Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study

Collier, Aileen; Sorensen, Ros; Iedema, Rick

doi:10.1093/intqhc/mzv095

Cited by 51 publications

(65 citation statements)

References 28 publications

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“…Finally, similar to other reviews, this study has focused purely on quality measurement, without inclusion of safety 3 5 10. Despite some progress noted in healthcare safety measurement over the past 15 years, considerable work is required to enable this in a systematic way22 for people with end-of-life care needs 30…”

Section: Discussionmentioning

confidence: 99%

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan

Virdun

Luckett

Lorenz

et al. 2018

BMJ Support Palliat Care

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Section: Discussionmentioning

confidence: 99%

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan

Virdun

Luckett

Lorenz

et al. 2018

BMJ Support Palliat Care

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“…These findings highlight an ongoing tension in nursing practice between a depersonalised and mechanistic approach to care delivery and the quality and safety of care (Kitson et al, ). As patients ascribe iatrogenic harm to relational and physical omissions of care, this is an important area for innovation (Collier, Sorensen, & Iedema, ; Doyle, Lennox, & Bell, ). As enquiry into health system failures demonstrate, health contexts which prioritise efficiencies (i.e.…”

Section: Discussionmentioning

confidence: 99%

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

Dale

Angus

Sutherland

et al. 2019

Journal of Clinical Nursing

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Aim:To explore descriptors of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care, consequences, modifiable antecedents and recommendations for improving care delivery.Background: Nurses report oral access and care delivery difficulty in most mechanically ventilated patients. Design:A prospective qualitative descriptive design.Methods: Data were collected using video and photographic elicitation interviews focused on delivery of oral care. Directed content analysis was used to explore descriptive categories. Reporting used the SRQR guidelines. Setting and participants:A university-affiliated hospital in Toronto, Canada.Participants included clinicians experienced in accessing the oral space of adults representing nursing, medicine, dentistry and allied health professionals.Findings: We recruited 18 participants; 9 representing critical care and 9 other specialties frequently accessing the mouth, that is dentistry. Descriptors for observed difficulty accessing the oral cavity were "oral crowding with tubes" and "aversive patient responses", which were considered to result in insufficient oral care.Participants perceived aversive patient responses (e.g. biting, turning head side to side, gagging, coughing) as a consequence of forced introduction of instruments inside a crowded mouth. A key finding identified by participants was the observation of substantial procedural pain during oral care interventions. Potentially modifiable antecedents to difficult oral care delivery identified were procedural pain, oral health deterioration (e.g. xerostomia) and lack of interprofessional team problem-solving.Recommendations to address these antecedents included patient preparation for oral care through verbal and nonverbal cueing, pharmacological and nonpharmacological strategies, and ICU interprofessional education. Conclusions:Oral care in mechanically ventilated adults is complex and painful. Visual research methods offer important advantages for oral care exploration including its | 1921 DALE Et AL.

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“…Video reflexive ethnography, developed by Iedema and colleagues [53], could be used to explore WAD. Video footage of real-time practices is shown back to participants in small groups where they collectively reflect to make sense of their work and negotiate meaningful, contextappropriate ways to improve their practices [54,55,53,56], Some models to study RHC had not incorporated sufficient details to enable problems to be understood and/or resolved in meaningful and comprehensive ways [25]. Current methods for studying RHC represent efforts to improve the understanding of RHC.…”

Section: Rhcmentioning

confidence: 99%

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Iflaifel

Lim

Ryan

et al. 2019

Preprint

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Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC was conceptualised, described and interpreted, to describe the methods used to study, and to identify factors that develop RHC. Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search for studies published in books that explained how RHC as a concept was interpreted, methods used to study, and factors to develop RHC. Studies were evaluated independently by two researchers. Data was synthesised using a deductive thematic approach. Results Twenty-seven studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods such as observations and interviews were used to study RHC. Models for studying RHC currently exist and were in the early stages of implementation. Effective team relationships, trade-offs and healthcare ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and factors to develop RHC, further research should focus on operationalising RHC assessment methods and developing, testing and evaluating interventions for developing RHC.

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Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study

Abstract: Current approaches to patient safety do not address fully the needs of dying patients and their families. Patients and their families regard poor communication with and by health professionals to be harmful in and of itself.

Cited by 51 publications

References 28 publications

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

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