. Future qualitative and quantitative studies are needed to better understand how to promote and mitigate adherence to safe-care principles by clinical nurses.
Acknowledgments
Nord University, Bodø, Kingdom of norway has supported the publication of this manuscript through coverage of publication charges.
Appendix A
Table A1
Search strategy and results based on each database.
| Database | Full in Each Database | Selection Based on Championship Reading | Option Based on Abstract Reading | Selection Based on Full-Text Reading/Appraisal |
|---|---|---|---|---|
| ProQuest | 3169 | 0 | 0 | 0 |
| CINAHL | 4271 | 40 | 8 | 1 |
| EBSCO | 673 | seven | 5 | 0 |
| PubMed [including Medline] | 33 | 27 | 20 | 1 |
| PsycINFO | 442 | 42 | half dozen | 0 |
| Scopus | 1387 | 203 | 33 | two |
| Spider web of Science | 856 | 62 | eleven | 1 |
| Norwegian databases | ||||
| Oria | four | 0 | 0 | 0 |
| Idunn | 0 | 0 | 0 | 0 |
| Norart | 0 | 0 | 0 | 0 |
| Helsebiblioteket.no | 1 | 0 | 0 | 0 |
| Cristin | 4 | 0 | ||
| Finnish database—Medic | xv | 1 | 1 | 1 |
| Manual search/backtracking references | 0 | 0 | 0 | 0 |
| Total of databases | 10855 | 382 | 84 | 6 |
Author Contributions
The authors contributed to the design and implementation of the inquiry, to the analysis of the results and to the writing of the manuscript as follows; M.5., Due south.T., J.Chiliad., F.V.-Chiliad.: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project assistants, Resources, Software; M.5., S.T., J.K., F.V.-M., P.A.L.: Writing—original draft, Writing—review and editing. All authors accept read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Conflicts of Interest
The authors have no conflicts of interest to declare.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142993/
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