Organizational Factors Associated With Nurses’ Competence in Averting Failure to Rescue in Acute Care Settings

For nursing students

Study summary

This article, titled "Organizational Factors Associated With Nurses’ Competence in Averting Failure to Rescue in Acute Care Settings," explores a critical aspect of nursing practice: how the environment and structure of healthcare organizations influence nurses' ability to prevent patient harm. The study was conducted by researchers at Olabisi Onabanjo University Teaching Hospital in Sagamu City, Nigeria. It is important for nursing students to understand that this research focuses on 'Failure to Rescue,' which refers to situations where a patient's condition worsens despite receiving appropriate medical care. This can happen due to various reasons, including delays or errors in treatment.

The authors aimed to assess the organizational factors associated with nurses' competence in averting Failure to Rescue (FTR) in acute care settings. They used a descriptive and correlational study design, which means they collected data from participants and looked for relationships between variables without trying to establish cause-and-effect directly. The study involved 173 registered nurses who provide sudden, urgent, or emergency direct patient care in the identified acute care areas of Olabisi Onabanjo University Teaching Hospital.

To gather information, a self-structured questionnaire with 38 items was used. This questionnaire covered four main parts: demographic characteristics (like age and years of experience), knowledge about FTR, competence in averting FTR, and organizational factors such as staffing levels, availability of resources, communication channels within the hospital, and leadership support.

The data collected were analyzed using statistical software called SPSS V. 22. Descriptive statistics like frequencies, percentages, means, standard deviations, and tables were used to summarize the data. To test their hypotheses about how organizational characteristics relate to nurses' competence in averting FTR, they used Spearman’s Rho correlation. This type of analysis is suitable when variables are measured on an ordinal scale (meaning they can be ranked or ordered) and helps determine if there's a significant relationship between two sets of data.

The results showed that most participating nurses had a high level of knowledge regarding FTR, with a mean score indicating strong understanding. However, their competence in actually averting FTR was rated as moderate, with a lower mean score compared to their knowledge scores. A key finding was the detection of a significant correlation between organizational characteristics and the studied nurses' level of competence in averting FTR (P=0.026). This means that there is a statistically significant relationship; better or more supportive organizational factors are associated with higher levels of competence among nurses.

The study concludes that Failure to Rescue could be reduced in acute care settings by modifying organizational factors. For nursing students, this highlights the importance of understanding not just clinical skills but also how the broader healthcare environment impacts patient outcomes. It suggests that improving aspects like staffing, resource availability, communication systems, and leadership support within a hospital can empower nurses to perform more effectively.

When appraising this research as an undergraduate student, consider several points: 1. **Source and Rights:** The article is published in the Journal of Client-Centered Nursing Care (DOI: 10.32598/jccnc.7.1.358.1) under a Creative Commons Attribution-NonCommercial license (CC BY-NC). This means you can share, copy, and build upon this work for non-commercial purposes as long as appropriate credit is given to the authors. 2. **Population:** The study focused on registered nurses providing direct care in acute settings at one specific hospital in Nigeria. While useful for understanding conditions there, results might differ in other locations or types of nursing roles (e.g., community health). 3. **Research Design:** As a descriptive and correlational study, it identifies associations but does not prove that organizational factors *cause* changes in competence. Other unmeasured variables could also be at play. 4. **Instrumentation:** The use of a self-structured questionnaire is appropriate for collecting data on knowledge, perceived competence, and attitudes towards organizational factors. However, the reliability and validity of this specific instrument were not detailed in the abstract provided. 5. **Generalizability:** Findings from one hospital may not be directly applicable to all nursing settings globally or even within Nigeria itself. 6. **Nurse Reasoning:** A nurse might reason that if organizational factors like adequate staffing and good communication are linked to better competence, then advocating for improvements in these areas could lead to fewer patient safety incidents related to FTR. This study provides evidence supporting such advocacy efforts by highlighting the role of the work environment.

In summary, this research underscores the complex interplay between nurses' skills/knowledge and their working conditions in preventing adverse patient outcomes like Failure to Rescue. It emphasizes that creating a supportive organizational culture is crucial for enhancing nursing competence and ultimately improving patient safety.

For educators

Teaching and appraisal notes

This study investigates the relationship between organizational factors within acute care settings and registered nurses' competence in averting Failure to Rescue (FTR). Conducted at Olabisi Onabanjo University Teaching Hospital in Sagamu City, Nigeria, it employs a descriptive and correlational research design. The authors aimed to assess how various aspects of hospital organization influence nurses' ability to prevent patient harm when conditions deteriorate despite appropriate care.

The study utilized purposive sampling to recruit 173 eligible registered nurses who provide sudden, urgent, or emergency direct patient care in the identified acute care areas of the hospital. A self-structured 38-item questionnaire was used for data collection. This instrument covered four domains: demographic characteristics (e.g., age, years of experience), knowledge regarding FTR, competence in averting FTR, and organizational factors such as staffing levels, resource availability, communication systems, leadership support, and overall work environment.

Data analysis involved SPSS V. 22 software. Descriptive statistics (frequency, percentages, mean scores, standard deviations) were used to summarize the data for each variable. To test the hypotheses linking organizational characteristics with nurses' competence in averting FTR, Spearman’s Rho correlation was employed. This non-parametric statistical method is suitable for assessing monotonic relationships between two ordinal variables and determining their significance (P<0.05).

Key findings from this study include: 1. A high level of knowledge regarding FTR among the participating nurses (mean score: 5.91), indicating a good understanding of what constitutes Failure to Rescue. 2. Moderate competence in averting FTR, with a mean score of 29.3 for the competence domain. 3. A statistically significant positive correlation between organizational characteristics and nurses' level of competence in averting FTR (P=0.026). This suggests that better or more supportive organizational factors are associated with higher levels of perceived competence among nurses to prevent FTR.

The authors conclude that modifying organizational factors within acute care settings could lead to a reduction in Failure to Rescue incidents. For nursing faculty, this study highlights the importance of considering the broader healthcare environment as a determinant of patient safety outcomes alongside individual nurse skills and knowledge. It provides empirical support for the idea that fostering positive organizational characteristics can enhance nurses' effectiveness.

When evaluating this research from an academic perspective: * **Strengths:** The use of a structured questionnaire allows for systematic data collection on multiple relevant variables. The statistical analysis (Spearman’s Rho) is appropriate for the type of data and hypotheses tested. The focus on FTR, a critical patient safety issue, is highly pertinent. * **Limitations:** As noted in the abstract, limitations include potential generalizability issues due to its single-hospital setting in Nigeria. Being a correlational study, it cannot definitively establish causality; other unmeasured confounding variables might influence both organizational factors and nurse competence. The reliance on self-reported data (knowledge scores, perceived competence) can introduce bias. * **Educational Value:** This article is valuable for nursing students as it bridges theoretical knowledge about patient safety with practical considerations of the healthcare workplace environment. It encourages critical thinking about how systemic issues impact clinical practice and outcomes. Faculty might use this to discuss topics such as organizational culture, resource allocation in healthcare, communication strategies within teams, leadership styles, and their collective influence on quality care. * **Applicability:** While specific to Nigerian acute care settings, the general theme of organizational factors influencing competence is universally relevant. It can stimulate discussions about improving hospital policies and practices globally to enhance patient safety.