God kommunikation är kvalitetssäkring av god vård. Vid patientöverlämning prövas kommunikationen och det föreligger risk att information faller bort eller tolkas olika. Det har visats i tidigare studier att vårdskador uppkommit på grund av bristande kommunikation och att inom akutsjukvården är risken än högre för patientsäkerhetsincidenter. Med hjälp av olika kommunikationsverktyg har svensk sjukvård eftersträvat att öka patientsäkerheten vid överlämnande av patient, varav det mest vedertagna är SBAR som står för Situation, Bakgrund, Aktuellt och Rekommendation. Syftet med denna studie var att beskriva hur kommunikationsverktyget SBAR påverkar patientsäkerheten vid överlämnandet av patient inom akutsjukvården. Metoden för studien var en litteraturöversikt med en systematisk ansats med både kvantitativ och kvalitativ design. Litteratursökning utfördes systematiskt i databaserna CINAHL och PubMed och data analyserades utifrån Bettany-Saltikov och McSherrys standardiserade integrerade analysmetod. Resultatet presenterades i tre kategorier vilka var: Kvalitativ överlämning med SBAR, Patientsäkerheten ökade med SBAR och Överlämningstiden förlängdes utan att påverka patientsäkerheten. Samt två underkategorier: SBAR ökade kvaliteten på patientöverlämningen och Strukturen påverkade patientöverlämningens kvalitet. SBAR gav en förbättrad och mer patientsäker patientöverlämning men överlämningsstrukturen påverkades både positivt och negativt samt tidsåtgången för patientöverlämnandet ökade.  Studiens slutsats var att SBAR i stor utsträckning ökade patientsäkerheten genom att ge en mer kvalitativ patientöverlämning och genom att förbättra mätbara och upplevda patientsäkerhetsaspekter. Likväl gav SBAR också viss negativ påverkan på patientsäkerheten. / Good communication is quality assurance of good care. During patient handover communication is tested and there is a risk that information is lost or interpreted differently. It has been shown in previous studies that healthcare injuries occur due to a lack of communication and that in emergency healthcare the risk is even higher for patient safety incidents. With the help of various communication tools Swedish healthcare has strived to increase patient safety when handing over patients, of which the most accepted is SBAR which stands for Situation, Background, Assessment and Recommendation. The purpose of this study was to describe how the communication tool SBAR affects patientsafety during the handover of patients in emergency healthcare. The method for the study was a literature review with a systematic approach with both quantitative and qualitative design. A literature research was systematically performed in the CINAHL and PubMed databases and the data were analyzed based on Bettany-Saltikov and McSherry's standardized integrated analysis method. The results were presented in three categories which were: Qualitative handover with SBAR, Patient safety increased with SBAR and Handover-time was extended without affecting patient safety. As well as two subcategories: SBAR increased the quality of patient handover and Structure affected the quality of patient handover. SBAR provided an improved and more patient-safe patient handover but the handover structure was affected both positively and negatively and the time required for patient handover increased. The study's conclusion was that SBAR increased patient safety to a large extent by providing a more qualitative patient handover and through measurable and perceived patient safety aspects. Nevertheless SBAR also had some negative impact on patient safety.

Syftet var att beskriva faktorer som kan påverka patientsäkerheten vid crowding på akutmottagningar. Designen som använts är en allmän litteraturöversikt med systematisk metod där data har samlats in genom sökningar i vetenskapliga databaser. Artiklar som har inkluderats har varit publicerade mellan år 2017–2022, skrivna på engelska och granskade av oberoende forskare. Resultatet visade att crowding på akutmottagningar får konsekvenser på flera plan och att orsakerna till crowding är flera. Dödligheten, vårdskador och missnöjdheten hos patienterna ökade. Orsaken till detta var blanda annat att inflödet av patienter var större än utflödet. Lokalerna var inte dimensionerade och anpassade för den ökad mängd patienter som vistades samtidigt på akutmottagningarna, vilket fick konsekvensen att korridorer och tillfälliga utrymmen användes till patientvård. Sjuksköterskorna som arbetade på akutmottagningarna hade då inte möjlighet att bedöma och reevaluera alla patienter de ansvarar för vilket ledde till att försämringar missas och orsakar lidande. Slutsatsen var att patientsäkerheten är hotad av crowding på akutmottagningar. Sjukvårdspersonal gavs inte möjligheten att bedriva patientsäker och personcentrerad vård när akutmottagningarna var högt belastade vilket kunde leda till att sjukvårdpersonalen upplevde stress och en negativinställning till sin arbetsplats. Genom att belysa riskerna kan sjukvårdspersonal och arbetsledningar arbeta proaktivt för att förebygga crowding och minska riskerna för vårdskada. / The aim was to describe factors that can affect patient safety in crowded emergency departments. The design used was a general literature review with a systematic method where data has been collected through searches in scientific databases. Articles that have been included was published between year 2017–2022, written in English and reviewed by independent researchers. The results showed that overcrowding in emergency departments had consequences on numerous levels and that the causes of overcrowding was various. Mortality, healthcare injuries, and patient dissatisfaction was increasing. The reason for this was, among other things, that the inflow of patients was greater than the outflow. The premises was not dimensioned and adapted to the increased number of patients staying at the same time in the emergency departments, which had the consequence that corridors and temporary spaces was used for patient care. The nurses who worked in the emergency departments did not have the possibility to assess and re-evaluate all the patients they were responsible for, which leads to deterioration being missed and causing suffering. The conclusion was that patient safety was jeopardized by crowding in the emergency departments. Healthcare staff were not given the opportunity to provide patient-safe and person-centred care when the emergency departments was crowded, which could lead to the healthcare staff experiencing stress and a negative attitude towards their workplace. By emphasising the risks, healthcare staff and work management can work proactively to prevent crowding and reduce the risks of healthcare injury.

Bakgrund: SARS-CoV-2 är ett nytt virus som framkallar infektionssjukdomen covid-19. Covid-19 är en luftvägsinfektion med risk för ett allvarligt sjukdomsförlopp som kräver omfattande och komplex omvårdnad. SARS-CoV-2 utlöste 2019 en pandemi som utmanade vården och påverkade patientsäkerheten. Patientsäkerheten är en grundpelare i sjuksköterskans omvårdnadsarbete. Bristande patientsäkerhet ökar risken för vårdskador och vårdlidande. Syfte: Syftet var att belysa hur covid-19 pandemin påverkade patientsäkerheten inom sluten vård sett ur ett sjuksköterskeperspektiv. Metod: En allmän strukturerad litteraturstudie baserat på fem kvalitativa artiklar, tre artiklar med mixad metod och en kvantitativ artikel. Resultatartiklarna analyserades enligt Popenoe et al. (2021) modell. Resultat: Sjuksköterskorna upplevde covid-19 pandemirelaterade förändringar som påverkade sjuksköterskornas arbetsmiljö och arbetssätt, vilket kunde äventyra patientsäkerheten. Förändringarna som framkom var roterande personal, ökad arbetsbelastning, resursbrist, utebliven omvårdnad, felaktig läkemedelshantering, användning av skyddsutrustning mot covid-19 och bristande kommunikation. Konklusion: Litteraturstudiens resultat visar att covid-19 pandemin innebar utmaningar i sjuksköterskans arbetsmiljö och arbetssätt som äventyrade patientsäkerheten. Sjuksköterskorna axlade det nya vårdandet med en plikt- och ansvarskänslan för sin profession, vilket bidrog till att patientsäkerheten till stor del kunde hållas intakt med ett fåtal brister. / Background: SARS-CoV-2 is a new virus that causes the infectious disease covid-19. Covid-19 is a respiratory infection with the risk of a severe disease course that requires extensive and complex care. In 2019, SARS-CoV-2 triggered a pandemic that challenged healthcare and affected patient safety. Patient safety is a cornerstone of nursing care. Inadequate patient safety increases the risk of health care injuries and suffering. Purpose: The purpose was to illustrate how the covid-19 pandemic affected patient safety in inpatient care from a nurse's perspective. Method: A general structured literature study based on five qualitative articles, three mixed method articles and one quantitative article. The articles were analyzed according to Popenoe et al. (2021) model. Results: The nurses experienced covid-19 pandemic-related changes that affected the nurses' work environment and practices, which could jeopardize patient safety. The changes that emerged were rotating staff, increased workload, lack of resources, lack of nursing care, incorrect medication management, use of protective equipment against covid-19, and lack of communication. Conclusion: The results of the literature study show that the covid-19 pandemic posed challenges in the nurses' work environment and working methods that jeopardized patient safety. The nurses shouldered the new care with a sense of duty and responsibility for their profession, which contributed to the fact that patient safety could largely be kept intact with a few shortcomings.

Simuleringar har använts och används fortfarande inom den anestesiologiska vården som en metod för att öka patientsäkerheten. Tidigare forskning har inte lyckats visa att simuleringar ökar patientsäkerheten. Syftet med arbetet var att undersöka betydelsen av simulering för patientsäkerheten inom den anestesiologiska omvårdnaden. En systematisk litteraturöversikt med integrativ metod har utförts. Litteraturöversikten inkluderade 11 vetenskapliga artiklar med totalt 1608 deltagare. Två huvudteman identifierades med totalt fem subteman. Tekniska och icke-tekniska färdigheter var de två identifierade teman som användes. Tekniska och icke-tekniska färdigheter ökade efter simuleringar. Ingen studie har direkt kunnat påvisa någon ökning av patientsäkerheten. En ökning av tekniska och icke-tekniska färdigheter bör leda till ökad patientsäkerhet. Ny forskning som undersöker simuleringars effekt på patientsäkerheten behövs. / Simulations have been and are still used in anaesthesiological care as a method to increase patient safety. Previous research has not managed to show that simulations increase patient safety. The aim of the review was to investigate the importance of simulation for patient safety in anaesthesiological nursing. A systematic literature review with an integrative method has been performed. The literature review included 11 scientific articles with a total of 1608 participants. Two themes were identified with a total of five subthemes. Technical and non-technical skills were the two identified themes used. Technical and non-technical skills increased after simulations. No study has been able to directly show any increase in patient safety. An increase in technical and non-technical skills should lead to increased patient safety. New research examining the effect of simulations on patient safety is needed.

Patient safety climate is defined as a holistic snapshot of enacted work environment practices and procedures related to patient safety, derived from shared perceptions of social and environmental work characteristics. While patient safety climate has been touted as a critical factor underlying safe patient care, our understanding of input factors influencing shared climate perceptions and, in turn, the effects of climate as a collective, group-level construct on important outcomes remains underdeveloped, both theoretically and empirically. Therefore, the current study examines (1) the antecedents that impact individual patient safety climate perceptions and (2) the relationships between hospital unit patient safety climate and two important unit level outcomes: patient willingness to recommend a facility to others and patient safety. This study also examines climate strength--the degree to which climate perceptions are shared--as a moderator of these relationships. While climate is conceptualized as a holistic description of the working environment, existing evidence has focused on relationships between the independent dimensions of patient safety climate and patient safety. No study to date has examined the configurations (i.e. patterns or profiles) among the multiple dimensions of patient safety climate or how these configurations are related to important employee and patient outcomes. This gap is redressed in the current study by examining patient safety climate in terms of three profile characteristics: (1) climate elevation (i.e., mean positive or negative valence across all dimensions), (2) climate variability (i.e., variance among dimensions), and (3) climate shape (i.e., the pattern of peaks and valleys among climate dimensions). Evidence from studies of general organizational climate suggests that the shape of the pattern among climate dimensions, the overall mean score across dimensions, and the degree to which dimension scores vary are predictive of employee attitudes, customer satisfaction, and organizational financial performance (Dickson et al., 2006; Joyce & Slocum, 1984; Jackofsky & Slocum, 1988; Gonzalez-Roma, Peiro, & Zornoza, 1999; Litwin & Stringer, 1968; Schulte et al., 2009). The current study, then, tests a theoretical model of patient safety climate examining the configural nature of the construct. An archival dataset collected from seven hospitals located in a metropolitan area of the southeastern United States was utilized to test study hypotheses. Data was collected from 3,149 individuals nested within 84 hospital units using the Hospital Survey on Patient Safety Culture (Sorra & Nieva, 2004). Unit level patient safety and patient willingness to recommend was collected by the hospital risk management and nursing administration departments. Hierarchical linear modeling (HLM7; Raudenbush, Bryk, Cheong, Congdon, & du Toit, 2011) was utilized to test hypotheses regarding antecedents of individual level perceptions of patient safety climate to account for the fact that individuals were nested within hospital units. Traditional multiple regression analyses were utilized to test unit level hypotheses examining the relationships between unit level patient safety climate and patient outcomes. Results indicated that unit membership was significantly related to individual climate perceptions--specifically, individual-level climate profile elevation. In turn, individual climate profile elevation and profile variability were related to employee willingness to recommend their organization to family and friends in need of care. At the unit level of analysis, climate profile variability was significantly related to patient willingness to recommend the organization to others, and climate shape was found to be related to patient safety. Furthermore, these results were not dependent on climate strength. The current study meaningfully contributes to the conceptual understanding of the patient safety climate construct by examining the degree to which configural aspects of the construct are predictive of important outcomes across multiple levels of analysis. In this way, it extends beyond existing studies of climate configurations to examine relationships at multiple levels of analysis and to also examine the moderating effects of climate strength. Practically, results provide insight into how the construct of patient safety climate can be used diagnostically and prescriptively to improve patient care and the working environment for providers. In addition to contributing to the theoretical understanding of the patient safety climate construct, this study also augments the evidence-base available to administrators, front-line providers, and regulators regarding how patient safety climate can be used to guide and align quality improvement efforts for greatest impact.

Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses* medication processes, the impact of interruption frequency on nurses* PCA interaction has not been fully measured or described. Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses* (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses* perceptions of the impact of interruption frequency. Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar*s test, and Friedman*s test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs* perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar*s test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses* perception of interruption frequency: the nature of interruptions and nurses* reaction to the interrupted work environment. Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs* described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs* perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs* performance accuracy and cognitive workload.

Patient safety in healthcare has become a national objective. Healthcare organizations are striving to improve patient safety and have turned to high reliability organizations as those in which to model. One initiative taken on by healthcare is improving patient safety culture--shifting from one of a 'no harm, no foul' to a culture of learning that encourages the reporting of errors, even those in which patient harm does not occur. Lacking from the literature, however, is an understanding of how safety culture impacts outcomes. While there has been some research done in this area, and safety culture is argued to have an impact, the findings are not very diagnostic. In other words, safety culture has been studied such that an overall safety culture rating is provided and it is shown that a positive safety culture improves outcomes. However, this method does little to tell an organization what aspects of safety culture impact outcomes. Therefore, this dissertation sought to answer that question but analyzing safety culture from multiple dimensions. The results found as a part of this effort support previous work in other domains suggesting that hospital management and supervisor support does lead to improved perceptions of safety. The link between this support and outcomes, such as incidents and incident reporting, is more difficult to determine. The data suggests that employees are willing to report errors when they occur, but the low occurrence of such reportable events in healthcare precludes them from doing so. When a closer look was taken at the type of incidents that were reported, a positive relationship was found between support for patient safety and medication incidents. These results initially seem counterintuitive. To suggest a positive relationship between safety culture and medication incidents on the surface detracts from the research in other domains suggesting the opposite. It could be the case that an increase in incidents leads an organization to implement additional patient safety efforts, and therefore employees perceive a more positive safety culture. Clearly more research is needed in this area. Suggestions for future research and practical implications of this study are provided.

Insight into opportunities for process improvement provides a competitive advantage through increases in organizational effectiveness and innovation As a result, it is important to understand the conditions under which employees are willing to communicate this information. This study examined the relationship between trust and psychological safety on the willingness to report errors in a medical setting. Trust and psychological safety were measured at the team and leader level. In addition, the moderating effect of a learning orientation climate at three levels of the organization (i.e., team members, team leaders, organizational) was examined on the relationship between trust and psychological safety on willingness to report errors. Traditional surveys and social network analysis were employed to test the research hypotheses. Findings indicate that team trust, when examined using traditional surveys, is not significantly associated with informally reporting errors. However, when the social networks within the team were examined, evidence that team trust is associated with informally discussing errors was found. Results also indicate that trust in leadership is associated with informally discussing errors, especially severe errors. These findings were supported and expanded to include a willingness to report all severity of errors when social network data was explored. Psychological safety, whether within the team or fostered by leadership, was not found to be associated with a willingness to informally report errors. Finally, learning orientation was not found to be a moderating variable between trust and psychological safety on a willingness to report errors. Instead, organizational learning orientation was found to have a main effect on formally reporting errors to risk management and documenting errors in patient charts. Theoretical and practical implications of the study are offered.

Background: One of the ambulance nurse's six core competences is safe care. Safe care meansto conduct care without any unwanted consequences for the patient, their next of kin or anypersonnel from the ambulance team. The environment in the prehospital setting is complex andcontains physical challenges for the ambulance nurse. There is a lot of research on how theambulance nurses safety is affected by their physical ability but there is a lack of research onhow the patient safety is affected. Aim: To explore how patient safety is affected by thephysical ability of the ambulance nurse. Method: A qualitative interview study based on acontent analysis. The participants were eight nurses specializing in ambulance care. Results:The results show that the ambulance nurse's different physical conditions had both positive andnegative effects on patient safety. It was of great importance to have self-awareness of one'sphysical conditions in order to avoid performing risky actions. When the physical ability wasinsufficient, methods such as mobility equipment and help from colleagues were used topreserve the patient safety. Conclusion: It is difficult for ambulance nurses to have a physicalability that meets all patient needs, thus the ambulance nurse was faced with situations wherethe patient care risked not being patient safe. In the case of time-critical patients, they thereforeneeded to weigh up whether the risk of injury during the patient care was less than delaying thetime at the scene in the event of serious injury or illness.

Bakgrund: Ischemisk hjärtsjukdom är den ledande dödsorsaken världen över. Det är avgörande att rätt behandling påbörjas i tid, då det annars kan ha skadliga eller fatala konsekvenser för patienten. Den prehospitala verksamheten är central i arbetet för att uppnå behandling inom målsatt tid.  Syfte: Arbetets syfte var att belysa faktorer som fördröjer behandlingstiden prehospitalt för patienter med hjärtinfarkt. Metod: Studiens metod var en allmän litteraturstudie. En strukturerad litteratursökning genomfördes i databaserna CINAHL complete och PubMed under perioden november 2020-april 2021, med sökorden Myocardial infarction, Emergency medical services, Treatment delay och Time-to-treatment. Totalt inkluderades och granskades 17 studier och en integrerad analys genomfördes.  Resultat: Det framkom faktorer under två kategorier: Patientens roll i fördröjningen och Systemets roll i fördröjningen. Under kategorierna indelades faktorerna i fem övergripande teman: Felaktig bedömning av symtom, Skjuta upp beslutet om att söka vård, Patienternas bakgrund, Försenad eller felaktig triagering samt Transport. Patienterna gjorde felaktiga bedömningar av deras symtom, särskild när de upplevde atypiska symtom på hjärtinfarkt. Känslor av skam, ångest eller osäkerhet gjorde att patienterna dröjde med att söka vård. Information om patienternas bakgrund analyserade. Informationen inkluderade demografiska och socioekonomiska faktorer samt informationer om tidigare sjukdomar och riskfaktorer för utvecklingen av hjärtinfarkt, men inget säkert samband kunde visas med fördröjning. Vårdgivarnas hantering och triagering av patienternas symtom kunde orsaka fördröjning.  Slutsats: Insikt i faktorer som fördröjer behandlingstiden prehospitalt kan användas i den fortgående kvalitetsutveckling av vården för patienter med hjärtinfarkt för att minska risken för vårdskador och död. Patientens perspektiv måste tas i beaktning, och läggas till grund för förbättringsarbetet. Resultatet var vid flera tillfällen motstridiga, och ytterligare forskning behövs inom området för att belysa om det finns ett säkert samband. / Background: Ischemic heart disease is the leading cause of death worldwide. It is crucial that proper treatment is initiated in a timely manner, otherwise it might have detrimental consequences for the patient. Emergency medical services is key in the efforts to achieve treatment within the allotted time.  Aim: The aim of this study was to illustrate the factors which cause prehospital delay in treating patients with heart infarction. Method: The method of the study was a general literature review. A structured literaturesearch was conducted in the databases CINAHL complete and PubMed in the timeframe November 2020- April 2021, with the search frases Myocardial infarction, Emergency medical services, Treatment delay and Time-to-treatment. In all, 17 studies were included and reviewed, and an integrated analysis was carried out.  Result: Two categories emerged: The patients’ role in the delay and The systems’ role in thedelay. Under these categories, the factors were classified into five general themes: Inaccurate assessment of symptoms, Delaying the decision too seek care, Patients’ background, Delayed or Inaccurate triage and Transport. The patients assessed their symptoms inaccurately, especially when they experienced atypical symptoms of a heart infarction. Feelings of shame, anxiety or uncertainty delayed patients in their decision to seek care. Information of patients’ backgrounds were analyzed. The information included demographical and socioeconomical factors, as well as information on medical history and risk factor for developing a heart infarction, but no certain connection could be shown to delay. Delay could also be caused by care providers management and triaging of the patient’s symptoms. Conclusion: Understanding the factors of prehospital treatment delay can be utilized in the continuous work to improve the quality of health care for patients with heart infarction to reduce the risk of injury or death. The patient’s perspective must be taken into consideration, in the efforts to improve quality of care. The result was contradictory in several cases, and additional research is needed to illustrate a definite correlation.