Keeping Patients Safe:: Transforming the Work Environment of Nurses

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National Academies Press, Feb 27, 2004 - Medical - 488 pages
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Building on the revolutionary Institute of Medicine reports To Err is Human and Crossing the Quality Chasm, Keeping Patients Safe lays out guidelines for improving patient safety by changing nurses' working conditions and demands.

Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform - monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis - provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system.

During the past two decades, substantial changes have been made in the organization and delivery of health care - and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk.

This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.

  

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Contents

Nursing Inseparably Linked to Patient Safety
23
THOUSANDS OF HEALTH CARE ERRORS
24
WHY HEALTH CARE ERRORS OCCUR
27
THE CENTRAL ROLE OF NURSES IN PATIENT SAFETY
31
PATIENT SAFETY RISK FACTORS IN NURSES WORK AND WORK ENVIRONMENTS
37
THREATS TO PATIENT SAFETY POSED BY WORK ENVIRONMENT FACTORS
46
ESSENTIAL TO PATIENT SAFETY
47
REFERENCES
49
SUPPORTING KNOWLEDGE AND SKILL ACQUISITION AND CLINICAL DECISION MAKING
201
FOSTERING INTERDISCIPLINARY COLLABORATION
212
REFERENCES
218
Work and Workspace Design to Prevent and Mitigate Errors
226
DESIGN OF WORK HOURS
227
DESIGN OF WORK PROCESSES AND WORKSPACES
239
REFERENCES
277
Creating and Sustaining a Culture of Safety
286

A Framework for Building Patient Safety Defenses into Nurses Work Environments
53
THE NEED FOR BUNDLES OF MULTIPLE MUTUALLY REINFORCING PATIENT SAFETY DEFENSES
55
AN EVIDENCEBASED MODEL FOR SAFETY DEFENSES EN WORK ENVIRONMENTS
56
UNIQUE FEATURES OF HEALTH CARE THAT HAVE IMPLICATIONS FOR PATIENT SAFETY DEFENSES
61
REFERENCES
63
Nurses Caring for Patients Who They Are Where They Work and What They Do
65
WHERE NURSES WORK
76
WHAT NURSES DO
89
REFERENCES
101
Transformational Leadership and EvidenceBased Management
108
THE ESSENTIAL PRECURSOR
109
FIVE ESSENTIAL MANAGEMENT PRACTICES
112
UNEVEN APPLICATION OF EVIDENCEBASED MANAGEMENT PRACTICES EM NURSES WORK ENVIRONMENTS
131
MODELS OF EVIDENCEBASED MANAGEMENT IN NURSES WORK ENVIRONMENTS
147
USE OF EVIDENCEBASED MANAGEMENT COLLABORATTVES TO STIMULATE FURTHER UPTAKE
153
REFERENCES
156
Maximizing Workforce Capability
162
PROMOTING SAFE STAFFING LEVELS
163
ESSENTIAL ELEMENTS OF AN EFFECTIVE SAFETY CULTURE
287
NEED FOR A LONGTERM COMMITMENT TO CREATE A CULTURE OF SAFETY
295
BARRIERS TO EFFECTIVE SAFETY CULTURES FROM NURSING AND EXTERNAL SOURCES
299
PROGRESS IN CREATING CULTURES OF SAFETY
303
NEED FOR ALL HCOS TO MEASURE THEIR PROGRESS IN CREATING CULTURES OF SAFETY
307
RECOMMENDATIONS
309
REFERENCES
310
Implementation Considerations and Needed Research
312
HEALTH CARE ORGANIZATIONS AND OTHER PARTIES SHOULD NOT WAIT TO ACT
313
MULTIPLE MUTUALLY REINFORCING SAFEGUARDS ARE NEEDED
315
BENEFITS IN ADDITION TO PATIENT SAFETY ARE LIKELY
316
ADDITIONAL RESEARCH IS REQUIRED TO FURTHER INCREASE PATIENT SAFETY
322
RECOMMENDATION
325
Committee Membership and Study Approach
329
Interdisciplinary Collaboration Team Functioning and Patient Safety
341
Work Hour Regulation in SafetySensitive Industries
384
Index
437
Copyright

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