How Medical Error Shapes Physicians' Perceptions of Learning: An Exploratory Study.

Medical errors are one of the major threats for patient safety in all countries. Medication errors are common medical mistakes that can lead to serious consequences and even death of patients. The aim of this study was to explore nurses' perspectives of factors influencing medication errors. This qualitative study based on content analysis included 20 nurses (n = 20) with at least 2 years of clinical experience working in a large teaching hospital. The nurses were selected using purposeful sampling. The data were collected using semi-structured interviews and analysed using deductive content analysis approach based on Reason's human error model. Rigor of the data was confirmed by external and member check. Two themes were identified by the participants: (1) the individual approach including personal and psychological characteristics of nurses, patient medical history and physicians' orders errors; and (2) the cultural and organizational approach including workplace conditions, learning process, risk management strategies, nurses' pharmacological knowledge, inevitable nursing errors and medication error complications. Concern about the potential consequences related to reporting of the medication errors was the major limitation of this study. Participants' concerns were handled by keeping their identity confidential and anonymous. Results show the importance of planning comprehensive educational programmes and providing constructive feedback in a favourable learning climate. Findings of this study can be beneficial to managers for nurturing a transparent organizational culture, whereby staff members freely discuss their errors in patient care and seek advice for problem solving.

Objective:To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training.Methods:One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20.Results:A total of 130 residents were included. Majority 128(98.5%) of these described some form of error. Serious errors that occurred were 24(19%), 63(48%) minor, 24(19%) near misses,2(2%) never encountered an error and 17(12%) did not mention type of error but mentioned causes and consequences. Only 73(57%) residents disclosed medical errors to their senior physician but disclosure to patient’s family was negligible 15(11%). Fatigue due to long duty hours 85(65%), inadequate experience 66(52%), inadequate supervision 58(48%) and complex case 58(45%) were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge (p=0.001), missing warning signs (p=<0.001), not seeking advice (p=0.003) and procedural complications (p=0.001). Medical errors had significant impact on resident’s behavior; 119(93%) residents became more careful, increased advice seeking from seniors 109(86%) and 109(86%) started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance (p=0.003) and (p=0.01) respectively.Conclusion:Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care.

&lt;p&gt; Background and purpose: Medical education programs' success depends on the efficiency and adequacy of clinical experiences, one of the most important factors recognized in this field is learning atmosphere and environment. Professor’s features, students' learning experiences and characteristics of the program implementation environment are of those cases that vary in different universities. One of the most important resources for the evaluation of universities’ educational atmosphere is students who interact directly with the process. The aim of this study was to investigating the viewpoint of residents of Babol University of Medical Sciences to educational atmosphere of education environment.&lt;/p&gt;&lt;p&gt; Methods: This was a cross-sectional study that was conducted on 100 residents studying in hospitals affiliated to Babol University of Medical Sciences. The tools used included 8 demographic questions and 30 questions related to the areas of a student perception of social conditions, clinical teachers and learning by DREEM standard questionnaire.&lt;/p&gt;&lt;p&gt; Results: Totally, residents have had desirable views toward perception of learning and clinical teachers (73%) and social conditions (63%). There was a significant relationship between all three areas (P=0.001). There was a significant relationship between clinical departments and residents' viewpoint of their learning (P=0.001). Pediatrics and internal medicine residents feel more positive towards their own learning environment. Residents with executive experience have had a more negative feeling to the university education status (P=0.05). Among all residents, those in the second year have had a more positive viewpoint towards the three areas in question (P=0.002).&lt;/p&gt;&lt;p&gt; Conclusions: According to the findings, residents have had a desirable viewpoint towards the university education environment. However, regarding problems in the clinical learning environments there is a need to adopt more comprehensive strategies.&lt;/p&gt;&lt;p&gt;Keywords: CLINICAL ENVIRONMENT, DREEM MODEL, SOCIAL CONDITIONS, LEARNING, TEACHERS&lt;/p&gt;&lt;p style="margin: 0cm 0cm 0pt;"&gt; &lt;/p&gt;

Learning experience of nursing students in a clinical partnership model: An exploratory qualitative analysis

This qualitative investigation examines the perceptions of Bangladeshi English language learners regarding the strengths and weaknesses of using long-form and short-form video content to develop spoken English.This study took a sample size of six semi-structured interviews with diverse socio-educational backgrounds using thematic analysis to classify patterns in the experience and perceptions of learners (Braun & Clarke, 2006).The theoretical framework combines Input Hypothesis by Krashen, Cognitive Load Theory, and Microlearning Theory, Multimedia Learning Theory and Self-Determination Theory (Deci & Ryan, 2000).The results indicate that even though YouTube Shorts are believed to have benefits of accessibility, engagement or specific skills acquisition, specifically related to pronunciation and acquisition of vocabulary, they are not seen as the thorough learning method, but rather as the addition or supplement (Simbolon & Ismahani, 2024).Long-form videos offer more detailed material and contextual education and consume more time and mental resources (Mayer, 2014).Another important consideration to learners is sociolinguistic factors that tend to determine the preferences and perceived effectivity of the learner on the basis of the educational background, geographical location, and exposure to English in the past (Rahman & Islam, 2020).The study will help know how new forms of video presentation can be successfully used in language learning classrooms and in the case of Bangladesh especially, where there is a challenge with the development of proficiency in English.

To explore healthcare professionals' experiences with medication errors (MEs) in terms of types and factors that contribute to them. A mixed-methods study was conducted to explore the MEs experiences of healthcare professionals. Quantitative data were collected through a cross-sectional, self-administered questionnaire, whereas qualitative data were collected via face-to-face semi-structured interviews. The study was conducted at Diwan Polyclinic in Muscat, a primary and secondary healthcare institute. The study population included healthcare workers who were practising (not retired) and actively involved in patient care and the medication-use cycle, either by prescribing, dispensing or administering medication. The total number of participants was 83 (55 females and 28 males) healthcare professionals, comprising doctors (38), nurses (32), pharmacists and assistant pharmacists (13). Omani participants accounted for 72%, whereas non-Omani participants accounted for 28%. Six of 83 healthcare professionals were purposefully selected to provide additional qualitative insights into their experiences with MEs and the measures they use to reduce them. None. The primary outcomes focused on identifying types, causes and effects of MEs, and the secondary outcomes aimed to explore the emotional and professional implications on healthcare workers as well as suggested strategies to minimise MEs. A total of 83 participants (55 females and 28 males) were included, with 72% Omani and 28% non-Omani. Of these, 44 participants (53%) encountered MEs during their practice at Diwan Polyclinic. The most common type of MEs was prescribing errors (51%), followed by dispensing errors (39%) and administering errors (10%). Incorrect dosing was the most typical cause of prescribing errors.In the qualitative part of the study, the interviewed participants implemented these measures to reduce MEs: 1) double-checking the prescribed medicines, patients 'names and identity before dispensing and administering drugs, 2) patient education on polypharmacy and 3) alerting prescribing doctors to errors in their prescriptions or orders. Several measures have been suggested to mitigate MEs, including better communication among health professionals and between them and patients, focusing on staff well-being and development and innovative built-in modules and programmes in electronic medical records for drug verification. The most common type of MEs was prescribing errors. Focusing on better communication and staff well-being, as well as the innovative development of electronic medical records, will help minimise MEs.

This paper reports on the preliminary findings of a research-in-progress project investigating what factors influence the students' learning experience while they study in an online environment. Online peer learning activities combined with current technology are expected to improve students' learning experience. The students were asked to respond to an online survey and attend virtual focus groups. Semi-structured interviews were also conducted with the teaching team. The questions raised were in the areas of relevance, reflection, interaction, teacher support, peer support, making sense, and course technology. This research utilizes a mixed method (quantitative and qualitative) data collection and data analysis. The preliminary findings from the research to date show that at the end of semester, students shifted from focusing on teacher support and content knowledge to an increased focus on technology and interaction through personal reflection of what and how they were learning.

Background:Clinical decision support systems (CDSS) can enhance patient safety and reduce medication errors by giving physicians alerts while dispensing medications. Physicians inappropriately override these alerts for various reasons, which can possibly lead to medication errors and impact patient safety.Objective:To assess the appropriateness of overridden major medication-related alerts, to investigate the reasons behind inappropriate overriding, and to evaluate if medication errors occur in inappropriately overridden alerts.Methods:A mixed-methods study was conducted.. Quantitative: Retrospective observation to evaluate the appropriateness of major drug-dose related alert overrides. A simple random sample was taken from appropriate and inappropriate overrides and reviewed for medication errors. Qualitative: Semi-Structured Interviews were conducted with ten consultant physicians from various specialties. Interviews were transcribed and coded inductively then analyzed using Thematic Content Analysis.Results:Out of 1087 alert overrides that were evaluated for appropriateness, 738 were inappropriately overridden (67.89%). In a sample of 283 inappropriate and 92 appropriate overrides; the resulted medication errors were 7 and 0, respectively. Qualitative analysis resulted in three emergent themes; Judgement, Experience & Guidelines, CDSS Issues & Limitations, Physician Behavior & Safety.Conclusion:The majority of alerts were found to be inappropriately overridden. This can be attributed to physician reliance on their clinical knowledge and medication databases, having the pharmacists’ checks, and alert fatigue. CDSS alerts can be improved by making them more prominent and suppressing or descaling unnecessary alerts. The drop-down justification list can be enhanced by adding free text options and relating recommended dosing to disease or specialty.

PurposePrevious studies suggest that within radiation oncology, medical physicists (MP) experience high workloads. Little is known about how MPs use social support (SS) in times of stress.MethodsIn collaboration with the Workgroup on Prevention of Medical Error, the American Association of Physicists in Medicine administered this Human Investigation Committee (HIC) approved email survey to 8566 members. Respondents were considered likely to seek SS if they answered (probably/definitely would) and unlikely to seek support if they answered (probably/definitely would not). Logistic regression was applied to determine associations between demographic factors and willingness to seek support as well as perception of barriers.ResultsOne thousand two hundred and ninety‐seven members (15.1%) accessed and gave consent for the survey. One thousand and one (11.7%) respondents answered all relevant questions. Respondents were predominantly male (69.1%), MP in radiation oncology (81.8%), private practice (51.6%), with practice duration> 10 yr (60.2%). MPs were likely to seek SS for personal physical illness (78.63%), involvement in a medical error (73.94%) or adverse patient outcome (75.17%). MPs sought SS in the setting of personal fatigue (33.2%) or burnout (44.3%). Barriers to seeking SS were lack of time (80.3%), and uncertainty about whom to access (70.7%). MPs responded that they would be most likely to seek support from an equally experienced medical physicist colleague (81.0%). Most MPs (67.0%) identified as having experienced stressors, with serious family illness (35.2%), or burnout (32.8%) being most common. Factors associated with MPs unwillingness to seek SS for medical error included> 20 yr in practice (vs still in training — OR 0.30, P = 0.015), and male gender (OR 0.60, P = 0.003). Male gender was associated with the lowest willingness to seek support (OR 2.10, P = 0.0001), but also with fewer perceived barriers (OR 1.60, P = 0.0075).ConclusionWillingness to seek SS is demonstrated, and MPs want colleagues to provide support. Given these results, peer support could be considered among MPs.

BACKGROUND:Medication errors are currently known as the most common medical errors. Research shows that work environment and organisation management, in addition to the role of nurses, contribute to the occurrence of an error.AIM:Therefore, the present study was conducted to determine the rate of nurses’ medication errors and its relation to the care complexity and work dynamics in the Taleghani Pediatric Hospital of Gorgan in 2017.MATERIAL AND METHODS:This was a descriptive-correlational and cross-sectional study. Sampling was done through census method (N = 100). The data collection tools consisted of four questionnaires of demographic information, Salyer work dynamics, Medication Administration Errors, and Velasquez Nursing Care Complexity. Data were analysed in SPSS V.16 software using descriptive and inferential statistical methods including independent t-test and Pearson’s correlation.RESULTS:Medication calculation errors, wrong dose and wrong medication were the most common non-injectable medication errors, respectively. Drug incompatibility, wrong infusion rate and medication calculation errors were the most common injectable medication errors, respectively. There was a positive correlation between medication calculation errors (P = 0.02, r = 0.23), wrong solvent (P = 0.04, r = 0.21), and drug incompatibility (P = 0.01, r = 0.25) with amount of work dynamics. Also, there was a positive correlation between medication calculation errors (P = 0.03, r = 0.22) and wrong medication (P = 0.00, r = 0.31) with the nursing care complexity.CONCLUSION:Regarding the irrefutable impact of working conditions on the occurrence of errors, it appears that the study and complete recognition of nurses’ working conditions and their adjustment would lead to a reduction in medication errors.

Aim: This research was conducted descriptively to determine the medical error tendencies of midwives and nurses working in maternity clinics and the factors affecting them.Materials and Methods: The sample of the study consisted of 135 midwives and nurses who agreed to participate in the study between January 2022 and February 2023. The Medical Error Tendency Scale in Nursing (METSN) and a descriptive information form developed by the researchers in line with the literature were used for data collection. Kruskal-Wallis and Mann-Whitney U tests were applied for data analysis.Results: The average age of the midwives and nurses participating in the study was 28.88±6.0 years, and the average duration of work was 5.84±5.9 years. It was determined that 25.4% of midwives and nurses made medical errors, and 57.8% witnessed medical errors. The mean total score of METSN was 226.20±31.78 (min-max: 126-245), and the mean scores of the sub-dimensions of the scale were determined as 84.27±10.23 for the "Medication and Transfusion Practices" sub-dimension, 55.30±9.88 for the "Prevention of Infections" sub dimension, 22.82±4.36 for the "Prevention of Falls" sub-dimension, 40.93±6.12 for the "Patient Monitoring and Material Device Safety" sub-dimension, and 22.87±4.38 for the "Communication" sub dimension.Conclusion: In our study, it was found that one-fourth of midwives and nurses made medical errors, and the risk of making medical errors was higher in midwives and nurses who had previously made medical errors and witnessed medical errors. The high rates of medical error tendencies and witnessing medical errors detected in our study indicate that there is a high tendency for medical errors in maternity clinics.

Encompassing some of its unique features, online education has given a new perception of learning processes.This reality prompted research into the features of online learning environments that affect students' learning experiences, and many features were discovered as a result of this initiative. However, most studies only look at one or a few of these variables, and the findings may be conflicting. In this review, the authors include most of the aspects found in the literature in an integrated model in order to decide which aspects have the greatest effect on students' satisfaction and understanding. This research study is aimed to identifythe psychological factors affecting online learningand discuss those factors in a compressive way. Identifying the aspects of online learning requires a number of fundamental concerns that are extremely relevant to educators today. “What are the factors that lead to the glory of online learning?” is the main issue. Two main variables must be defined on priority basis for addressing research questions. Such as, 1) assessing the final outcome and 2) determining the way used by students to learn by utilizing suitable educational resources.The dimensions we investigated in this study were students' mood, affect, motivation, and experience of using an Online Learning Tool. To help us assess these variables, we performed a survey using validated items from previous related research work. Our study was focused on an exploratory factor analysis (EFA).

Medical errors are responsible for a large number of deaths every year in the Unites States. Hospitals use various strategies including leadership, staffing, and structural changes to deal with this concerning issue. Hospital physician integration is a structural strategy to possibly improve patient safety. Using the conceptual lens of Donabedian's Structure Process Outcome model, this study aims to investigate how hospital physician integration affects organizational, management, and communication attributes of patient safety culture. A pooled cross sectional study design using the Hospital Survey on Patient Safety Culture, the American Hospital Association data, and Area Health Resource File was used to analyze the relationship between hospital physician integration and organizational and management patient safety culture attributes. The dataset comprised of hospital level data from 2021 and 2022 for patient safety culture and hospital characteristics and contained a final sample of 205 observations. The independent variable was levels of integration across five levels. Three attributes of safety culture were chosen-positive perceptions of communication openness, organizational learning, and hospital management support for patient safety. The control variables were organizational characteristics. Multivariable linear regression was used as the analytic method. Findings demonstrated a statistically significant correlation between higher level of hospital physician integration and positive perceptions of hospital management support for patient safety. There are 0.063 higher positive perceptions of hospital management support for patient safety for higher levels of integration compared with lower levels of integration ( P < 0.05). Perceptions of communication openness and organizational learning did not demonstrate a statistically significant correlation with any level of hospital physician integration. Hospital physician integration and hospital management support for patient safety were moderately but significantly related. Hospital physician integration allows resources to become available for physician. As physicians take on management roles management of resources and eventually performance can improve, there is a need for future research in this area to examine if integration is a step in the right direction to overcome the challenges of patient safety and if investments in resources and training can be beneficial to safety culture.

Medication errors are common upon hospital admission. Clinical pharmacist involvement in medication reconciliation is effective in identifying and rectifying medication errors. However, data is lacking on the economic impact, time requirements, and severity of errors resolved by clinical pharmacists. To determine the incidence of unintended admission medication discrepancies resolved by clinical pharmacists. Secondary objectives were to determine the type of discrepancies, potential severity, proximal cause, and economic impact of this clinical pharmacy program. This was a single-center, prospective, observational study conducted at a major teaching medical institution. Following institutional review board approval, data collection was conducted over a 4-week period (August 22, 2011, to September 16, 2011). Descriptive statistical methods were performed for all data analyses. A total of 517 patients involving 5006 medications were included in this study. More than 25% (n = 132) of patients had at least 1 error associated with a medication ordered on hospital admission. Pharmacists resolved a total of 467 admission medication errors (3.5 ± 2.3 errors/patient). The most common type of medication error resolved was medication omission (79.6%). In regard to severity, 46% of medication errors were considered significant or serious. Overall, the mean total time was 44.4 ± 21.8 minutes per medication reconciliation. This clinical pharmacy program was estimated to carry a net present value of $5.7 million over 5 years. Clinical pharmacist involvement within a multidisciplinary health care team during the admission medication reconciliation process demonstrated a significant improvement in patient safety and an economic benefit.

Background Medication errors have been identified as a problem in health care that results in adverse drug events. It has been identified as a failure of an intended plan of action or the initiation of a wrong plan of action. Medication errors are pervasive in community dwelling older adults. Strategies that facilitate the prevention of medication errors warrant consideration. Medication reconciliation has been identified as one such a strategy. Objectives The objective of this systematic review was to identify, appraise and synthesize the best available evidence to determine the effectiveness of medication reconciliation strategies on medication errors among community dwelling older adults. Inclusion criteria Types of participants This review included older adults of all races and ethnicities (65 years of age and older) living in the community. Older adults with dementia or who were dependent on family or other individuals for care were not included. Types of intervention(s) This review considered studies that evaluated the effects of medication reconciliation strategies on medication errors in community dwelling older adults. Types of studies This review considered randomized controlled trials, non-randomized controlled trials and quasi-experimental studies. In the absence of the above, other study designs including case control, cross-sectional cohort, and before and after studies were considered. Types of outcomes This review considered the primary outcome measure of the number of medication errors. Medication errors may include but are not limited to: prescribing, labeling, dispensing, medication administration and medication reconstitution. Search strategy This search examined published and unpublished studies from the inception of databases to the present that were in English. Databases included: MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Academic Search Premier, PsycINFO, Healthsource Nursing/Academic edition, and PubMed. Gray literature included Science.gov, scricus.com, Robert Wood Johnson Institute, and Dissertations Abstract International. Searches were completed in November 2012. Methodological quality Two independent reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instruments from the Joanna Briggs Institute. Disagreements between the reviewers were resolved with a third reviewer. Data collection Data were extracted using the standardized data extraction tool from the Joanna Briggs Institute. Data synthesis Statistical pooling was not possible due to heterogeneity of the studies; therefore findings were presented as a narrative. Results This review yielded two level one randomized controlled trials and one level three prospective randomized comparative study. Studies presented evidence as to the potential positive outcomes of a pharmacist-led medication reconciliation on medication errors for community dwelling older adults. The way in which the pharmacist conducted the medication reconciliation varied across studies. Conclusions Medication reconciliation is complex and may be implemented in a variety of ways. For older adults residing in community settings, pharmacist-led medication reconciliation may possibly play a role in the reduction of medication errors.