Publications (English) by Patrick A Palmieri
The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry, Jan 28, 2021
Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and c... more Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain). Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis. Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Patient safety culture in European hospitals: A comparative mixed methods study, Jan 14, 2022
Background: Poorly organized health systems with inadequate leadership limit the development of t... more Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.
Women caring for husbands living with Parkinson’s disease: A phenomenological study protocol, Apr 20, 2022
Parkinson’s disease (PD) is an emerging pandemic caused by aging, longevity, and industrializatio... more Parkinson’s disease (PD) is an emerging pandemic caused by aging, longevity, and industrialization. Most people diagnosed with PD initially experience mild symptoms, but over time the symptoms become debilitating. Given their intensive care requirement, most married people living with PD receive care from their spouses; most are female caregivers. Because caregiving is hard work with long hours, caregivers experience stress, fatigue, and depression, often leading to exhaustion and burnout. The purpose of this descriptive phenomenological study is to understand the lived experience of women caregivers of husbands living with PD. As part of this study protocol, women caring at home for their husbands diagnosed with PD will be purposely recruited from the Colorado Parkinson Foundation. Semi-structured interviews will be conducted by Zoom© until data saturation is achieved. Colaizzi’s seven-step process will be used to analyze the data in Atlas.ti. Strategies have been incorporated into the study protocol to maximize trustworthiness and to insure methodological rigor. The study will be reported using recommendations from the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research. Findings from this study may guide intervention development to improve the caregiving experience and to inform clinical practice guidelines for health care professionals.
Reproductive decision-making of Black women living with HIV: A systematic review, Apr 11, 2022
Background: Black women living with HIV account for a higher proportion of new HIV diagnoses than... more Background: Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality. Objective: The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present. Methods: This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919). Results: Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decisionmaking were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness. Conclusion: No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.
Improving the physical health of psychiatric hospital residents: An evaluation of an obesity education program for mental health professionals, Sep 23, 2022
Background: People living with mental health disorders are at increased risk for developing obesi... more Background: People living with mental health disorders are at increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the obesity rate is 36% in the general population and more than 50% for people living with mental health disorders. Although mental health clinicians concentrate on managing psychiatric disorders, they seldom recognize the gradual increase in body mass index of their patients. The result is a disconnection between the clinical management of psychiatric disorders and the medical management of obesity. Purpose: This study assessed the effectiveness of an evidence-based education program for improving the obesity management practices of mental health clinicians caring for residents at a state psychiatric hospital. Methods: This was a quasi-experimental study design with a pretest and posttest evaluation. Convenience sampling was used to recruit mental health professionals, or clinicians, at a large psychiatric hospital in the Southern region of the United States. Data was collected with the Advising and Treating Overweight and Obese Patient questionnaire (17 items). Data analysis included descriptive and inferential statistics. The findings were reported in accordance with the TREND and GREET guidelines. Results: The education program was completed by 50 MHCs. The pretest indicated that 76% of MHCs were not involved in helping obese residents manage their weight, but the posttest indicated 90% were involved. There was a significant increase in MHC knowledge about obesity management and reported actions 90-days after the program. MHCs were unable to arrange follow-up visits for residents, a task not directly within their control. Conclusions: Mental health clinicians reported increased knowledge and improved clinical practice after an education program. Because the outcomes were reported at 90-days after the program, further research needs to evaluate the longitudinal impact of this type of program, where the reported behaviors are correlated to process and clinical outcome measures for obesity.
'Staying alive' with antiretroviral therapy: A grounded theory study of people living with HIV in Peru, Oct 28, 2021
Background To achieve an optimal quality of life through chronic disease management, people livin... more Background To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America. Methods A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas. ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality. Results The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers. Conclusion Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.
BMC Pregnancy and Childbirth, 2021
Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and c... more Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).
Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi’s seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.
Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
BMC Nursing, 2020
Background: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple... more Background: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. Methods: This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. Results: The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate).
Journal of Nursing Education, 2019
Background: People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative at... more Background: People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV.
Method: The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru.
Results: The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest.
Conclusion: Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion.
AIDS Research and Therapy, 2019
Background: There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adher... more Background: There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiret-roviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). Methods: This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. Results: The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efa-virenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. Conclusions: Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis , pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.
The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organiz... more The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.
Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.
KEYWORDS: Healthcare, health information technology, planning, error, iatrogenesis, risk management, failure mode effect analysis, root cause analysis, diffusion of innovation theory, rogers, complexity theory, complex adaptive systems, organizational development, patient safety, change management, human factors, ivan illich, medical nemesis.
Iatrogenesis is a term typically reserved to express the state of ill health or the adverse outco... more Iatrogenesis is a term typically reserved to express the state of ill health or the adverse outcome resulting from a medical intervention, or lack thereof. Three types of iatrogenesis are described in the literature: clinical, social and cultural. This paper introduces a fourth type, technological iatrogenesis, or emerging errors stimulated by the infusion of technological innovations into complex healthcare systems. While health information technologies (HIT) have helped to make healthcare safer, this has also produced contemporary varieties of iatrogenic errors and events. The potential pitfalls of technological innovations and risk management solutions to address these concerns are discussed. Specifically, failure mode effect analysis and root cause analysis are discussed as opportunities for risk managers to prevent problems and avert errors from becoming sentinel events.
KEYWORDS: Healthcare; health information technology; computerized physician order entry; decision support system; bar coding; patient safety; complexity theory; complex adaptive systems; medical error; adverse event; sentinel event; innovation; technology; risk management; failure mode effect analysis; root cause analysis; Medical Nemesis; Ivan Illich; Rogers; diffusion of innovation.
Nephrology Nursing Journal, 2002
Palmieri, P. A. (2002). Obstructive nephrology: Pathophysiology, diagnosis, and collaborative man... more Palmieri, P. A. (2002). Obstructive nephrology: Pathophysiology, diagnosis, and collaborative management. Nephrology Nursing Journal, 29(1), 15-23. PMID: 11887486. Awarded Best Manuscript of the Year.
Publications (Spanish) by Patrick A Palmieri
La ciencia de enfermería enfrenta ahora el reto de avanzar a la siguiente fase de desarrollo, a l... more La ciencia de enfermería enfrenta ahora el reto de avanzar a la siguiente fase de desarrollo, a lo que llamamos ´Ser relevantes a nivel mundial´. Este movimiento implica una variedad de actividades y cambios en la forma que hacemos ciencia, una responsabilidad que debe ser compartida por los científicos en todo el mundo. En el paradigma de la ciencia del cuidado, el método "es siempre subordinado a la esencia del cuidado, y el ethos es el valor basado en la ciencia del cuidado” (Lindberg, von Post, y Eriksson, 2013, p. 100). Esto significa que los estudios de investigación de alta calidad son un resultado importante de la alineación correcta de la ontología, epistemología, metodología y métodos en respuesta a una pregunta de investigación bien definida. La disciplina de la enfermería está "Basada en la ciencia del cuidado; esto a su vez, informa a la profesión. La ciencia del cuidado sirve como punto de partida-moral-filosófico-teórico fundamental para la formación de enfermería, atención al paciente, investigación, e incluso prácticas administrativas" (Watson, 2008, p. 16). En esta tradición, la ciencia de enfermería puede ampliarse para incorporar nuevos métodos de investigación (Phillips, 1990).
Seguridad del paciente y calidad en servicio de salud, Aug 2012
Conference Proceedings (Indexed and Peer-Reviewed) by Patrick A Palmieri
… of the Annual Meeting of the …, Jan 1, 2008
Nurses spend more time with patients than other health care providers, and patient outcomes are i... more Nurses spend more time with patients than other health care providers, and patient outcomes are impacted by nursing care quality. Thus, enhancements in nursing performance can lead to improvements in patient safety. Results of our comprehensive literature review (DeLucia, Ott, & Palmieri, in press) indicated that numerous factors affect the performance of nurses. These include cognitive factors (interruptions, cognitive processes), physical factors (musculoskeletal disorders, environment), and organizational factors (work hours, staffing). Here, we focus on cognitive factors. Nurses' work is cognitively demanding. Nursing involves multi-tasking, relies on procedural and prospective memory, and occurs under frequent interruptions. We discuss interruptions and cognitive processes in nursing and provide a conceptual analysis and recommendations. We conclude that the nurses' work system does not accommodate limitations and capabilities of the nurse, particularly limits in cognitive processes. The field of human factors and ergonomics is uniquely suited to redesign the nurses' work system to enhance nursing performance and improve patient safety. Of particular importance for future research is the study of interruptions and cognitive processes in nursing.
Book Chapters (Indexed & Peer-Reviewed) by Patrick A Palmieri
Case Study Contributor: Patrick A. Palmieri
Book Editor: Jonathan Leviss
Book Description
In H.I... more Case Study Contributor: Patrick A. Palmieri
Book Editor: Jonathan Leviss
Book Description
In H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations, the editors—all of whom have led successful electronic health record (EHR) and Health Information Technology (HIT) projects—have collected case studies of HIT implementations that didn't go as planned, offering expert insight into key obstacles that must be overcome to leverage IT and modernize and transform healthcare.
Through their study of HIT implementations that failed, the editors document, catalogue, and share key lessons that all project managers of HIT, health system leaders in informatics and technology, hospital executives, policy makers, and service and technology providers must learn in order to succeed with HIT.
H.I.T. or Miss presents a model to discuss HIT failures in a safe and protected manner, providing an opportunity to focus on the lessons offered by a failed initiative as opposed to worrying about potential retribution for exposing a project as having failed.
Key Features:
Presents 17 de-identified, author-anonymous case studies that highlight specific failtures in health information techonology projects. Editor's analysis and editor's commentary on each case. Lessons learned presented for each case. Appendixes include an easily searchable listing of cases by project type and lessons learned, an extensive bibliography of resources, and full text of appliciable AHIMA and government resources.
The editor and associate editors all served on the 2007 leadership board of the Clinical Information Systems Working Group of the American Medical informatics Association (AMIA).
KEYWORDS: Healthcare, health information technology, information systems, computerized physician order entry, bar coding, electronic medical record, electronic health record, decision support system, complexity theory, complex adaptive systems, error, adverse event, root cause analysis, technology, iatrogenesis, human factors.
The Institute of Medicine’s seminal report, To err is human: Building a safer health system, esta... more The Institute of Medicine’s seminal report, To err is human: Building a safer health system, established the national patient safety framework and initiated interest in changing the traditionally punitive healthcare culture. This paper reviews a multidisciplinary literature and offers an attribution framework to explicate the organizational processes that contribute to an industry-wide culture where clinicians are routinely blamed for adverse patient events. Attribution theory is concerned with the manner in which people explain the behaviors of others or themselves by assigning causality for events. To date, attribution theory, though well established in the management literature, has yet to be translated to healthcare. In this paper, we first describe the historical evolution of attribution theory in relation to human behavior in clinical practice and healthcare management and then discuss the work environments in contemporary healthcare organizations. Next, we demonstrate the applicability of attribution theory to healthcare by providing two adverse event exemplar cases. Then, the Healthcare Attribution Error Model is offered to demonstrate how concepts from attribution theory serve as antecedents to the employee cynicism, learned helplessness, organizational inertia, and the emerging Just Culture perspective. We conclude by suggesting attribution theory offers an important theoretical framework that warrants further conceptual development and empirical research. In the quest to produce exceptional healthcare environments where safety and quality are fundamental employee concerns, healthcare managers and clinical professionals need theoretically supported knowledge and evidence-based insights.
KEYWORDS: Attribution theory; patient safety; just culture; punitive culture; safety culture; cynacism; learned helplessness; blame; organizational inertia; complexity theory; complex adaptive system; leadership; organizational behavior; organizational development; human resource management; sentinel event; adverse event; error; medical error; mistake; Institute of Medicine; To err is human; James Reason.
Nurses spend more time with patients than do any other health care providers, and patient outcome... more Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. We review the literature on nursing performance, including cognitive, physical, and organizational factors that affect such performance, focusing on research studies that reported original data from nurse participants. Our review indicates that the nurse’s work system often does not accommodate human limits and capabilities and that nurses work under cognitive, perceptual, and physical overloads. Specifically, nurses engage in multiple tasks under cognitive load and frequent interruptions, and they encounter insufficient lighting, illegible handwriting, and poorly designed labels. They spend a substantial amount of their time walking, work long shifts, and experience a high rate of musculoskeletal disorders. Research is overdue in the areas of cognitive processes in nursing, effects of interruptions on nursing performance, communications during patient handoffs, and situation awareness in nursing. Human factors and ergonomics (HF/E) professionals must play a key role in the redesign of the nurses’ work system to determine how overloads can be reduced and how the limits and capabilities of performance can be accommodated. Collaboration between nurses and HF/E specialists is essential to improve nursing performance and patient safety.
KEYWORDS: Healthcare, human factors, ergonomics, nursing, work, tasks, cognition, cognitive load, interruptions, occupational health, performance, complexity theory, complex adaptive system, situational awareness, nursing shortage, patient safety, organizational behavior, organizational development, sentinel event, adverse event, error, mistake; slip, lapse, human resource management.
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Publications (English) by Patrick A Palmieri
Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi’s seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.
Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
Method: The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru.
Results: The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest.
Conclusion: Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion.
Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.
KEYWORDS: Healthcare, health information technology, planning, error, iatrogenesis, risk management, failure mode effect analysis, root cause analysis, diffusion of innovation theory, rogers, complexity theory, complex adaptive systems, organizational development, patient safety, change management, human factors, ivan illich, medical nemesis.
KEYWORDS: Healthcare; health information technology; computerized physician order entry; decision support system; bar coding; patient safety; complexity theory; complex adaptive systems; medical error; adverse event; sentinel event; innovation; technology; risk management; failure mode effect analysis; root cause analysis; Medical Nemesis; Ivan Illich; Rogers; diffusion of innovation.
Publications (Spanish) by Patrick A Palmieri
Conference Proceedings (Indexed and Peer-Reviewed) by Patrick A Palmieri
Book Chapters (Indexed & Peer-Reviewed) by Patrick A Palmieri
Book Editor: Jonathan Leviss
Book Description
In H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations, the editors—all of whom have led successful electronic health record (EHR) and Health Information Technology (HIT) projects—have collected case studies of HIT implementations that didn't go as planned, offering expert insight into key obstacles that must be overcome to leverage IT and modernize and transform healthcare.
Through their study of HIT implementations that failed, the editors document, catalogue, and share key lessons that all project managers of HIT, health system leaders in informatics and technology, hospital executives, policy makers, and service and technology providers must learn in order to succeed with HIT.
H.I.T. or Miss presents a model to discuss HIT failures in a safe and protected manner, providing an opportunity to focus on the lessons offered by a failed initiative as opposed to worrying about potential retribution for exposing a project as having failed.
Key Features:
Presents 17 de-identified, author-anonymous case studies that highlight specific failtures in health information techonology projects. Editor's analysis and editor's commentary on each case. Lessons learned presented for each case. Appendixes include an easily searchable listing of cases by project type and lessons learned, an extensive bibliography of resources, and full text of appliciable AHIMA and government resources.
The editor and associate editors all served on the 2007 leadership board of the Clinical Information Systems Working Group of the American Medical informatics Association (AMIA).
KEYWORDS: Healthcare, health information technology, information systems, computerized physician order entry, bar coding, electronic medical record, electronic health record, decision support system, complexity theory, complex adaptive systems, error, adverse event, root cause analysis, technology, iatrogenesis, human factors.
KEYWORDS: Attribution theory; patient safety; just culture; punitive culture; safety culture; cynacism; learned helplessness; blame; organizational inertia; complexity theory; complex adaptive system; leadership; organizational behavior; organizational development; human resource management; sentinel event; adverse event; error; medical error; mistake; Institute of Medicine; To err is human; James Reason.
KEYWORDS: Healthcare, human factors, ergonomics, nursing, work, tasks, cognition, cognitive load, interruptions, occupational health, performance, complexity theory, complex adaptive system, situational awareness, nursing shortage, patient safety, organizational behavior, organizational development, sentinel event, adverse event, error, mistake; slip, lapse, human resource management.
Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi’s seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.
Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
Method: The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru.
Results: The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest.
Conclusion: Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion.
Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.
KEYWORDS: Healthcare, health information technology, planning, error, iatrogenesis, risk management, failure mode effect analysis, root cause analysis, diffusion of innovation theory, rogers, complexity theory, complex adaptive systems, organizational development, patient safety, change management, human factors, ivan illich, medical nemesis.
KEYWORDS: Healthcare; health information technology; computerized physician order entry; decision support system; bar coding; patient safety; complexity theory; complex adaptive systems; medical error; adverse event; sentinel event; innovation; technology; risk management; failure mode effect analysis; root cause analysis; Medical Nemesis; Ivan Illich; Rogers; diffusion of innovation.
Book Editor: Jonathan Leviss
Book Description
In H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations, the editors—all of whom have led successful electronic health record (EHR) and Health Information Technology (HIT) projects—have collected case studies of HIT implementations that didn't go as planned, offering expert insight into key obstacles that must be overcome to leverage IT and modernize and transform healthcare.
Through their study of HIT implementations that failed, the editors document, catalogue, and share key lessons that all project managers of HIT, health system leaders in informatics and technology, hospital executives, policy makers, and service and technology providers must learn in order to succeed with HIT.
H.I.T. or Miss presents a model to discuss HIT failures in a safe and protected manner, providing an opportunity to focus on the lessons offered by a failed initiative as opposed to worrying about potential retribution for exposing a project as having failed.
Key Features:
Presents 17 de-identified, author-anonymous case studies that highlight specific failtures in health information techonology projects. Editor's analysis and editor's commentary on each case. Lessons learned presented for each case. Appendixes include an easily searchable listing of cases by project type and lessons learned, an extensive bibliography of resources, and full text of appliciable AHIMA and government resources.
The editor and associate editors all served on the 2007 leadership board of the Clinical Information Systems Working Group of the American Medical informatics Association (AMIA).
KEYWORDS: Healthcare, health information technology, information systems, computerized physician order entry, bar coding, electronic medical record, electronic health record, decision support system, complexity theory, complex adaptive systems, error, adverse event, root cause analysis, technology, iatrogenesis, human factors.
KEYWORDS: Attribution theory; patient safety; just culture; punitive culture; safety culture; cynacism; learned helplessness; blame; organizational inertia; complexity theory; complex adaptive system; leadership; organizational behavior; organizational development; human resource management; sentinel event; adverse event; error; medical error; mistake; Institute of Medicine; To err is human; James Reason.
KEYWORDS: Healthcare, human factors, ergonomics, nursing, work, tasks, cognition, cognitive load, interruptions, occupational health, performance, complexity theory, complex adaptive system, situational awareness, nursing shortage, patient safety, organizational behavior, organizational development, sentinel event, adverse event, error, mistake; slip, lapse, human resource management.
KEYWORDS: Safety culture, safety climate, safety attitude, safety industry, patient safety, high reliability theory, normal accident theory, complexity theory, complex adaptive system, human factors, organizational psychology, organizational sociology, human resource management, strategic human resource management, organizational behavior, organizational development, leadership, sentinel event, adverse event, errors, mistakes, Institute of Medicine, Charles Perrow, James Reason.
KEYWORDS: Healthcare, patient safety; safety culture; safety climate; safety attitude; high reliability organization; high reliability theory; complex adaptive system; complexity theory; organizational development; organizational behavior; safety science; errors; medical error; human error; adverse event; sentinel event; root cause analysis; blame; law; leadership; Swiss cheese model; Institute of Medicine; To err is human; James Reason; Charles Vincent; Peter Pronovost.
Methods: he Nursing Mentorship Resource Guide, published by the Canadian Association of Public Health Nursing Management, supported the development of nurse leader mentoring relationship. The resourse guide is based on the Mertz's Conceptual Model of Mentoring that distinguishes mentoring from other kinds of supportive relationships. The quality improvement work was guided by Roger's diffusion of innovation Theory (changing culture through innovation), King's Systems Interaction Model (interaction of nursing within organizations), and Donabedian's Quality Improvement Triad (structures + processes = outcomes). With this framework, the nurse leaders were mentored to developed a project committee and specific chapter teams, where each team identified projects and sub-projects ranked from lowest to highest resistance to change for each deficiency, SMART goals were established, an iterative PDSA quality improvement process was implemented, and the results for each subproject and project were evaluated.
Key points for discussion: The nurse-leaders successfully implemented a system-wide QI project. The first self-evaluation demonstrated 27% compliance with all accreditation standards. Nurse leaders were guided in formulating strategies to impact the uncompliant areas. In addition, nurse leaders recieve mentoring to manage and overcome obstacles in implementing QI strategies. The subprojects and projects then resulted in an 86% compliance. Importantly, the standards deemed as “critical standards” were assessed at 100%. Furthermore, the operational balanced scorecard demonstrated improvements in financial outcomes and a decreased number of adverse events with harm. The official accreditation evaluation resulted in no chapter deficiencies and a full three-year accreditation was granted.
Conclusion and recommendations: Hospitals in developing countries can substantially increase the quality and decrease the cost for health services by fully engaging nurses. Specifically, international nurse leaders, educators, and clinicians can empower developing country nurse leaders to effect positive change. In addition, empowered nurses can convience hospital leaders to authorize nurse-led quality improvement projects based on accreditation standards. This quality improvement effort resulted in the diffusion of quality innovation organization-wide. In Peru, the importance of nursing practice in hospitals is under appreciated and not recognized as a quality improvement strategy. This nursing-led project clearly demonstrates that simple, structured, and affordable projects can improve hospital quality in developing countries.