Digital Commons Network^™

Creating A Climate Of Safety: Preparing Nursing Students For Responsible Artificial Intelligence Use, Shanti Srinivas, Jennifer L. Stewart

HCA Healthcare Journal of Medicine

Safety is the foundation of high-quality, effective, and efficient health care, requiring intentional dedication from organizations, leaders, educators, providers, and patients alike. The increasing integration of artificial intelligence (AI) into health care settings is outpacing the development of structured safety education designed for its use. As AI tools become increasingly embedded in diagnosis, documentation, and clinical decision-making, a climate of safety must extend to encompass the unique risks these technologies introduce, including algorithmic biases, data privacy vulnerabilities, and the possible erosion of clinical judgment through overreliance on machine-generated outputs.

Equally essential is the promotion of workplace wellbeing, which recognizes that …

From Hired To Hands-On-Deck Status: Solving Delays In Health Care Hiring Processes And Supporting Workforce Safety Across A Large For-Profit Health System, Cynthia Skeens

HCA Healthcare Journal of Medicine

Background

During and after the COVID-19 pandemic, health care staffing shortages and onboarding inefficiencies, specifically delays in employee health clearance, prolonged time to hire, and threatened workplace and patient safety.

Methods

An employee health onboarding workflow at a large health care organization was redesigned across 3 domains: people, process, and technology. Interventions included workflow standardization, elimination of non–value-added steps, optimized tuberculosis screening, increased appointment capacity, and technology integration (electronic health record [EHR]documentation, centralized scheduling and communication, and completion of pre-visit forms). Following a pilot from May to December 2022, the workflow was expanded organization-wide with a structured rollout and ongoing …

Promoting Safety In Alcohol Withdrawal Syndrome: A Proactive Nursing Process Framework, Julie Anne C. Comia, Elizabeth Card

HCA Healthcare Journal of Medicine

Background

Alcohol withdrawal syndrome (AWS) is a potentially life-threatening response to the abrupt cessation or reduction of heavy, prolonged alcohol use. Untreated, it can progress to delirium tremens (DT), a medical emergency historically associated with mortality as high as 40%. Agitation and hallucinations during withdrawal also pose safety risks to the health care team in addition to the patient. Because deterioration follows a predictable course, timely nursing recognition and intervention are central to protecting both the patient and the care team from avoidable harm. The evidence-based framework is intended as an educational tool to help nurses anticipate and avoid harm; …

A Conceptual Framework For Clinical Quality Oversight In Telehealth-Enabled Home-Based Urgent Care, Taylor Spencer, Jason P. Williams

HCA Healthcare Journal of Medicine

Background

Home-based urgent care serving frail older adults should aspire to high-quality clinical care with optimal patient outcomes. However, monitoring and ensuring this quality can be challenging. For example, telemedicine and value-based frameworks introduce substantial complexity to clinical quality monitoring.

Purpose

We describe the conceptual framework for a multidimensional quality monitoring program within a national home-based urgent care model.

Framework Description

Medical care was delivered via a multi-state home-based primary, palliative, and urgent care practice serving medically complex Medicare Advantage (MA) populations. Our model of care incorporated distributed clinical and operational teams delivering 24/7 care via telephonic triage, video-enabled encounters, …

A Safety Framework: Empowering Faculty To Build A Culture Of Safety, Rebekah L. Randall, Sarah Woodward

HCA Healthcare Journal of Medicine

Background

Prelicensure nursing curricula lack a defined safety framework for clinical education, leaving faculty with minimal guidance on how to model and teach foundational safety concepts. Nursing accrediting bodies identify psychological and physical safety as institutional priorities, emphasizing the need to equip future clinicians with foundational safety competencies early in their training.

The purpose of this quality improvement project was to develop the ABCs of Prevention (Awareness, Body, Communication) and 4Rs of Intervention (Remove, Report, Record, Reflect) safety framework for clinical nursing education, provide faculty education and resources to support its application in teaching, and assess the impact of the …

Integrating The Icare Compassionately Model Into Disaster Simulation, Chelsea Baker

HCA Healthcare Journal of Medicine

While global efforts to increase access to health care have been successful, the provision of high-quality, safe care remains a critical priority as adverse events continue to impact patient outcomes. To combat this issue, nurse educators need to address gaps in both technical and relational domains of care, including compassion. Despite being identified as a core competency to safe practice, compassionate care principles remain inconsistently taught and practiced within nursing curriculum. This study examined the integration of the iCare (inclusivity, character, accountability, respect, excellence) Compassionately model into a simulated disaster scenario to provide students with an opportunity to apply emotional …

Thermal Skin Burns Following Infrared Vein Finder Application In Pediatric Patients: A Report Of 2 Cases And Protocol Revision, Sujata S. Rawlani, Nandini Banad, Jenil Sheth, Raja Narsingrao

HCA Healthcare Journal of Medicine

Background

Peripheral venous cannulation remains a cornerstone of pediatric anesthesia practice. Infrared vein finder devices have gained popularity as aids to improve venous visualization in children with difficult access. However, the thermal hazards associated with certain device types, particularly pocket flashlight-based models, remain underappreciated among clinical staff.

Case Presentation

We report 2 pediatric patients who sustained grade 2 thermal burns at peripheral venous access sites following the use of a pocket flashlight-based infrared vein finder during ophthalmic surgical procedures. The first patient, an 8-month-old girl born at term with appropriate developmental milestones undergoing congenital cataract surgery, developed a ruptured blister …

Assessment Of Hypoglycemia Management In Acute Care Hospitals, Carley Warren, Christina Wing, Chenette Burks, Brooke Schmidt, Adam Hasse

HCA Healthcare Journal of Medicine

Background

Hypoglycemia is a common and potentially preventable complication among hospitalized patients, particularly those receiving insulin or other glucose-lowering therapies. Delayed recognition and inconsistent management can increase adverse outcomes. Although protocols exist, variability in treatment selection and timing may influence the likelihood of returning to normoglycemia. Understanding these patterns is critical to optimizing patient safety in acute care settings.

Methods

This retrospective review evaluated hypoglycemia management in adult inpatients across acute care hospitals within a large health system. Patients were included if they were aged 18 years or older, were hospitalized within the health system, and experienced a hypoglycemic event, …

Yellow Gowns For Fall Prevention: A Quality Improvement Initiative To Enhance Patient Safety, Kimberly Nathan, Obumneke Umerah, Lorenna C. Garcia-Bochas, George A. Helmrich Sr, Nayda Parisio Poldiak, Jilian R. Sansbury

HCA Healthcare Journal of Medicine

Background

Falls, with and without harm, are monitored as a quality metric for inpatient units and are an important component of patient safety. Across the medical-surgical (Med-Surg) units at our facility, fall rates have shown some variability over time, prompting further evaluation of fall-prevention practices and opportunities for improvement. From quarter 1 (Q1) of 2022 through Q2 of 2025, several units reported fall rates ranging between 4.0 and 7.0 falls per 1000 patient days. A review of contributing factors highlighted opportunities to strengthen consistency in fall-prevention practices, enhanced education around alarm use, and improve visibility of patients at higher risk …

Time To Antibiotic Administration In The Treatment Of Sepsis: A Retrospective Cohort Study, Dennis Anthony Cardriche, Grayson Carter, Thomas Matese

HCA Healthcare Journal of Medicine

Background

The 2026 Surviving Sepsis Campaign (SSC) guidelines recommend antimicrobial therapy within 1 hour for probable septic shock, while the Centers for Medicare and Medicaid Services (CMS) mandates a 3-hour window. Current literature presents conflicting evidence on whether these universal time thresholds yield a definitive survival benefit. This study aims to evaluate the real-world impact of delayed antibiotic administration on patient mortality and length of stay (LOS).

Methods

A retrospective cohort study was conducted analyzing 62 153 adult encounters with severe sepsis or septic shock at emergency departments (EDs) between December 31, 2023, and December 31, 2025. Time to first …

A Heuristic Tool To Enable Root Cause Analysis Of Safety Events, William D. Porter, Kianca Joseph, Demitria Stafford, Kurt Larson, John Mier, Michelle Butler-Jackson, Musaddiq Waheed

HCA Healthcare Journal of Medicine

Background

Hospitals routinely collect wide-ranging data related to quality, efficiency, and clinical practice. As part of these efforts, patient safety event data are collected, compiled, and analyzed to drive process improvement.

Methods

We present a novel adaptation and application of the Department of Defense Human Factors Analysis and Classification System (HFACS) as a heuristic tool to improve the conduct of root cause analysis (RCA) sessions that follow serious patient safety events. To assess individual knowledge improvement after reviewing the heuristic tool, a 1-page summary (including a graphical image of the tool) was developed and provided to a convenience sample of …

The Use Of Infra-Red Spectroscopy To Assess Intact Skin Of Various Skin Tones, Mary Lee A. Potter, Stacie Sosa, Charlott Polm, Sherry Campton, Wisam Salameh, Ronnie Klein, Yaniv Cohen

HCA Healthcare Journal of Medicine

Background

Pressure injuries (PI) continue to be a serious medical complication in the acute care setting. Industry leaders advocate for the use of objective technologies to provide accurate and quantifiable skin assessments for all patients across diverse skin tones. The Infra-Red Spectroscopy Scanner (IRSS) is a novel non-invasive decision support system (DSS) electro-optic technology that uses near infra-red spectroscopy to examine and assess physical and chemical changes prior to visual skin breakdown in real-time.

Methods

A 2-phase prospective open-label pilot device study was launched under protocol IRM-02-1123 (USA version 3.0, November 1, 2023). In both Phase 1 and Phase 2, …

Building A Culture Of Safety Through Faculty Mentorship: The Peer Pairing Framework For Clinical Nurse Educators, Clare A. Chambers

HCA Healthcare Journal of Medicine

Background

Clinical nurse educators often transition from bedside practice to clinical education in high-risk settings without structured support. Limited or absent mentorship during this transition may affect educator confidence, student learning outcomes, patient outcomes, and the ability to sustain a culture of safety. Although mentorship is widely recommended in nursing education, implementation strategies remain limited. The Peer Pairing Framework was developed as a staged mentorship approach to support clinical nurse educators and inform a comprehensive mentorship model.

Methods

The Peer Pairing Framework was informed by a voluntary onboarding survey of 914 clinical faculty, of whom 73.52% expressed interest in having …

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

Retrospective Exploratory Pre And Post Evaluation Of Waste Anesthetic Gas Scavenging System And Association With Post Anesthesia Care Unit (Pacu) Nurse Health, Jessica Garibay, Dina A. Krenzischek, Ryan Macdonald, Elizabeth Card

HCA Healthcare Journal of Medicine

Background

The Occupational Safety and Health Administration (OSHA) recognizes the negative health impact of occupational exposure to anesthetic gases in the operating room. As a result, OSHA has implemented regulations, engineering controls, and regular air quality surveillance programs to protect surgical staff. However, immediate postoperative patients exhale waste anesthetic gases (WAGs) into the Post Anesthesia Care Unit (PACU) environment, exposing nurses to occupational health risks, including headaches, fatigue, organ damage, cancer, and reproductive complications. The PACU lacks any regulations or even recognition of this safety issue; in fact, most nurses and leadership are unaware. One potential solution, a scavenging oxygen …

Laboratory Study Of A Waste Anesthetic Gas Mask Scavenging System To Reduce Airborne Pathogen Exposure For Health Care Workers In Post Anesthesia Care Units, Josh Horton, Trevor Lim, Andrew Kanach, John Moenning, James Mcglothlin, Bruce M. Applegate Sr.

HCA Healthcare Journal of Medicine

Introduction

A scavenging oxygen mask system (SOMS) utilizing house vacuum has been demonstrated to significantly reduce exposure of post anesthesia care unit (PACU) health care workers (HCWs) to waste anesthetic gases (WAGs). Therefore, it was proposed that the same system could also be used to protect HCWs in the PACU by reducing Infectious Respiratory Particles (IRPs) spread from patients who may harbor airborne infective pathogens, such as Mycobacterium tuberculosis, certain strains of influenza, and SARS-CoV-2.

Methods

A life-like adult manikin head equipped with a bio-aerosol Collison nebulizer was set up to simulate patients exhausting pathogenic droplets. Further evaluation of …

A Nurse-Driven Escalation In Trauma Team Activation Reduces Mortality Of Injured Patients, Darrell L. Hunt, Yingxian Liu, Jordan S. Rahm, Bailey Segura, Mercedes Huens, Emily Lopez, Esther Krinsky, Joe Spinell, Andrea Palmer

HCA Healthcare Journal of Medicine

Background

There is a dearth of literature examining the clinical outcomes of injured patients who experience physiological deterioration in the emergency department (ED). At our trauma center, injured patients who develop hemodynamic, respiratory, or mental status instability after arrival are retriaged and upgraded to a full trauma team activation (fTA). The purpose of this study was to compare the clinical outcomes of patients with fTA based on prehospital signs and symptoms (initial) versus upgraded fTA patients.

Methods

This was a single-center, retrospective cohort study of injured patients presenting to a tertiary trauma center between June 1, 2022, and June 30, …

Adaptations To Medical Education In A State-Specific Abortion Ban Paradigm, Crystal Duncombe, Anthony Sciuva, Shyamalee A. Ramaraj, Douglas Mcgill, Jilian R. Sansbury, Jennifer Risinger, Nayda Parisio Poldiak, William S. Hart

HCA Healthcare Journal of Medicine

The United States (US) Supreme Court’s overturning of Roe v Wade in 2022 via the decision made in Dobbs v Jackson Women’s Health Organization removed the national protection for doctors to perform abortions and made states able to impose restrictions on this medical procedure. This change immediately affected health care availability in the US, with many states outright banning or effectively banning abortion through gestational limits. Immediate negative effects were reported in populations and locations where maternal health outcomes were already poor, including among Black women and patients living in rural areas. Here we review how the Dobbs decision disrupted …

Making Diagnostic Uncertainty Visible At Intensive Care Unit Transitions: A Narrative Review Of Diagnostic Pause Strategies, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Diagnostic error is a significant patient safety issue in critical care. However, it is often difficult to detect during ongoing care. Patients in the Intensive Care Unit (ICU) often have incomplete histories, overlapping symptoms, changing physiology, and concurrent issues. During ICU transitions, patient diagnoses are often reported without clear information on diagnostic confidence, potential alternative diagnoses, pending results, or triggers needing review.

Methods

This clinical narrative review explored diagnostic uncertainty at ICU transitions, specifically those during ICU-to-ward transfers or unplanned escalations to the ICU. A targeted literature search identified studies of adult ICU diagnostic errors, ICU transition safety, ICU-PAUSE …

Beyond Bed Numbers: A Proposed Quality Improvement Framework For Reviewing Icu Acuity, Workload, And Medical Staffing, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Intensive care unit (ICU) medical staffing is often planned using bed numbers or fixed ratios. These counts do not describe the work required when patients deteriorate, urgent tasks overlap, or clinicians have duties outside the unit. A structured review could help teams discuss whether available cover can meet these demands.

Methods

We undertook a targeted narrative synthesis of adult ICU staffing guidance, acuity and workload measures, physician workload studies, and capacity-strain research available through 8 September 2026. We examined study settings, findings, and limitations to inform the framework domains. The authors proposed the review prompts and response options. No …

Brief, Handoff, Backbrief, Forecast, Review: A Communication Cycle For Safer Trauma And Surgical Intensive Care Unit Transitions, Constantine Stephens, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Safety in trauma and surgical critical care is inseparable from the reliability of communication at transitions of care. Handoffs are recurrent, high-risk moments in which teams transfer not only information but responsibility, prioritization, uncertainty, and contingency planning; failures at these points propagate into omissions, delayed escalation, and preventable harm to patients and strain on the workforce. Structured handoff tools improve completeness and clarity but inconsistently change hard clinical endpoints, and tools alone do not create the culture of safety on which high-reliability organizations (HROs) depend. This narrative review synthesizes civilian handoff research, human-factors and HRO theory, situation-awareness, psychological safety, trauma …

Bathrooms As A Patient Safety Blind Spot In Emergency Departments: A Narrative Review And Nursing Practice Framework, Carmelo Villani

HCA Healthcare Journal of Medicine

Background

Emergency department (ED) bathrooms preserve privacy and dignity but interrupt direct observation. Risks described across clinical publications and professional guidance include falls, unrecognized deterioration, overdose, hazardous ingestion, infection, inaccessible environments, and unmet elimination needs. This review integrated those risks and translated them into a nursing practice framework.

Methods

For the structured narrative review, PubMed/MEDLINE, CINAHL Plus, and Scopus were searched on July 30, 2026, without date, language, age, or publication-type filters. Backward and forward citation chasing and a targeted search for professional documents supplemented database searching. Publications were categorized by ED relevance and synthesized thematically. Professional guidance was analyzed …

From Restraint To Calm: A Narrative Review Of Nonpharmacologic Alternatives To Physical Restraints In Adult Acute Care And Introduction Of The Calm Bedside Restraint Alternatives Framework, Elizabeth Card, Brandi Puet

HCA Healthcare Journal of Medicine

Background

Nurses and health care workers are dedicated to creating a therapeutic environment for healing. Sometimes, physical restraints may be used to ensure safety in patients exhibiting violence, confusion, or agitation, or in patients with life-saving medical devices. While the regulatory requirements for use of physical restraints are well developed, this is not the case with alternatives to using restraints, and many nurses may lack clarity on the best practice for identification and application of alternatives to physical restraint use.

Methods

Two trained reviewers searched PubMed, Google Scholar, and professional health care organizations’ websites guided by a search strategy and …

A Digital Safety Detection And Control System For Proactive Risk Management, Karla Miller, Jennifer Lee Mcalister, Keri Melson, Gita Nadimpalli, Becca Moore, Brett Powell, Kenneth E. Sands, Mary Catherine Harris, Cali Cerami, Shanna Arnold Egloff, Yauheni Solad, Randy Fagin

HCA Healthcare Journal of Medicine

Patient safety remains a defining dimension of health care quality, yet systems rely on retrospective assessment after harm has occurred, limiting visibility into upstream risks, including process failures and near misses. This challenge underscores the need for an approach that unifies fragmented safety activities to support proactive safety risk management. We describe a phased pilot implementation and evaluation framework of a Digital Safety Detection and Control System (DSDC) within a large integrated health care system to operationalize enterprise-wide patient safety. The DSDC integrates governance, human oversight, and digital capabilities across 4 operational phases: detection, triage, investigation, and learning. These capabilities …

Pharmacovigilance As An Act Of Awareness And Mindfulness, Mahima Silas, Hale Z. Toklu

HCA Healthcare Journal of Medicine

The term “pharmacovigilance” defines the activities related to the collection, detection, assessment, monitoring, and prevention of adverse reactions due to pharmaceuticals. While it is often framed as a technical and regulatory discipline, it can also be understood through a more reflective lens as a form of mindfulness practice. At its core, pharmacovigilance requires a way of thinking that closely mirrors mindfulness, including sustained attention, openness to uncertainty, and deep awareness of human experience. Viewing pharmacovigilance in this way reframes it not just as a safety mechanism, but as a thoughtful, patient-centered approach to medicine.

Unheard Voices: Reducing Psychological Barriers To Publication In Nursing Research, Caryn R. Alper

HCA Healthcare Journal of Medicine

Despite their interest in clinical inquiry, many nurses face psychological barriers, including imposter syndrome (IS), that prevent them from engaging in research and disseminating their findings. This editorial explores how psychologically safe work environments can help counter these barriers through supportive leadership, respect, and mentorship to strengthen skills and confidence and reduce vulnerability in scholarly work. Normalizing self-doubt and creating environments where nurses feel safe asking questions and testing ideas can help more nurses recognize the value of their expertise and contribute their voice to the base of evidence.

Psychological Safety Is Everyone’S Work: A Call To Practice, Education, And Leadership In Nursing, Gina Rivera

HCA Healthcare Journal of Medicine

Psychological safety is essential to nursing practice, education, and leadership because it enables individuals to speak up, ask questions, report concerns, and learn from mistakes without fear of humiliation or blame. In health care settings, psychological safety supports patient safety by encouraging error reporting, timely escalation, and interprofessional collaboration. For nurses, it strengthens teamwork, accountability, well-being, and retention in complex, high-pressure environments. In nursing education, psychological safety allows students to admit uncertainty, engage in feedback, and develop clinical judgment across simulation, clinical, didactic, and online learning spaces. This article argues that psychological safety is often discussed separately across practice, academia, …

No Place For Workplace Violence, Ryan Sledge

HCA Healthcare Journal of Medicine

Workplace violence in health care is often discussed as an employee safety issue, but that framing misses a larger operational reality. Violent incidents affect the individuals involved, but they also disrupt care delivery, strain teams, reduce patient safety, contribute to health care worker burnout, and expose organizational conditions that leaders cannot afford to ignore. Incident reports rarely tell the full story. In many settings, aggressive behavior becomes normalized to the point that staff stop reporting much of what they experience. This creates a false sense of awareness and visibility. This editorial argues that health care leaders should approach workplace violence …

Safer Together: A Special Nursing Issue Focusing On Safety In Health Care, Tracy A. Ortelli, Lori M. Brodie

HCA Healthcare Journal of Medicine

Safety is a shared responsibility dependent upon the collective efforts of health care professionals, educators, leaders, organizations, and systems. This special nurse-led issue of the HCA Healthcare Journal of Medicine highlights scholarly works addressing education, clinical practice, and health care workforces. We are informed about safety through research, clinical reviews, case-based learning, and education. This issue was created to inspire the entire health care workforce to pursue continuous improvement to make health care safer together.

Development And Implementation Of A Scholarly Curriculum For Internal Medicine Residents And Subspecialty Fellows, Yuri Matusov, Hawas Kaderi, Liza Raffi, Louie Cao, Jacqueline Lee, Mariko Ishimori, Odelia Cooper

Graduate Medical Education Research Journal

Background. To create and assess the efficacy of a standardized curriculum for trainees in the core competency of critical appraisal of medical literature.

Methods. We implemented a 10-hour scholarly lecture curriculum, in 1-hour blocks, over 1 academic year for postgraduate trainees in internal medicine (IM) and IM subspecialties at a single major academic medical center. The aims of the curriculum were to increase trainee comfort with clinical research methodology, to place this methodology in the context of historical and current ethical challenges, to provide trainees with guidance on how to conduct clinical research at the institutional level, and to provide …