Greater accountability in nursing handover

Nursing handover exemplifies both the nurse’s professional ethics and the profession’s integrity. The article by Yetti et al. acknowledges the critical role of structure and process in handover implementation. At the same time, they emphasised the fundamental necessity to establish and update handover guidelines. I assert that effective patient handover practices do not simply happen; instead, nurses require pertinent educational support. It is also pivotal to develop greater professional accountability throughout the handover process. The responsibility for ensuring consistent handover quality should be shared between nurse managers and those who do the actual handover practices.

The Private World of Nursing Related to Incident Reporting

<p>During the 1990s governments, professionals and the public in general have had brought to their attention that incidents in healthcare are occurring in larger numbers than had ever been imagined and are costing tax-payers large amounts of money. Research sponsored by governments has tried to identify some objective evidence of the number of incidents and types of incidents that occur and to put forward some tools to assist with the risk management of incidents. The purpose of this project was to explore the experience of nurses related to incident reporting. The reporting of incidents is important as it identifies professional risks for nurses. A descriptive qualitative approach was the methodology used and individual interviews of five senior nurses was the method of data collection. Attention was given to finding out about the supports for and barriers against nurses in reporting incidents; the outcomes for nurses of incident reporting; and the organisational culture and scope of 'professional' behaviour of nurses around incident reporting. The findings revealed that nurses identified themselves as the major reporters of incidents. They considered there was not 'a level playing field' for all professionals around who, how and why incidents were reported, investigated and within the post incident processes. The nurses reported that they made daily decisions about what was an incident, and whether to report events as incidents. They identified aids and supports to the decisions they made such as the medium for reporting and fear of what happened when the incident form left the nurse and went to management. A number of significant implications were identified for nursing, management and organisations in this research. Nurses need to feel they work in organisations which have a culture of safety around incident reporting. Management need to clearly communicate policies, processes and organisational expectations related to incident reporting. This should include how incidents will be reported, investigated and the purposes for which management use incident reporting information. It is also important that adequate structures are in place to support nurses when an incident occurs as incidents when they occur have stressful consequences for the nurses who are involved. Professional nursing bodies need to give consideration to the development of clear guidelines on the legal and professional accountability of nurses related to incident reporting including the limitations of this accountability. When processes are clear a more effective approach can be taken to incident reporting, learning can occur and this will prevent the recurrence of some incidents.</p>

The Private World of Nursing Related to Incident Reporting

<p>During the 1990s governments, professionals and the public in general have had brought to their attention that incidents in healthcare are occurring in larger numbers than had ever been imagined and are costing tax-payers large amounts of money. Research sponsored by governments has tried to identify some objective evidence of the number of incidents and types of incidents that occur and to put forward some tools to assist with the risk management of incidents. The purpose of this project was to explore the experience of nurses related to incident reporting. The reporting of incidents is important as it identifies professional risks for nurses. A descriptive qualitative approach was the methodology used and individual interviews of five senior nurses was the method of data collection. Attention was given to finding out about the supports for and barriers against nurses in reporting incidents; the outcomes for nurses of incident reporting; and the organisational culture and scope of 'professional' behaviour of nurses around incident reporting. The findings revealed that nurses identified themselves as the major reporters of incidents. They considered there was not 'a level playing field' for all professionals around who, how and why incidents were reported, investigated and within the post incident processes. The nurses reported that they made daily decisions about what was an incident, and whether to report events as incidents. They identified aids and supports to the decisions they made such as the medium for reporting and fear of what happened when the incident form left the nurse and went to management. A number of significant implications were identified for nursing, management and organisations in this research. Nurses need to feel they work in organisations which have a culture of safety around incident reporting. Management need to clearly communicate policies, processes and organisational expectations related to incident reporting. This should include how incidents will be reported, investigated and the purposes for which management use incident reporting information. It is also important that adequate structures are in place to support nurses when an incident occurs as incidents when they occur have stressful consequences for the nurses who are involved. Professional nursing bodies need to give consideration to the development of clear guidelines on the legal and professional accountability of nurses related to incident reporting including the limitations of this accountability. When processes are clear a more effective approach can be taken to incident reporting, learning can occur and this will prevent the recurrence of some incidents.</p>

Supporting the pursuit of professionalism during a crisis

BackgroundCrisis plans for healthcare organisations most often focus on operational needs including staffing, supplies and physical plant needs. Less attention is focused on how leaders can support and encourage individual clinical team members to conduct themselves as professionals during a crisis.MethodsThis qualitative study analysed observations from 79 leaders at 160 hospitals that participate in two national professionalism programmes who shared their observations in focus group discussions about what they believed were the essential elements of leading and addressing professional accountability during a crisis.ResultsAnalysis of focus group responses identified six leadership practices adopted by healthcare organisations, which were felt to be essential for organisations to navigate the crisis successfully. Unique aspects of maintaining professionalism during each phase of the pandemic were identified and described.ConclusionsLeaders need a plan to support an organiation’s pursuit of professionalism during a crisis. Leaders participating in this study identified practices that should be carefully woven into efforts to support the ongoing safety and quality of the care delivered by healthcare organisations before, during and after a crisis. The lessons learnt from the COVID-19 pandemic may be useful during subsequent crises and challenges that a healthcare organisation might experience.

Designing and validating an evaluation inventory for assessing teachers’ professional accountability

Research has already established the boundless potential of teachers in assisting effective learning processes, and there is still a need to expand research to illustrate interrelation and connection between the construct of teachers’ professional accountability which moderates and directs student learning. To this end, a comprehensive review of the literature was conducted by the researchers to explore and extract relevant theoretical constructs to teacher accountability. A literature review was followed by structured interviews with 20 administrators, teachers, students, and parents to record perceived concepts related to teacher accountability. Content analysis of recorded interviews and thematic network analysis of literature resulted in a 30-item Likert scale. The researcher-made questionnaire was subject to reliability and validity issues. Thus, in the second phase, the questionnaire was piloted with 142 male and female EFL in-service teachers selected on the basis of the convenient sampling method. Factor analysis on data collected through this reduced the items to 29 and indicated that data on teacher accountability loaded on five components including accountability towards students (N: 7 items), parents (N: 5 items), school leadership (N: 5 items), society (N: 7 items), and the profession (N: 5 items). The results also indicated that the questionnaire enjoys sound psychometric properties of reliability (α: 0.88 ˂0.5). The upshots of this study could provide a better understanding of the concept and lead teachers to be more coherent and accountable.

Defining clinical pharmacy and support activities indicators for hospital practice using a combined nominal and focus group technique

Background Although clinical pharmacy is a crucial part of hospital pharmacist’s day-to-day activity, its performance is not usually subject to a holistic assessment. Objective To define a set of relevant and measurable clinical pharmacy and support activities key performance indicators (cpKPI and saKPI, respectively). Setting Portuguese Hospital Pharmacies. Method After a comprehensive literature review focusing on the metrics already in use in other countries, several meetings with directors of hospital pharmacies were conducted to obtain their perspectives on hospital pharmacy practices and existing metrics. Finally, five rounds with a panel of 8 experts were performed to define the final set of KPIs, where experts were asked to score each indicator’ relevance and measurability, and encouraged to suggest new metrics. Main outcome measure The first Portuguese list of KPIs to assess pharmacists’ clinical and support activities performance and quality in hospital pharmacies. Results A total of 136 KPIs were assessed during this study, of which 57 were included in the original list and 79 were later added by the expert panel. By the end of the study, a total of 85 indicators were included in the final list, of which 40 are considered to be saKPI, 39 cpKPI and 6 neither. Conclusion A set of measurable KPIs was established to allow for benchmarking within and between Portuguese hospital Pharmacies and to elevate professional accountability and transparency. Future perspectives include the use of both cpKPIs and saKPIs on a national scale to identify the most efficient performances and areas of possible improvement.

Governing education in times of crisis: State interventions and school accountabilities during the COVID-19 pandemic

Strategic government interventions in public education have shifted and blurred the boundaries between state, market and civil society modes of governance. Within this matrix of interdependent relations, schools operate under increasingly hybrid accountability arrangements in which public accountability can both complement and compete with market and social regimes and their associated institutional logics, goals, values and mechanisms. During the first wave of the COVID-19 pandemic, however, national governments implemented a wide range of emergency measures which had consequences for the mixes and layers of school accountabilities. This article examines the principal policy changes in Denmark, England and Italy. Drawing on state theories and the concept of ‘hybrid accountability’, semi-structured interviews with national and local policymakers and school practitioners were analysed thematically. While cultural nuances exist between the cases, our findings reveal that state interventions reinforce a public–professional accountability hybrid and hierarchies of control and command within and outside networks. Concomitantly, state non-interventions and the distinct underlying institutional logics associated with national large-scale assessments suggest policy inertia with implications for professional accountability and institutionalised change. Future research might investigate whether educators’ experiences influence the direction of national and local accountability policy reforms in a post-pandemic era.

Identifying the Barriers to Incorporating Reflective Practice into a Veterinary Curriculum

A portfolio with good reflective content can play a large role in learning and setting up the lifelong learning practice required by veterinary surgeons in practice or in research. The aim of this project was to investigate students’ experience with their reflective diaries within an electronic portfolio (e-portfolio). Focus groups were conducted with veterinary students at the University of Liverpool in years 1–4 to explore student perceptions of the e-portfolio, with an emphasis on reflection. Three themes emerged from the qualitative analysis: assessment, understanding the assignment (i.e., is it a useful and fair exercise?), and student well-being (i.e., stress, professional accountability, anxiety). Students had clear concerns about the assessment and did not see the relevance of the reflective diaries to their future career and learning. This has led the university’s School of Veterinary Science to restructure the reflections on professional skills in the portfolio.

Criminalisation of human error in health care: How and why legal accountability can crowd out professional accountability and undermine patient safety

This research is about accountability in health care. Theoretically it aims to shed light on two types of public accountability, how these types interact and relate to the aim of learning to improve patient safety. The study addresses the theoretical questions how and why legal accountability can crowd out professional accountability. It seeks to answer the empirical question what is the impact of criminal charges against health professionals by presenting two sets of data: First, a case study of an event, first of its kind in Iceland, in which a nurse in an intensive care unit was charged for manslaughter by negligence in May 2014. The court case material is examined and specialised in-depth and semistructured interviews conducted to describe the experience at the level of the individual and to account for organisational responses. Second, explorative focus groups were carried out in preparation of an internet survey conducted among all practising nurses in Iceland measuring the impact of the prosecution. The narrative highlights the complexities and risks of error involved in health care. Survey results show that the prosecution has increased the level of insecurity among nurses and raised awareness of the risk involved to themselves in their job. This court case established a precedent and constitutes a defining moment in the health care system. While accountability mechanisms were in their infancies in the system, health professionals in Iceland lost their immunity with a possible setback for the fostering of effective professional accountability mechanisms and devastating consequences for patient safety.