Gunilla Mårtensson

SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study

Objectives We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors. Design A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation. Setting Anaesthetic clinics at two hospitals in Sweden. Participants All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and postanaesthesia care units at anaesthetic clinics in two hospitals were invited to participate. Intervention Implementation of SBAR in an anaesthetic clinic. Primary and secondary outcomes The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication. Results In the intervention group, there were statistically significant improvements in the factors ‘Between-group communication accuracy’ (p=0.039) and ‘Safety climate’ (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%. Conclusions Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors. Trial registration ISRCTN37251313.

Mental health nursing staff's attitudes towards mental illness : an analysis of related factors

Accessible summary Employer/workplaces have an impact on mental health nursing staffs general attitudes towards persons with mental illness. Staff have more positive attitudes if their knowledge about mental illness is less stigmatized and currently have or have once had a close friend with mental problem. More favourable attitudes among staff towards persons with mental illness could be developed and transmitted in the subculture at work places. Abstract There is growing awareness that mental illness is surrounded by negative attitudes and stigmas. The aim of the present study was to investigate factors associated with mental health nursing staffs attitudes towards persons with mental illness. Data were collected from 256 mental health nursing staff employed by one county council and 10 municipalities. The findings show that staff have more positive attitudes towards persons with mental illness if their knowledge about mental illness is less stigmatized, their work places are in the county council, and they currently have or have once had a close friend with mental health problems. The multiple regression model explained 16% of the variance; stigma-related knowledge and employer had significant Beta-coefficients. To account for unknown correlations in data, a linear generalized estimating equation was performed. In this model, stigma-related knowledge and employer remained significant, but a new significant factor also emerged: personal contact, i.e. currently having or having once had a close friend with mental health problems. This indicates correlations at unit level in the county council and in the municipalities. The conclusion is that more favourable attitudes among staff towards persons with mental illness could be developed and transmitted in the subculture at work places.

Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers : A prospective interventional study of postoperative handovers

BACKGROUND Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking. OBJECTIVE The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers’ information retention after postoperative handover. DESIGN A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention. SETTING The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012. PARTICIPANTS Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital. INTERVENTION Implementation of the communication tool SBAR in one hospital. MAIN OUTCOME MEASURES The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form. RESULTS Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time. CONCLUSION Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover. TRIAL REGISTRATION Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.

The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses

Objectives To investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover. Design A focus group interview study with a descriptive design using qualitative content analysis of transcripts. Setting One anaesthetic clinic at two hospitals in Sweden. Participants Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8). Results Patterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patients privacy and that frequent interruptions could be disturbing. Conclusions The present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care.

Mental health nursing staff's attitudes towards mental illness: an analysis of related factors: Nursing staff's attitudes towards mental illness

Accessible summary Employer/workplaces have an impact on mental health nursing staffs general attitudes towards persons with mental illness. Staff have more positive attitudes if their knowledge about mental illness is less stigmatized and currently have or have once had a close friend with mental problem. More favourable attitudes among staff towards persons with mental illness could be developed and transmitted in the subculture at work places. Abstract There is growing awareness that mental illness is surrounded by negative attitudes and stigmas. The aim of the present study was to investigate factors associated with mental health nursing staffs attitudes towards persons with mental illness. Data were collected from 256 mental health nursing staff employed by one county council and 10 municipalities. The findings show that staff have more positive attitudes towards persons with mental illness if their knowledge about mental illness is less stigmatized, their work places are in the county council, and they currently have or have once had a close friend with mental health problems. The multiple regression model explained 16% of the variance; stigma-related knowledge and employer had significant Beta-coefficients. To account for unknown correlations in data, a linear generalized estimating equation was performed. In this model, stigma-related knowledge and employer remained significant, but a new significant factor also emerged: personal contact, i.e. currently having or having once had a close friend with mental health problems. This indicates correlations at unit level in the county council and in the municipalities. The conclusion is that more favourable attitudes among staff towards persons with mental illness could be developed and transmitted in the subculture at work places.