Esther Hjälmhult

Adjusting team involvement: a grounded theory study of challenges in utilizing a surgical safety checklist as experienced by nurses in the operating room

BackgroundEven though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance. In this grounded theory study we aimed to explore the challenges and strategies of performing the WHO’s Safe Surgical Checklist as experienced by the nurses appointed as checklist coordinators.MethodsGrounded theory was used in gathering and analyzing data from observations of the checklist used in the operating room, in conjunction with single and focus group interviews. A purposeful sample of 14 nurse-anesthetists and operating room nurses as surgical team members in a tertiary teaching hospital participated in the study.ResultsThe nurses’ main concern regarding checklist utilization was identified as “how to obtain professional and social acceptance within the team”. The emergent grounded theory of “adjusting team involvement” consisted of three strategies; distancing, moderating and engaging team involvement. The use of these strategies explains how they resolved their challenges. Each strategy had corresponding conditions and consequences, determining checklist compliance, and how the checklist was used.ConclusionEven though nurses seem to have a loyal attitude towards the WHO’s checklist regarding their task work, they adjusted their surgical team involvement according to practical, social and professional conditions in their work environment. This might have resulted in the incomplete use of the checklist and therefore a low compliance rate. Findings also emphasized the importance of: a) management support when implementing WHO’s Safe Surgical Checklist, and b) interprofessional education approach to local adaptation of the checklists use.

Critical appraisal of health claims: science teachers’ perceptions and practices

Purpose – Critical appraisal skills are necessary to navigate the numerous contradictory and pseudo-scientific claims in the popular media. Health and science education in schools is essential for promoting these skills in students. The purpose of this paper is to explore lower secondary school science teachers’ perceptions and reported practices related to teaching critical appraisal of health claims. Design/methodology/approach – Interpretive description strategy guided the study process. A purposeful sample of 25 Norwegian teachers was interviewed individually or in groups. Interviews were analysed using the constant comparative method. Findings – One main theme, “unexploited opportunities for teaching critical appraisal”, and three sub-themes were identified: “inattentive to the relevance of critical appraisal”, “prioritise facts over critical appraisal”, “limited competency in critical appraisal”. Teachers’ descriptions of science sessions devoted to health education uncovered important opportunities...