Discussion Question
1.Describe a clinical experience that was troubling to you.Describe what bothered you about the experience and what could have you done differently utilizing critical thinking.
2. 3 paragraphs of 3 sentences each.
3. 2 references not older than 2015.
4. APA style.
Patient Safety and
Professional
Chapter 8
Patient Safety
Ensures that nursing practice is safe, effective,
efficient, equitable, timely, and patient-centered
(ANA)
Minimization of risk of harm to patients and
providers through both system effectiveness and
individual performance (QSEN & NOF)
To Err is Human: Building a Safer
Health System (IOM, 2000)
At least 44,000 and possibly up to 98,000
people die each year as the result of
preventable harm
Cause of the errors is defective system
processes that either lead people to make
mistakes or fail to stop them from making a
mistake, not the recklessness of individual
providers
Error
Error is the failure of a planned action to be
completed as intended, or the use of a wrong
plan to achieve an aim with the goal of
preventing, recognizing, and mitigating harm
Common errors include drug events and
improper transfusions, surgical injuries and
wrong-site surgeries, suicides, restraint-related
injuries or death, falls, burns, pressure ulcers,
and mistaken patient identities (IOM, 2000)
Event Analysis
Individual approach or system approach
Culture of blame
Culture of safety
Just culture
Root-cause analysis
TERCAP
Reasons Adverse Event Trajectory
Classification of Error
Type of error
Communication
Patient management
Clinical performance
Where the error occurs
Latent failure and active failure
Organizational system failures and system process
or technical failure
Human Factor Errors
Skill-based
Deviation in the pattern of a routine activity such
as an interruption
Knowledge-based
Rule-based
Conscious decision by the nurse to workaround
or take a shortcut, so the system defense
mechanisms are bypassed, thereby increasing risk
of harm to patient
To Err is Human: Building A Safer
Health System (IOM, 2000) (1 of 2)
User-centered designs with functions that make
it hard or impossible to do the wrong thing
Avoidance of reliance on memory by
standardizing and simplifying procedures
Attending to work safety by addressing work
hours, workloads, and staffing ratios
Avoidance of reliance on vigilance by using
alarms and checklists
To Err is Human: Building A Safer
Health System (IOM, 2000) (2 of 2)
Training programs for interprofessional teams
Involving patients in their care; anticipation of
the unexpected during organizational changes
Design for recovery from errors
Improvement of access to accurate, timely
information such as the use of decision-making
tools at the point of care
Crossing the Quality Chasm: A New
Health System for the 21st Century
(IOM, 2000)
STEEEP
Safe
Timely
Effective
Efficient
Equitable
Patient-centered
10 rules for redesign
Rule #6: Safety is a
system property
Keeping Patients Safe: Transforming the
Work Environment of Nurses
(IOM, 2004)
Chief nursing executive should have leadership role
in the organization
Creation of satisfying work environments for nurses
Evidence-based nurse staffing and scheduling to
control fatigue
Giving nurses a voice in patient care delivery
Designing work environments and cultures that
promote patient safety
Preventing Medication Errors: Quality
Chasm Series (IOM, 2006)
Paradigm shift in the patient-provider
relationship
Using information technology to reduce
medication errors
Improving medication labeling and packaging
Policy changes to encourage the adoption of
practices that will reduce medication errors
Joint Commission National
Patient Safety Goals
Reviewed and updated annually, focuses on
system-wide solutions to problems
2015 goals: Identify patients correctly, use
medications safely, improve staff
communication, use alarms safely, prevent
infection, identify patient safety risks, and
prevent mistakes in surgery
National Quality Forum Goals
Improve quality health care by setting
national goals for performance improvement
Endorsement of national consensus standards
for measuring and public reporting on
performance
Promoting the attainment of national goals
National Quality Forum Safe Practices
Endorsed safe practices defined to be
universally applied in all clinical settings in
order to reduce the risk of error and harm for
patients
34 practices have been shown to decrease the
occurrence of adverse health events
Also endorses list of 29 preventable, serious
adverse events for public reporting
Sentinel Events
An unexpected occurrence involving death or
serious physical or psychological injury or the
risk thereof
Examples include wrong patient events, wrong
site events, wrong procedures, delays in
treatment, operative or postoperative
complications, retention of foreign body,
suicides, medication errors, perinatal death or
injury, and criminal events
Progress
Healthcare organizations have responded to
incentive programs, accreditation standards, and
public opinion
Professional organizations have responded with
revisions to standards that place more emphasis
on healthcare quality and patient safety
Educators have responded by infusing quality
and safety concepts into student didactic and
clinical experiences guided by initiatives such as
the QSEN and Nurse of the Future
Patient Narratives
A short video sharing the story of Josie King is
available at: https://youtu.be/Mp8Kq3ajv3w
A short video about The Betsy Lehman Center for
Patient Safety and Medical Error Reduction is
available at: https://youtu.be/wwB88zF4wvU
The Chasing Zero: Winning the War on Healthcare
Harm video is available at:
The Transparent HealthLewis Blackman Story
video is available at: https://youtu.be/Rp3fGp2fv88
https://youtu.be/Mp8Kq3ajv3w
Why Is Critical Thinking Important in
Nursing Practice?
Essential to providing safe, competent, and
skillful nursing care
The inability of a nurse to set priorities and
work safely, effectively, and efficiently may
delay patient treatment in a critical situation and
result in serious life-threatening consequences
Thinking Like a Nurse
Clinical judgment
Clinical reasoning
Mindfulness
Clinical Judgment (1 of 2)
Clinical judgments are more influenced by
what nurses bring to the situation than the
objective data about the situation at hand
Sound clinical judgment rests to some degree
on knowing the patient and his or her typical
pattern of responses, as well as engagement
with the patient and his or her concerns
Clinical Judgment (2 of 2)
Clinical judgments are influenced by the
context in which the situation occurs and the
culture of the nursing unit
Nurses use a variety of reasoning patterns
alone or in combination
Reflection on practice is often triggered by a
breakdown in clinical judgment and is critical
for the development of clinical knowledge and
improvement in clinical reasoning
Critical Thinking and Clinical
Judgment in Nursing
Purposeful, informed, outcome-focused thinking
Carefully identifies key problems, issues, and risks
Based on principles of the nursing process, problem
solving, and the scientific method
Applies logic, intuition, and creativity
Driven by patient, family, and community needs
Calls for strategies that make the most of human
potential
Requires constant reevaluating
Characteristics of Critical Thinking
Rational and reasonable
Involves conceptualization
Requires reflection
Includes cognitive skills and attitudes
Involves creative thinking
Requires knowledge
Characteristics of a Critical Thinker (1 of 2)
Flexible
Bases judgments on facts and reasoning
Doesnt oversimplify
Examines available evidence before drawing
conclusions
Thinks for themselves
Remains open to the need for adjustment and
adaptation throughout the inquiry
Characteristics of a Critical Thinker (2 of 2)
Accepts change
Empathizes
Welcomes different views and values
examining issues from every angle
Knows that it is important to explore and
understand positions with which they disagree
Discovers and applies meaning to what they
see, hear, and read
Approaches to Developing Critical
Thinking Skills
Nursing process
Concept mapping
Journaling
Group discussions
Nursing Process
Assessment
Diagnosis
Outcome identification
Planning
Implementation
Evaluation
Concept Mapping
Visual representation of the relationships
among concepts and ideas
Useful for summarizing information,
consolidating information from different
sources, thinking through complex problems,
and presenting information in a format that
shows an overall structure of the subject
Journaling
Allows you to view your own thinking,
reasoning, and actions
Helps create and clarify meaning and new
understandings of experiences
Should be able to recall what you did or would
do differently and reasoning when you
encounter a similar situation
Journaling Suggestions
What happened?
What are the facts?
What feelings and
senses surrounded the
event?
What did I do?
How and what did I
feel about what I did?
What was the setting?
What were the
important elements of
the event?
What preceded the
event, and what
followed it?
What should I be aware
of if the event recurs?
Group Discussions
Cooperative learning occurs when groups
work together to maximize learning
Explore alternatives
Different scenarios of What if?, What else?,
and What then?
Arrive at conclusions
Connect clinical events or decisions with
information obtained in the classroom
