Choi, Ji-an Keum, Kyeong-lim Choi, Seon-yeong Kim, Myung-Ja

Development of an Instrument to Measure Knowledge, Skills and Attitude for Patient Safety among Nursing Officers & Civilian Nurses of Military Hospitals Choi, Ji-an Keum, Kyeong-lim Choi, Seon-yeong Kim, Myung-Ja

Contents 001 Study Purpose 002 Methodology 003 Result 004 Conclusion Suggestion

001 Study Purpose

Study purpose (3-1) Importance of Patient Safety in Hospital settings Patient Safety strategies worldwide ROK. JCI since 2000, Accreditation since 2010 Nurses effort toward Patient Safety Quality improvement

Study purpose (3-2) Another Patient Safety Strategy? Research works related to Patient safety Perceived CULTURE, Reporting Civilian Nurses, Nursing students Nursing Education on capability(ksa)

Study purpose (3-2) Another Patient Safety Strategy? QSEN(Quality But the ideas for and what Safety to Education for Nurses) teach, Researches how to related teach, and to Patient how to safety Lack of ideas Patient assess learning of the Teamwork about competencies Perceived what to teach, CULTURE, How to teach, are sorely Report lacking, PS Centered Collaboration how to assess learning Care of and the Civilian competencies there are Nurses, few, if Nursing students any, examples of schools Funded claiming Nursing by the EBP Quality to execute Education a on capability(kas) Improvement Robert Wood Johnson Foundation comprehensive TWO quality versions and safety curriculum. : DEFINING Nurses, pre-licensure THE Nurses Safety Informatics COMPETENCIES Cronenwett, L. et al(2007). Quality and safety education for nurses. Nurs Outlook 2007;55:122-131.

Study purpose (3-2) Another Patient Safety Strategy? Researches related to Patient safety Perceived CULTURE, Reporting Civilian Nurses, Nursing students Nursing Education on capability(ksa) Patient Safety KNOWLEDGE, SKILLS, ATTITUDE among nurses in ROK military (civilians, officers)

Study purpose (3-3) Verify factors of patient safety KSA Develop MEASUREMENT for KSA

002 Methodology

Methodology (3-1) Sound Psychometric Properties Comprehensive literature review Pilot Questionnaire QSEN, JC National Patient Safety Goals, ROK standards 87 items Scale : Knowledge(Y or N) Skills/Attitude(4-point Likert scale) Content Validity 10 experts CVI : Knowledge(.83), Skills(.85), Attitude(.79) 14 items omitted Total 73 items Data Collection(Questionnaire) 443 nursing officers and civilian nurses

Methodology (3-2) Construct Validity Sound Psychometric Properties Exploratory Factor Analysis(Varimax) Reliability Cronbach s α Kuder-Richadson-20(KR-20) Level of Difficulty Knowledge

003 Result

Result (4-1) Demographic Data Age : 28yrs on average (21-51 yrs) Have worked for 5 years on average Sex Degree Position Male Master s Civilian Nurses Female Baccalaureate Nr. Officer Rank Second Lieutenant Captain Lieutenant PS Work Experience No Yes

Result (4-2) Knowledge 17 items (Yes/No answer) Standard-based, Validity test Level of Difficulty Cangelosi(1993) Level of Difficulty How many Items No. Hard (<.25) Moderate (.25~.75) Easy (>.75) Reliability : r KR20 =.34 3 2,4,11 4 5,12,15,16 10 Score : 0~17 points (11.58±1.7 on average) 1,3,6,7,8,9, 10,13,14,17

Result (4-2) Knowledge No. Item 1 Collaboration between healthcare professionals affect patient safety. 2 Verbal order is valid when DNR and chemotherapy is conducted. 3 4 5 Sentinel events should be reported to a direct supervisor or a secretary of the patient safety council. It is allowable to apply restraints to a patient in order to prevent him/her from removing a mechanical ventilator spontaneously. When a mechanical ventilator is applied, low pressure alarm can be initiated when ventilator circuit is bent or airway secretion increases. 6 Defibrillator should be mobilized within 3-4 minutes. 7 A person who experienced emotional shock recently has a high risk of falldown. 8 Warm/Cooling methods should not be applied to a patient who does not feel the temperature appropriately. 9 For those who have a high risk of suicide, it can be prevented by regular rounds. 10 Against violent patients, it is required to work with a security team, rather than responding him/herself alone.

Result (4-2) Knowledge No. 11 12 13 Item The process to use fire extinguisher is as follow: press the handle, remove a safety pin and splash it. To prepare 1:20,000 of epinephrine, mix 5cc of 0.1% epinephrine to 95cc of normal saline. Alarming notice should be attached to a storage of high-concentration electrolytes substance. The notice is "Do not directly administer via vein, Required to mix with solution and infuse. Check out dosage" 14 Protective gear should be used to protect myself from chemo-agents. 15 As fatigue occurring during transfusion is the common symptom, transfusion should not be stopped and close observation needs to be done. 16 Standard precaution is needed to take care HIV-positive individuals or suspects. 17 Systematic quality improvement efforts contribute to an improvement of patient safety.

Result (4-3) Skills 5 Dimensions, 30 items (4-point Likert Scale) Content, construct validity (Factor analysis) Reliability : Cronbach s α.94 (.64 ~.89) Major Practice Error Management Rare Error Management Patientcentered Care Safety Habit Score : 30 ~ 120 points (98.7 ± 10.9 on average)

Result (4-3) Skills No. Item 1 I apply the nursing process for every nursing practice. 2 I assess patient's needs before I provide nursing care. 3 I know my patient's personal characteristics. 4 I communicate with healthcare professionals freely for patient care. 5 I can present evidence for nursing care I provide. 6 I utilize 2(or more) patient identifiers. 7 I confirm a surgery site before a surgery, by promoting patient participation. 8 9 I check out if an informed consent for invasive/non-invasive procedure is obtained by a doctor. I can administer correct doses of CPR medications in a emergency crash cart to patients through a correct route. 10 I can evaluate location, stage and size of bed sore.

Result (4-3) Skills No. 11 I report every falldown case by writing a "safety report form" through a report system. 12 13 14 15 When transferring a critical patient, I bring medical team members with me and if needed, I prepare emergency medicines and instruments as well. Item I follow 7 Rs(correct patient, drug, dose, time, route, documentation, and reason) when administering a medication. I check out basic information of medication such as its name, ingredients, contents, effects, regimen, and dosage. If verbal order is inevitable, I read back, reconfirm, and write down the order, and retrieve written order as soon as possible. 16 I prepare a medication and directly administer it to patient by myself. 17 I administer a medication that a patient brings after confirming with a physician in charge. 18 19 For medications with similar looking, name and code, I store those in separate containers because of medication errors. I manage emergency medicines; for example, inspect emergency medicine's storage and supplement, and maintain the list of medicines and their expired dates. 20 I hand over narcotics(name, number, dosage, etc) to a nurse of the next shift.

Result (4-3) Skills No. Item 21 I check out blood products with other healthcare professionals. 22 I discard medical waste following regulations. 23 I do not leave medical records or information unattended. 24 I correctly fill out a "safety report form" when a medical error occurs. 25 I analyze a situation to find out reasons of an error. 26 I support and advise a colleague about how to respond to a medical error. 27 I report a medical error to a supervisor. 28 I know and perform hand washing method correctly. 29 I always check out if patients keep bed siderails upstanding. 30 I always lock the wheels of beds and wheelchairs when transferring a patient.

Result (4-4) Attitude 4 Dimensions, 26 items (4-point Likert Scale) Content, construct validity (Factor analysis) Reliability : Cronbach s α.90 (.61 ~.82) Safety Practice Error Management Patientcentered Care Ethics Score : 26 ~ 104 points (80.0 ± 7.9 on average)

Result (4-4) Attitude No. Item 1 It is imperative to apply scientific nursing process in order to provide patient-centered care. 2 It is required to think all the situations happening in a hospital from patient's perspectives. 3 I try to understand preferences and diversity that patients have when providing nursing care. 4 I contribute to patient safety as a member of a medical team. 5 It is important to apply new knowledge in order to supplement and develop current nursing practices. 6 It is required to review educational contents delivered to patients after patient education. 7 It is required to inform a patient of everything about treatment under non-emergency conditions. 8 CPR team training should be held regularly(quarterly or half-yearly) 9 Possibility of bed sore should be evaluated for every patient, using a bed sore evaluation tool. 10 Possibility to fall down should be reminded for every patient in a hospital(both inpatient and outpatient units)

Result (4-4) Attitude No. 11 12 Item It is important to control pain through either pharmacological or non-pharmacological intervention. When physical restraint is needed, alternative methods should be considered as well as direct restraint band application. 13 Quality improvement activities should meet ethical standards. 14 It is important to monitor indicators for patient safety and quality improvement. 15 Patient information(medical and personal) should be protected 16 Skilled healthcare professionals do not commit errors harming patients. 17 Only doctors can verify reasons of medical errors. 18 19 Healthcare professionals should recognize that there might be an uncertainty in a process of caring patients. Organizational culture plays a key role when healthcare professionals deal with medical errors systematically. 20 Methods to improve patient safety should be incorporated into nursing curriculum.

Result (4-4) Attitude No. 21 Item Healthcare professionals should regularly share information about an error and its reasons when an error occurs. 22 Healthcare professionals should report medical errors and related data regularly. 23 An error reporting system diminishes the occurrence of medical error. 24 When an error occurs, healthcare professionals should notice a patient and his/her family about it. 25 If an error does not harm a patient, it is not needed to mention about it. 26 When I witness a medical error, I will keep it a secret.

004 Conclusion Suggestion

Conclusion Instrument to measure Individual level of Patient safety Knowledge, Skills and attitude Looking at Areas to be improved Evaluating education outcomes

Suggestion Study to increase reliability in Knowledge Study to verify validity and reliability of the tool Assess the level of Patient Safety KSA among military nurses Utilize as a basic data to create educational programs

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