Dosen Pengajar : Rizky Neguita Hanna, S.S., M.

Pd

Tugas : English II (Mid)

“REVIEW JOURNAL ARTICLE”

Disusun Oleh :

Name : Muhammad Nurjaya AlfitrahMustari

Nim : P201901072

Clas : T2 Keperawatan

PROGRAM STUDI S-1 KEPERAWATAN

FAKULTAS ILMU KEPERAWATAN

UNIVERSITAS MANDALA WALUYA

KENDARI

T.A 2021
 REVIEW JOURNAL
A. Citation.

The Working Hours Of Hospital Staff Nurses And Patient Safety

Su-yin Hor, Natalya Godbold, Aileen Collier and Rick Iedema

University of Technology, AustraliaHealth 0(0) 1–17© The Author(s) 2013

B. Abstrac.
In the last decade, the field of patient safety has grappled with the complexity of
health- care systems by attending to the activity of frontline clinicians. This article
extends the field by highlighting the activity of patients and their carers in determining
the safety of these systems. We draw on data from three studies exploring patients’
accounts of their health-care experiences in Australia and internationally, to show how
patients and carers are currently contributing to the safety of their own care.
Furthermore, we emphasise the importance of patient–clinician collaboration in
ensuring the success of these activities. We argue that it is no longer sufficient to
discuss if patients should be involved with ensuring their own safety. Given that
patients are already involved, we propose a new conceptualisation of safety and systems
that acknowledges their involvement and supports patient–provider collaboration to
achieve safer care.

C. Introduction.
The last decade of the patient safety movement has seen vast growth in safety
research and programs (Wachter, 2010), but when we take stock of all that has been
achieved, the voices of patients themselves are largely missing. Medical error is
understood as some- thing that happens to patients, and despite recent developments in
incident disclosure (Iedema et al., 2011), these errors are not necessarily communicated
with patients (Kronman et al., 2011). Researchers and policymakers, however, have
argued prospec- tively for the involvement of patients, noting, for example, that ‘there is
considerable scope for [patients] to play an active part’ in ensuring that their care is safe
and appropriate
D. Problem.
Travaglia and Braithwaite (2009) observed that currently, ‘what an error is, how
it is defined, and what is included has been left exclusively to clinicians and
researchers’ (p. 603). And yet, researchers have argued that patients may have
information and experi- ences of which health-care staff are unaware (Richardson,
2004), patients may be more alert to safety risks than staff who have become inured to
‘risky’ events (Giles et al., 2006) and patients are especially motivated to avoid harm
(Weingart et al., 2005). Research is also mounting showing that patients and their carers
– especially those with chronic illnesses – are particularly knowledgeable about the
workings and frailties of health-care systems (Iedema et al., 2011; Taylor et al., 2008;
Vincent, 2006).
Recent studies have shown that patients have been able to identify adverse
events in their own care that were not otherwise reported by clinicians (Weingart et al.,
2005; Weissman et al., 2008). Interestingly, both studies used clinicians, primarily
doctors, to determine the validity of patient-reported adverse events. In contrast, two
other studies (Kuzel et al., 2004; Scott et al., 2012) focused on eliciting patients’
definitions of safety and found that these differed in emphasis from clinical criteria;
patients foregrounded instead the quality of communication and responsiveness from
their clinicians and men- tioned instances of insensitivity and miscommunication as
critical events impacting on their perceptions of safety (Kuzel et al., 2004; Scott et al.,
2012).
E. Date And Result.
We have drawn our data for this article from three interrelated but separate
studies, two of which are ongoing and one recently completed. These studies share the
aims of under- standing and articulating the experiences of patients and carers in health
care and have been conducted by a team of researchers who work closely with one
another in a univer- sity research centre. All three studies obtained formal ethics
approval from The University of Technology, Sydney, as well as the relevant Local
Health Networks in New South Wales, Australia, where relevant. We have chosen to
 draw on data from all three studies in this article to highlight the commonality of our
findings across these different approaches and patient populations.
The first study, the Dialysis study, aims to understand how renal patients make
sense of their experiences with dialysis using online discussion boards. This study
draws on data from 2 years of participant observation in three international online
discussion groups, with access to archives covering 7 years of messages created by over
6000 con- tributors in total (who are mainly renal patients and carers from the United
States, United Kingdom, Canada and Australia). Daily discussions in these groups
concern the ongoing experiences of renal failure and its treatments. This study has been
described in more detail by Godbold (2010, in press).
F. Research Method.
To begin with, patients and carers often described being vigilant against error,
by check- ing and documenting their medications and by checking and questioning staff
when something was wrong. A common theme in these accounts was that their safety
practices were initiated because previous expectations of safety were not met:

There are so many mistakes you know. I see them all around me. You have to
count your tablets. Make sure you have the right number, keep an eye on the oxygen.
You see they come along and change things. These hospitals are making thousands of
mistakes I see them, I see them all the time. (Patient, Palliative Care study)

He always had a sheet of his medication list in case he had to go to hospital And
because they had made lots of mistakes – and they did, in [major hospital], with his
medication in front of us, actually said he didn’t need Physeptone because it wasn’t on
the list, and I looked at the page, and there it was! Not to worry. [Patient] had it stuck on
the wall beside the bed because he really wanted to live. He knew he didn’t have much
longer left, but what he had, he wanted to have. (Carer, Open Disclosure study)
G. Research Result.
Mistakes featured often in participants’ accounts of safety work, but what
emerged as being significant in participants’ accounts was how much they were reliant
on the coop- eration of health-care staff to enable or advance their self-initiated safety
behaviours, and how they could (and did) face harm when that cooperation was not
forthcoming. In the examples below, we see the severity of the harm that patients can
experience as part of their care, underscoring how strongly motivated patients and their
families can be to protect themselves, and their intense frustration and anger when they
are unable to do so:

I kept saying, you know, there’s something wrong, there’s something wrong and
they just kept feeding me up on painkillers and I kept saying, you know, don’t keep
giving me these because you’re just masking the fact that something’s wrong. And they
just kept feeding them to me and something was wrong, you know, I haemorrhaged
twice, I had a heart attack, I was rushed in for an emergency operation, which was a
curette because they’d left so much placenta in there.
As mentioned by the patient in the last example, we found that participants
distinguished between clinicians who were unfamiliar to them and those with whom
they had relation- ships. Furthermore, participants also predicted conflict or cooperation
by this distinction. The excerpt below illustrates the difference recounted by a patient,
between an unknown nephrologist ‘on call’ in the emergency department who relies on
a generic guideline, and the patient’s ‘real’, that is to say her usual, nephrologist:

I think some of the problem with Dialysis is that ‘one size fits all’. Case in point:

In November, I had severe food poisoning […] 3 days later I went to the
emergency room (just not recovering). ER nurse could not find a vein for possible fluids
as all my veins were collapsed. Finally, after ultra sound – they found something to
stick. (severe dehydration). Next, the Neph on call contacted. He refused any fluids for
me. Since I was a [dialysis] patient, of course I can’t have fluids, right? One size fits all.
I was panicked – I don’t want to lose what function I have left. Finally, after much ado
from me, my ‘real’ Neph was contacted. He ordered 2 liters of saline quick drip, and
another over 24 hrs. (Patient, Dialysis study)
H. Analisis.
Patients are already involved in the safety of their care. Our findings
demonstrate their particular capacities for doing so, including longitudinal and intimate
knowledge of themselves, and biomedical and treatment knowledges that are not
exclusive to clini- cians. We also demonstrate patients’ and carers’ abilities to carry out
close and ongoing monitoring and strong motivations to protect themselves from harm.
Furthermore, patients’ and carers’ safety efforts are not limited to discrete instances of
medication delivery or treatment. Instead, they enact an ongoing vigilance, against the
possibilities of harm that often arise in their care.
The question therefore is no longer if or how patients should be involved in
safety since they are already involved. We have shown that patients’ involvement can
be critical and that collaborative patient–provider relationships allow for their success.
Conversely, we have also shown that ignoring patients’ involvement can detract from
safety. For many participants in our studies, their efforts at safety were ignored or
blocked by the care they encountered, resulting in intense frustration and anger, and at
times significant pain or acute illness requiring intensive care and prolonged
hospitalisation. Therefore, even as we foreground the significance of patient-initiated
safety work and highlight the success of patient–provider collaboration, patients’ efforts
nevertheless depend on communication and cooperation with clinicians, who are not
always forthcoming. We need therefore to acknowledge the complex ways in which
power can intersect with patient-produced safety.