Health care professionals’ skills regarding patient safety

O iginal Resea ch A icle Heal h ca e p o essionals' skills ega ding pa ien sa e y Ind ė B asai ė a,b, *, Ma ja Kaunonen a,c , A ydas Ma inkėnas b , Vida Mockienė b , Ta ja Suominen a a School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland b Facul y o Heal h Sciences, Klaipėda Uni e si y, Klaipėda, Li huania c Pi kanmaa Hospi al Dis ic , Tampe e, Finland m e d i c i n a 5 2 ( 2 0 1 6 ) 2 5 0 – 2 5 6 a i c l e i n o A icle his o y: Recei ed 5 Oc obe 2015 Recei ed in e ised o m 17 Ma ch 2016 Accep ed 26 May 2016 A ailable online 30 June 2016 Keywo ds: Pa ien sa e y Heal h ca e p o essionals Skills a b s a c Backg ound and objec i e: The impo ance o pa ien sa e y is g owing wo ldwide, and e e y day, heal h ca e p o essionals ace a ious challenges in how o p o ide sa e ca e o hei pa ien s. Pa ien sa e y skills a e one o he main ools o ensu e sa e p ac ice. This s udy looks o desc ibe heal h ca e p o essionals' skills ega ding pa ien sa e y. Ma e ials and me hods: Da a we e collec ed using he skill scale o he Pa ien Sa e y A i- udes, Skills and Knowledge (PS-ASK) ins umen om di e en heal h ca e p o essionals (n = 1082: physicians, head nu ses, nu ses and nu se assis an s) wo king in hospi als o adul pa ien s in h ee egional mul i-p ofile hospi als in he wes e n pa o Li huania. Resul s: O e all, he esul s o his s udy show ha based on hei own e alua ions, heal h ca e p o essionals we e compe en ega ding hei sa e y skills. In pa icula , hey we e compe en in he sub-scale a eas o e o analysis (mean = 3.09) and in a oiding h ea s o pa ien sa e y (mean = 3.31), bu only somewha compe en in using decision suppo echnology (mean = 2.00). Demog aphic and o he wo k ela ed backg ound ac o s we e only sligh ly associa ed wi h hese pa ien sa e y skills a eas. Especially, i was no ed ha nu se assis an s may need mo e suppo om manage s and colleagues in de eloping hei pa ien sa e y skills compe ence. Conclusions: This s udy has se ed o in es iga e he gene al skills o heal h ca e p o es- sionals in ega d o pa ien sa e y. I p o ides new knowledge abou he opic in he con ex o he Bal ic coun ies and can hus be used in he u u e de elopmen o heal h ca e se ices. # 2016 The Li huanian Uni e si y o Heal h Sciences. P oduc ion and hos ing by Else ie Sp. z o.o. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i e- commons.o g/licenses/by-nc-nd/4.0/). Pee e iew unde he esponsibili y o he Li huanian Uni e si y o Heal h Sciences. * Co esponding au ho a : Depa men o Nu sing, Facul y o Heal h Sciences, Klaipėda Uni e si y, He kaus Man o 84, 92294 Klaipėda, Li huania. E-mail add ess: B asai e.Ind e.X@s uden .u a.fi (I. B asai ė). A ailable online a www.sciencedi ec .com ScienceDi ec jou nal homepage: h p://www.else ie .com/loca e/medici h p://dx.doi.o g/10.1016/j.medici.2016.05.004 1010-660X/# 2016 The Li huanian Uni e si y o Heal h Sciences. P oduc ion and hos ing by Else ie Sp. z o.o. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/). 1. In oduc ion Mos ecen ly, he concep o sa e y skills (i.e. skills and beha io s ha enhance he sa e deli e y o ca e) has eme ged in heal hca e li e a u e [1–3]. Sa e y skills include non- echnical skills such as leade ship, eamwo k, communica- ion, co-ope a ion, si ua ion awa eness and decision making, and also go beyond hese o include o he beha io s and a ibu es such as conscien iousness, igilance and humili y. Impo an ly, hese skills ha e been ecognized as bo h c ucial o pa ien sa e y and also as highly ainable [1]. Non- echnical skills suppo echnical skills such as sys ema ic assessmen , fluid managemen du ing simula ion, u e h al ca he e iza- ion, cen al enous ca he e inse ion pe o med du ing esusci a ion, o ca ying ou su ge y [3]. Resea che s in es iga ing heal h ca e p o essionals' knowl- edge, a i udes and skills ega ding pa ien sa e y ha e ema ked ha a less in es iga ed field is ha o sa e y skills [4]. In he a ied and complex heal h ca e sys ems seen wo ldwide, isks equen ly occu ha impac upon sa e pa ien ca e. Heal h ca e p o essionals ha e o manage hese isks using hei knowledge and skills in complex sys ems, and also whils main aining a sa e le el o pa ien ca e [5]. Physicians play an impo an ole in hei wo kplace ela ed o pa ien sa e y. As such, hey need sa e y skills in hei daily ac i i ies. They should also be able o ecognize pa ien sa e y inciden s, conduc pa ien sa e y inciden analysis using p o ocols, wo k in a eam, lea n om e o s, and be able o iden i y ac ions and ecommenda ions on how o p e en pa ien sa e y inciden s [6,7]. Nu ses ha e a adi ion o enhancing he quali y o heal h ca e and pa ien sa e y, pa icula ly h ough he use o p oblem-sol ing and p ac ice de elopmen skills [8]. Fo example, nu ses mus exe cise hei p o essional judgmen when adminis e ing any medica ion, and apply hei skills in any gi en si ua ion so as o ac in he bes in e es s o he pa ien [9]. P e ious esea ch has lacked any in es iga ion o how well heal h ca e p o essionals pe o m in e o analysis, al hough e o s hemsel es ha e been gi en mo e co e age. Fo example, i was ound ha mo e han 90% o medical e o s in he Uni ed S a es we e p e en able, and ha o imp o e pa ien sa e y and e o p e en ion, i is essen ial o u ilize e o epo ing mechanisms [10]. Imp o emen s in su geons' skills ha e been epo ed as imp o ing ollowing he analysis o pa ien sa e y issues, and a g ea e unde s anding and ecogni ion o pa ien sa e y issues was seen ollowing a sa e y skills aining cou se [1]. Also, ano he s udy [11] ound ha sa e y imp o emen p og am cou ses imp o ed heal h ca e p o essionals' unde s anding and allowed hem o conduc a oo -cause analysis, and mos ag eed ha his imp o ed hei skills o lead o be in ol ed in oo -cause analysis. In he same s udy, mos o he heal h ca e p o essionals in ol ed gained mo e skills ega ding e o epo ing p ac ices. The e a e se e al ways o a oid h ea s o pa ien sa e y in clinical p ac ice, such as using p essu e elie ing bedding ma e ials o p e en p essu e ulce s, o using an imic obial handwashing subs ances o educe in ec ion. Handwashing has been in es iga ed in se e al heal h ca e s udies, and a compliance wi h hand hygiene p o ocols is seen as a good quali y indica o o pa ien sa e y [12]. Based on ea lie s udies, a poo compliance wi h hand hygiene has been seen. In one s udy, only 66% o pe sonnel pe o med hand hygiene be o e o upon en y in o a pa ien 's oom, and 58% upon exi ing he pa ien 's oom [13], al hough a sys ema ic e iew o handwashing p ac ices wo ldwide has showed ha app oxi- ma ely 19% o he wo ld's popula ion washes hei hands wi h soap a e con ac wi h exc e a [14]. One way o add suppo o pa ien sa e y is o conside how we may use echnology o assis ou decision making, ela ed o pa ien sa e y issues. The deg ee o which echnology has succeeded in suppo ing heal h ca e p o essionals in hei decision making has no been in es iga ed in any dep h. O e all howe e , while s udies ha e shown a gene al imp o emen in pa ien sa e y skills, hey ha e no epo ed any di ec pa ien benefi s [15]. The heal hca e managemen body has a cen al ole in helping s a o de elop good pa ien sa e y skills. Wi hin his, a ans o ma ional leade ship s yle has been shown o ha e a big influence in c ea ing a posi i e sa e y clima e, con a y o a mo e laisse - ai e s yle o leade ship which ends o ocus on a cul u e o blame [16]. This s udy looks o desc ibe he kinds o pa ien sa e y skills ha heal h ca e p o essionals ha e and he associa ions ha ela ed indi idual backg ounds ac o s ha e on hem. 2. Ma e ials and me hods 2.1. Da a collec ion The da a we e collec ed in h ee egional mul i-p ofile hospi als in he wes e n pa o Li huania. The s udy pa icipan s we e heal h ca e p o essionals (physicians, head nu ses, nu ses and nu se assis an s) wo king in hospi als o adul pa ien s. Pe mission o conduc he s udy and collec da a was g an ed by he e hical commi ees o he hospi als which pa icipa ed in bo h he pilo phase and he main da a collec ion. The e hical conside a ions ela ed o da a collec ion ocused on he e hical p inciples o esea ch, namely hose o confiden iali y, p i acy, and he olun a y na u e o pa icipa- ion in he s udy [17]. Pe mission o use he ins umen used in he s udy was ob ained om he copy igh holde o he ins umen by he fi s au ho . The ques ionnai e consis ed o wo pa s: backg ound ques ions, and he ins umen which measu ed he espon- den 's skills ega ding pa ien sa e y. Nine een backg ound ques ions ga he ed da a on basic demog aphic cha ac e is ics (e.g. wo k posi ion, age, gende , educa ion, yea s a wo k, usual shi , e c.), and u he ques ions ga he ed in o ma ion abou hei expe iences o pa ien sa e y. Skills we e in es iga ed using he skills scale (13 i ems) o he Pa ien Sa e y A i udes, Skills and Knowledge (PS-ASK) ins umen de eloped by Schnall [18] measu ing heal h ca e p o essionals' gene al skills ela ed o pa ien sa e y. The scale has h ee subscales: e o analysis (6 i ems), h ea s o pa ien sa e y (4 i ems) and decision suppo echnology (3 i ems). The i ems measu ing heal h ca e p o essionals' e o analysis ela ed o pa ien sa e y included i ems such as ‘‘pa icipa ing as a eam membe o a Failu e Mode & E ec analysis,’’ m e d i c i n a 5 2 ( 2 0 1 6 ) 2 5 0 – 2 5 6 251 ‘‘in e p e ing agg ega e e o epo da a,’’ ‘‘pa icipa ing as a eam membe o a oo - cause analysis,’’ ‘‘accu a ely en e ing an e o epo ,’’ ‘‘pa icipa ing in mo bidi y and mo ali y con e ences,’’ and ‘‘suppo ing and ad ising a pee who mus decide how o espond o an e o .’’ The subscale conce ned wi h a oiding h ea s o pa ien sa e y included i ems such as ‘‘using an imic obial hand washing subs ances,’’ ‘‘using p essu e elie ing bedding ma e ials o p e en p essu e ulce s,’’ ‘‘asking pa ien s o ecall and es a e wha hey ha e been old du ing he in o med consen p ocess,’’ and ‘‘disclos- ing an e o o a pa ien and/o amily membe .’’ The use o decision suppo echnology was in es iga ed by i ems such as ‘‘using compu e -based p o ide o de en y,’’ ‘‘using com- pu e -based alls isk assessmen ,’’ and ‘‘using ba code medica ion adminis a ion sys em.’’ All i ems we e a ed on a Like scale (1, no compe en ; 2, somewha compe en ; 3, compe en ; 4, p oficien ; 5, expe ; and 6, no applicable). The ins umen used was o iginally de eloped in he US, and was ansla ed om English in o Li huanian using he back- ansla ion echnique [19]. Fo an e alua ion o he ins umen 's alidi y and i s use in he Li huanian con ex , a pilo s udy was conduc ed in one egional hospi al in Wes e n Li huania. The hospi al was selec ed, based on he mul i- p ofile se ices i p o ided o adul pa ien s. Da a we e collec ed om all o he heal h ca e p o essionals in ol ed in he pilo es (n = 90), which ook place in Feb ua y 2014. Based on he pilo , he ins umen de eloped by Schnall was shown o ha e good psychome ic p ope ies in he Li huanian con ex , so no changes we e made. The scale's eliabili y was assessed wi h a o al C onbach's alpha o 0.91, co ec ed by in e -i em co ela ion om 0.13 o 0.84. The C onbach's alpha alues we e good o he whole scale in bo h he pilo and main s udy, and also o he sub-scales o e o analysis (0.82 and 0.90), h ea s o pa ien sa e y (0.53 and 0.66), and decision suppo echnology (0.91 and 0.92) (Table 1). The main da a we e collec ed in h ee egional hospi als in May 2014. Each hospi al ga e hei pe mission o conduc he s udy, and o ha e one con ac pe son who ci cula ed ques ionnai es wi h en elopes o all o he s a (N = 1687). A e wo weeks, he esea che collec ed he ques ionnai es in sealed en elopes om each uni . In o de o inc ease he esponse a e, an addi ional wo weeks esponse ime was gi en. A e ha , he esea che e u ned o he uni s o collec he emaining ques ionnai es. The o al esponse a e o his s udy was 64% (n = 1082). 2.2. S a is ical analysis Desc ip i e s a is ics we e used o desc ibe he cha ac e is ics o esponden s, he sa e y skills sub-scale i ems, and he scale- le el esul s o he h ee hospi als. Di e ences in sample cha ac e is ics be ween hospi als and p o essional g oups we e es ed using he K uskal–Wallis es . Di e ences in sample cha ac e is ics be ween specific hospi als we e es ed using he Mann–Whi ney U es . Da a we e p esen ed using mean (SD) o median (IQR) exp essions. Any nega i ely wo ded i ems o he ins umen s we e e e sed p io o analysis. The in e nal consis ency o he sa e y skills ins u- men s and he sub-scales o e o analysis ela ed o pa ien sa e y, a oiding h ea s o pa ien sa e y, and decision suppo echnology was measu ed by calcula ing he C onbach's alpha o each sub-scale and o al field. Associa ions be ween esponden s' backg ound ac o s and hei pa ien sa e y skills we e calcula ed by way o Spea man co ela ions. All o he da a we e analyzed using SPSS ( . 22.0; SPSS Inc., Chicago, IL, USA). A P alue o <0.05 was conside ed o be s a is ically significan . 3. Resul s 3.1. Pa icipan s Al oge he , 1082 heal h ca e p o essionals pa icipa ed in he s udy. The bigges employmen g oup o pa icipan s we e nu ses (n = 756, 70%), wi h smalle g oups o nu se assis an s (n = 180, 17%) and physicians (n = 146, 14%). The numbe o e u ns om he h ee egional hospi als was: 301 (28%) om hospi al 1; 411 (38%) om hospi al 2; and 370 (34%) om hospi al 3. The mean age o pa icipan s was 46.7 (SD = 11) yea s. They had many yea s o wo k expe ience (mean = 24), and wo ked an a e age o 40 h pe week in hei uni . The uni s in which esponden s wo ked we e in e nal medicine (n = 276, 26%), acu e (n = 161, 15%), psychia ic (n = 134, 12%), su gical (n = 131, 12%), and o he s (n = 380, 35%). Gi en ha he bigges g oup o pa icipan s we e nu ses, he mos common educa- ion ins i u ion o he s udy pa icipan s was medical school 493 (46%), and he main base-qualifica ions we e a non- uni e si y bachelo 130 (12%) and a uni e si y bachelo p og am 118 (11%). The majo i y o heal h ca e p o essionals (n = 659, 61%) wo ked a iable shi s, in uni s wi h an a e age o 30.7 (SD = 17.27) beds pe uni , 24.1 s a membe s pe uni (SD = 10.33), and hey had an a e age o 18 pa ien s pe wo king shi (SD = 12.03). Mo e han hal o he pa icipan s (n = 673, 62%) o his s udy had ecei ed no in o ma ion abou pa ien sa e y du ing hei oca ional educa ion, bu abou hal (n = 589, 54%) had ecei ed in o ma ion du ing hei con inu- ing educa ion. Fou -fi hs (n = 866, 80%) o esponden s had epo ed no pa ien sa e y inciden s du ing he las yea . 3.2. Sa e y skills O e all, he esul s o his s udy showed ha based on hei own e alua ions, heal h ca e p o essionals pe cei ed Table 1 – Sa e y skills sub-scales and psychome ic p ope ies. Sa e y skills sub-scales I ems C onbach's alpha om pilo s udy C onbach's alpha om main s udy E o analysis 6 0.82 0.90 Th ea s o pa ien sa e y 4 0.53 0.66 Decision suppo echnology 3 0.91 0.92 m e d i c i n a 5 2 ( 2 0 1 6 ) 2 5 0 – 2 5 6252 hemsel es as compe en ega ding hei sa e y skills. They we e compe en in e o analysis (mean = 3.09) and skills o a oid h ea s o pa ien sa e y (mean = 3.31), bu only somewha compe en in using decision suppo echnology (mean = 2.00). In e o analysis, he esponden s we e mos skilled in suppo ing and ad ising a pee who mus decide how o espond o an e o . Responden s we e seen o be leas skilled in in e p e ing agg ega e e o epo da a. In looking a he a ea o how skilled s a was in a oiding h ea s o pa ien sa e y, he highes e alua ed skill was seen o be in using an imic obial handwashing subs ances. Lesse e alua ed skills included disclosing an e o o a pa ien and/o amily membe . A conside able amoun o a ia ion was seen in he a ea o using decision suppo echnology (Table 2). Based on hei p o ession and he a ea o hospi al heal h ca e ha p o essionals wo ked in, some s a is ically signifi- can findings we e ound. Physicians and nu ses we e mo e skilled han nu se assis an s in e o analysis (P < 0.001). Nu ses we e mo e skilled ega ding he a oidance o h ea s o pa ien sa e y han nu se assis an s (P < 0.001), and also mo e skilled in using decision suppo echnology han nu se assis an s (P < 0.01). Di e ences be ween sa e y skills sub- scales ega ding using decision suppo echnology we e also seen by hospi al, and heal h ca e p o essionals we e less skilled in hospi als 1 and 2 han in hospi al 3 (P < 0.001) (Table 3). Many o he pa icipan s demog aphic and wo k ela ed backg ound ac o s we e sligh ly associa ed wi h se e al a eas o pa ien sa e y skills. Especially, he p o essionals' back- g ound ac o s seem o co ela e wi h hei sa e y skills in ol ing e o analysis and he a oidance o h ea s o pa ien sa e y (Table 4). Heal h ca e p o essionals wi h a uni e si y o college educa ion we e seen o be less skilled ega ding e o analysis (0.062, P < 0.05), in a oiding h ea s o pa ien sa e y (0.158, P < 0.01), and in using decision suppo echnology (0.065, P < 0.05), han hose who had ecei ed hei nu se educa ion in medical school ( oca ional). Heal h ca e p o essionals wi h mo e expe ience in hei p ima y special y we e seen o be mo e skilled in e o analysis (0.098, P < 0.01), a oiding h ea s o pa ien sa e y (0.061, P < 0.05), and using decision suppo echnology (0.089, P < 0.01). Those who ecei ed no in o ma ion abou pa ien sa e y in hei con inuing educa ion had less skills in ega d o e o analysis (0.082, P < 0.01) and a oiding h ea s o pa ien sa e y (0.079, P < 0.01). P o essionals wi h mo e beds pe uni e alua ed hem- sel es o be less skilled in a eas ela ed o a oiding h ea s o pa ien sa e y (0.090, P < 0.01), bu mo e skilled wi h using decision suppo echnology (0.072, P < 0.05). When mo e nu ses wo ked on a nigh shi , heal h ca e p o essionals we e seen o ha e be e skills in e o analysis (0.086, P < 0.05) and in a oiding h ea s o pa ien sa e y (0.097, P < 0.01). The highe he numbe o pa ien s ha heal h ca e p o essionals usually had pe wo king shi , he less skilled hey we e in a oiding h ea s o pa ien sa e y (0.077, P < 0.05), bu he mo e skilled hey seemed o be wi h using decision suppo echnology (0.067, P < 0.05). Compa ing he sa e y skills be ween heal h ca e p o es- sionals by wo king uni , some significan di e ences we e ound. Those wo king in acu e and o he uni s had signifi- can ly mo e sa e y skills ega ding e o analysis (P < 0.05) compa ed o heal h ca e p o essionals who wo ked in in e nal medicine, su gical, and psychia ic uni s. Heal h ca e p o es- sionals wo king in acu e uni s had significan ly mo e sa e y skills ela ing o he a oidance o h ea s o pa ien sa e y (P < 0.05), han hose wo king in in e nal medicine, su gical, and psychia ic uni s. No significan di e ences we e ound be ween heal h ca e p o essionals by wo king uni ega ding hei skills in using decision suppo echnology. Amongs esponden s who had epo ed a sa e y inciden du ing he las yea , physicians and nu ses had significan ly highe sa e y skills ela ed o e o analysis (P < 0.01) han nu se assis an s. Also wi hin he same g oup, skills ela ing o he a oidance o h ea s o pa ien sa e y (P < 0.01) we e significan ly highe o nu ses han nu se assis an s. In he heal h ca e p o essional g oup who had no epo ed a sa e y inciden du ing he las yea , physicians and nu ses had significan ly highe sa e y skills ela ed o e o analysis han nu se assis an s (P < 0.001). Physicians who had no epo ed sa e y inciden s du ing he las yea had mo e skills ega ding Table 2 – Pa ien sa e y skills by pa icipan s. Sa e y skills sub-scales Mean SD E o analysis Suppo ing and ad ising a pee who mus decide how o espond o an e o 3.19 0.840 Pa icipa ing as a eam membe o a oo -cause analysis 3.18 0.816 Pa icipa ing as a eam membe o a Failu e Mode & E ec analysis 3.16 0.834 Accu a ely en e ing an e o epo 3.09 0.792 Pa icipa ing in mo bidi y and mo ali y con e ences 3.06 0.925 In e p e ing agg ega e e o epo da a 2.93 0.871 A oidance he h ea s o pa ien sa e y Using an imic obial handwashing subs ances 3.78 0.734 Using p essu e elie ing bedding ma e ials o p e en p essu e ulce s 3.12 0.955 Asking pa ien s o ecall and es a e wha hey ha e been old du ing he in o med consen p ocess 3.08 0.840 Disclosing an e o o a pa ien and/o amily membe 2.75 0.883 Using decision suppo echnology Using compu e -based p o ide o de en y 1.93 1.210 Using ba code medica ion adminis a ion sys em 1.92 1.193 Using compu e -based alls isk assessmen 1.72 1.090 m e d i c i n a 5 2 ( 2 0 1 6 ) 2 5 0 – 2 5 6 253 Table 3 – Pa ien sa e y skills by pa icipan g oups and hospi als. Sa e y skills sub-scales Mean (SD) Median (IQR) Chi-squa e P alue E o analysis 67.22 <0.001 Physicians 3.25 (0.59) 3.33 (0.7)*** Nu ses 3.16 (0.59) 3.0 (0.7) ### Nu se assis an s 2.64 (0.84) 2.83 (1.2)*** ,### To al 3.09 (0.67) 3.0 (0.7) A oidance he h ea s o pa ien sa e y 40.41 <0.001 Physicians 3.27 (0.58) 3.25 (0.7)** Nu ses 3.39 (0.59) 3.33 (0.8)** ,### Nu se assis an s 3.01 (0.76) 3.0 (1.0)** ,### To al 3.31 (0.63) 3.25 (0.75) Use o decision suppo echnology 8.61 0.014 Physicians 1.96 (1.13) 1.67 (2.0) Nu ses 2.08 (1.19) 1.67 (2.0) ## Nu se assis an s 1.69 (0.99) 1.0 (1.3) ## To al 2.00 (1.16) 1.67 (2.0) The mean di e ence be ween pa icipan s by chi-squa e (K uskal–Wallis es ). The mean di e ence be ween conc e e pa icipan s (Mann–Whi ney es ): ** P < 0.01 be ween physicians and nu ses, nu se assis an s. *** P < 0.001 be ween physicians and nu se assis an s. ## P < 0.01 be ween nu ses and nu se assis an s. ### P < 0.001 be ween nu ses and nu se assis an s. E o analysis 3.26 0.196 Hospi al 1 3.10 (0.60) 3.0 (0.6) Hospi al 2 3.04 (0.71) 3.0 (0.7) Hospi al 3 3.13 (0.68) 3.0 (0.7) To al 3.09 (0.67) 3.0 (0.7) A oidance he h ea s o pa ien sa e y 0.97 0.617 Hospi al 1 3.35 (0.64) 3.25 (0.8) Hospi al 2 3.27 (0.60) 3.25 (0.7) Hospi al 3 3.32 (0.66) 3.25 (0.8) To al 3.31 (0.63) 3.25 (0.75) Use o decision suppo echnology 26.84 <0.001 Hospi al 1 1.73 (0.97) 1.0 (1.3)*** Hospi al 2 1.70 (1.09) 1.0 (1.7) ### Hospi al 3 2.33 (1.26) 2.0 (2.3)*** ,### To al 2.00 (1.16) 1.67 (2) The mean di e ence be ween h ee hospi als by chi-squa e (K uskal–Wallis es ). The mean di e ence be ween specific hospi als (Mann–Whi ney es ): *** P < 0.001 be ween hospi al 1 and hospi al 3. ### P < 0.001 be ween hospi al 2 and hospi al 3. Table 4 – Co ela ions be ween esponden s' backg ound ac o s and hei pa ien sa e y skills. Demog aphic and wo k ela ed cha ac e is ics E o analysis A oidance o h ea s o pa ien sa e y Use o decision suppo echnology Age 0.060 * 0.035 0.021 Educa ion (e.g. medical school, college, bachelo , e c.) 0.062 * 0.158 ** 0.065 * Yea s o expe ience in p ima y special y 0.098 ** 0.061 * 0.089 ** Yea s o wo k expe ience in gene al 0.091 ** 0.027 0.057 In o ma ion abou pa ien sa e y in con inuing educa ion 0.082 ** 0.079 ** 0.011 Usual shi 0.063 * 0.052 0.033 Ex a job 0.054 0.012 0.063 * Recei ed hou s ega ding ex a job 0.071 0.077 0.207 * Numbe o beds pe uni 0.061 0.090 ** 0.072 * Numbe o physicians wo king in uni on day shi s 0.035 0.080 * 0.007 Numbe o nu ses wo king in uni on day shi s 0.058 0.116 ** 0.001 Numbe o nu ses wo king in uni on e ening shi s 0.101 ** 0.071 0.055 Numbe o nu ses wo king in uni on nigh shi s 0.086 * 0.097 ** 0.026 Numbe o pa ien s heal h ca e p o essionals usually ha e pe wo king shi 0.041 0.077 * 0.067 * * P < 0.05. ** P < 0.01. m e d i c i n a 5 2 ( 2 0 1 6 ) 2 5 0 – 2 5 6254 he a oidance o h ea s o pa ien sa e y han nu ses (P < 0.05) and nu se assis an s (P < 0.01). Nu ses in he same g oup we e significan ly mo e skilled han nu se assis an s (P < 0.001), and had significan ly highe sa e y skills ela ed o decision suppo echnology (P < 0.01) han nu se assis an s in he same g oup. 4. Discussion O e all, heal h ca e p o essionals we e compe en ega ding pa ien sa e y skills, based on hei own e alua ions. In mo e de ail, heal h ca e p o essionals we e compe en ega ding e o analysis and he a oidance o h ea s o pa ien sa e y, bu only somewha compe en ega ding hei use o decision suppo echnologies. Rega ding h ea s o pa ien sa e y, hey we e mos compe en in using an imic obial handwashing subs ances and using p essu e elie ing bedding ma e ials o p e en p essu e ulce s, and o e all, he mean o handwash- ing skills was seen o be he highes . Heal h ca e p o essionals we e also seen o be compe en in suppo ing and ad ising a pee who mus decide on how o espond o an e o , and in pa icipa ing as a eam membe o a oo -cause e o analysis. Heal h ca e p o essionals showed he lowes le el o compe ence ega ding he use o decision suppo echnology (mean = 2.00). Decision suppo echnologies a e qui e new in Li huania and no o en used. The e o e, in his se ing, hospi al manage s may need o pay mo e a en ion o compu e -based lea ning when planning heal h ca e p o essionals' con inuing educa ion in his field. Na ional-le el suppo may also be needed wi h he in eg a ion o compu e -based echnologies in o heal h ca e p o essionals' daily p ac ices, so as o p omo e pa ien sa e y and good quali y pa ien ca e. This is an especially impo an issue, as a he ime o da a collec ion, he hospi als included in his s udy we e a di e en s ages in using decision suppo echnologies in he a ea o pa ien sa e y. Howe e , he esou ces, echnology and ela ed s a educa ion should be a same le el a simila ypes o hospi als o ensu e he p o ision o equal ca e in each publicly unded hospi al, he e o e we asked how much hey used he echnology and no whe he i was a ailable. Based on his s udy, he cen al issues ela ed o he esponden 's pa ien sa e y skills a e whe he hey we e mo e expe ienced and educa ed, and whe he he e we e mo e nu ses wo king du ing nigh shi s. A su p ising esul is ha heal h ca e p o essionals wi h a lowe le el o educa ion (such as ha ecei ed in a medical school o nu ses) e alua ed hemsel es as mo e skilled han hose who ecei ed hei p o essional educa ion a bachelo le el a a uni e si y. Howe e , gi en ha hey may also be di e en ly ained, ha e less esponsibili y e c., his may influence how hey e alua e hei skills compa ed o hose who ha e di e en oles and esponsibili ies. In he Li huanian con ex , nu sing science is e y young and bachelo s udies we e only es ablished in 1990 (ini ially only a ailable in he ci y o Kaunas). Mos o pa icipan s in his s udy we e nu ses, and one o he main easons o his educa ional obse a ion is ha nu ses who s udied a medical school ended o gain mo e p ac ical skills which hey could use mo e easily in clinical p ac ice. The esul s o his s udy also confi m ha heal h ca e p o essionals end o gain hei sa e y skills h ough many yea s' o expe ience, and so hei educa ion le el is no he only con ibu o y ac o . Sa e y compe ence was seen o be closely associa ed wi h he p esence o mo e nu ses wo king on nigh shi s, and his is qui e a na u al finding as ha ing mo e s a o do clinical wo k is likely o make o a sa e nu sing en i onmen . Especially, ha ing a highe s a fing a io is impo an in managing si ua ions ha en ail a high numbe o pa ien s. When mo e nu sing pe sonnel a e p esen , i may also be ha heal h ca e p o essionals eel hey ha e a suppo i e wo king a mosphe e and a e be e able o consul wi h colleagues when aced wi h challenging wo king si ua ions. Howe e , i seemed ha mo e beds and a highe numbe o pa ien s in he uni posed a h ea o pa ien sa e y skills. Acco ding o he Li huanian Minis e o Heal h O de [20], nu ses should ha e a maximum o 11 pa ien s pe nu se when hey a e wo king wi h psychia ic pa ien s and a descending a io wi h pa ien s o o he p ofiles. I seems ha a high pa ien - o-nu se a io o ces nu ses o wo k quickly because hey do no ha e enough ime o each pa ien , and his p esen s a challenge o nu ses o main ain a high quali y o nu sing ca e, and o ake sa e ca e o hei pa ien s. P e ious li e a u e has ound ha sa e y inciden s ha e been especially associa ed wi h nu se o e ime and pa ien –nu se a ios [21], and i is he e o e impo an o nu ses o ha e enough s a fing and esou ces o deli e a good quali y o nu sing ca e [22]. S eng hs and limi a ions o his s udy ha e o be men ioned. The s eng h o his s udy is ha he sample size (n = 1082) was la ge and he esponse a e (64%) was good. I also comp ised se e al heal h ca e p o essional g oups, including physicians, nu ses, and nu se assis an s. Gi en he lack o p e ious s udies conce ning pa ien sa e y conduc ed in he Bal ic a ea, his s udy can be conside ed as a pionee ing wo k. Fu he mo e, his s udy is he fi s o i s kind o in es iga e he gene al pa ien sa e y skills o heal h ca e p o essionals in Li huania. Howe e , a limi a ion exis s ela ed o he ins umen used in his s udy. The issues conce ning pa ien sa e y skills we e in es iga ed a gene al le el, o he pu pose o in es iga ing a ep esen a i e spec um o heal h p o essionals such as physicians, nu ses and nu se assis an s. To expand his gene al iew, u he esea ch is needed o in es iga e he specific skill a eas in di e en p o essions, and also in di e en clinical se ings. The da a we e pu pose ully collec - ed in one egion, bu i is one o he bigges egions in Li huania and may be seen as ep esen a i e o he na ional con ex . Also, hose who d opped-ou (36%) migh ha e a di e en le el o pa ien sa e y skills han majo i y esponden s o his s udy. Fu he mo e he co ela ions ound we e e y weak, so we need o mode a e which kind o conclusions we make based on he esul s. Rega dless o hese poin s, howe e , he ins umen s used in he s udy we e alida ed and pilo ed in he ea u ed esea ch con ex , and e u ned a good psychome ic pe o mance. 5. Conclusions This s udy has se ed o in es iga e he gene al skills o heal h ca e p o essionals in ega d o pa ien sa e y. I p o ides new m e d i c i n a 5 2 ( 2 0 1 6 ) 2 5 0 – 2 5 6 255 knowledge abou he opic in Bal ic coun ies, and can hus be used in he de elopmen o heal h ca e se ices. O e all, heal h ca e p o essionals in his se ing had good skills in e o analysis and skills linked o he a oidance o h ea s o pa ien sa e y, bu we e less skilled in using decision suppo echnology. Heal h ca e p o essionals who we e mo e expe i- enced and wi h a medical school educa ion had be e sa e y skills, as did hose who wo ked on nigh shi s wi h mo e nu sing pe sonnel. Howe e , i was shown ha compa ed o he o he g oups in his s udy, nu se assis an s we e less skilled ega ding pa ien sa e y. The e o e, mo e suppo by manage s and colleagues is needed o ensu e hei compe- ence. Fu he esea ch is also needed o in es iga e he pa ien sa e y skills o di e en heal hca e p o essions, and mo e specifically, o de e mine hei sa e y skills needs. Conflic o in e es None decla ed. Au ho s' con ibu ion S udy concep ion/design: I.B., M.K., T.S.; da a collec ion/ analysis: I.B., A.M.; d a ing and w i ing he manusc ip : I.B., M.K., A.M., V.M., T.S.; app o al o he final ex : I.B., M.K., A.M., V.M., T.S. Funding The s udy was pa ly unded by he Compe i i e S a e Resea ch Financing o he Expe Responsibili y A ea o Tampe e Uni e si y Hospi al: G an Numbe 9S065. E hical app o al E hical app o al was ecei ed om he e hical commi ee o Klaipeda Uni e si y, Facul y o Heal h Sciences and s udy pe mission was ob ained om he hospi als who pa icipa ed in his s udy. e e e n c e s [1] A o a S, Se dalis N, Ahmed M, Wong H, Moo hy K, Vincen C. Sa e y skills aining o su geons: a hal -day in e en ion imp o es knowledge, a i udes and awa eness o pa ien sa e y. Su ge y 2012;152(1):26–31. [2] Go don M, Da byshi e D, Bake P. Non- echnical skills aining o enhance pa ien sa e y: a sys ema ic e iew. Med Educ 2012;46:1042–54. [3] Whi e N. Unde s anding he ole o non- echnical skills in pa ien sa e y. Nu s S and 2012;26(26):43–8. [4] B asai e I, Kaunonen M, Suominen T. Heal hca e p o essionals' knowledge, a i udes and skills ega ding pa ien sa e y: a sys ema ic li e a u e e iew. Scand J Ca ing Sci 2015;29:30–50. [5] Leape L, Be wick D, Clancy C, Conway J, Gluck P, Gues J, e al. T ans o ming heal hca e: a sa e y impe a i e. Qual Sa Heal h Ca e 2009;18(6):424–8. [6] Ahmed M, A o a S, Bake P, Hayden J, Vincen C, Se dalis N. Building capaci y and capabili y o pa ien sa e y educa ion: a ain- he- aine s p og amme o senio doc o s. BMJ Qual Sa 2013;22(Augus (8)):618–25. [7] Ahmed M, A o a S, Tiew S, Hayden J, Se dalis N, Vincen C, e al. Building a sa e ounda ion: he Lessons Lea n pa ien sa e y aining p og amme. BMJ Qual Sa 2014;23:78–86. [8] Milligan F, Dennis S. Building a sa e y cul u e. Nu s S and 2005;20(11):48–52. [9] Ndosi Mwidimi E, Newell R. Nu ses' knowledge o pha macology behind d ugs hey commonly adminis e . J Clin Nu s 2009;18:570–80. [10] Hughes RG, edi o . Pa ien sa e y and quali y: an e idence- based handbook o nu ses. AHRQ Publica ion No. 08-0043. Rock ille, MD: Agency o Heal hca e Resea ch and Quali y; 2008, Ma ch [chap e 35]. [11] B ai hwai e J, Wes b ook MT, Mallock NA, T a aglia JF, Iedema RA. Expe iences o heal h p o essionals who conduc ed oo cause analyses a e unde going a sa e y imp o emen p og amme. Qual Sa Heal h Ca e 2006;15:393–9. [12] Ma a AR, Edmond MB. New echnologies o moni o heal hca e wo ke hand hygiene. Clin Mic obiol In ec 2014;20(1):29–33. [13] Comunale ME, Sando al M, B oussa d T. An assessmen o basic pa ien sa e y skills in esiden s en e ing he fi s yea o clinical aining. J Pa ien Sa 2015. h p://dx.doi.o g/ 10.1097/PTS.0000000000000179 [14] F eeman MC, S ocks ME, Cumming O, Jeand on A, Higgins JP, Wol J, e al. Hygiene and heal h: sys ema ic e iew o handwashing p ac ices wo ldwide and upda e o heal h e ec s. T op Med In Heal h 2014;19(8):906–16. [15] Ki kman MK, Se dalis N, A o a S, Bake P, Vincen C, Ahmed M. The ou comes o ecen pa ien sa e y educa ion in e en ions o ainee physicians and medical s uden s: a sys ema ic e iew. BMJ Open 2015;5:e007705. h p://dx. doi.o g/10.1136/bmjopen-2015-007705 [16] Me ill KC. Leade ship s yle and pa ien sa e y: implica ions o nu se manage s. J Nu s Adm 2015;45(6):319–24. [17] Decla a ion o Helsinki. WMA Decla a ion o Helsinki – E hical P inciples o Medical Resea ch In ol ing Human Subjec s; 2013, h p://www.wma.ne /en/30publica ions/ 10policies/b3 [accessed 22.01.15]. [18] Schnall R, S one P, Cu ie L, Desja dins K, John RM, Bakken S. De elopmen o a sel - epo ins umen o measu e pa ien sa e y a i udes, skills, and knowledge. J Nu s Schola sh 2008;40:391–4. [19] Bu ns N, G o e SK. The p ac ice o nu sing esea ch: app aisal, syn hesis, and gene a ion o e idence. S . Louis, MO: Saunde s Else ie ; 2009. [20] Lie u os Respublikos s eika os apsaugos minis o įsakymas N . V-400. Dėl Slaugy ojų da bo k ū io nus a ymo a kos ap ašo pa i inimo (Žin., 2012, N . 55-2751) [Li huanian Minis e o Heal h O de No. V-400. P ocedu al app o al o es ablishing nu ses wo kload (O ficial Gaze e. 2012, No. 55-2751)]. [21] Liu LF, Lee S, Chia PF, Chi SC, Yin YC. Explo ing he associa ion be ween nu se wo kload and nu se-sensi i e pa ien sa e y ou come indica o s. J Nu s Res 2012;20 (4):300–9. [22] Smeds Alenius L, Tishelman C, Runesdo e S, Lindq is R. S a fing and esou ce adequacy s ongly ela ed o RNs' assessmen o pa ien sa e y: a na ional s udy o RNs wo king in acu e-ca e hospi als in Sweden. BMJ Qual Sa 2014;23(3):242–9. m e d i c i n a 5 2 ( 2 0 1 6 ) 2 5 0 – 2 5 6256