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Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify operational failures; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with operational failures in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of operational failures detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about operational failures encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 operational failures over 4,497 shifts, a rate of 6.07 operational failures per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/ Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that operational failures are frequent and varied across system processes, and that organizations may readily obtain crucial information about operational failures from frontline nurses. Nurses' detection of operational failures could provide organizations with rich, real-time information about system operations to improve organizational reliability.

ObjectiveTo qualitatively explore the impact of parental incarceration on children and families from the perspective of the incarcerated parent in a county jail.BackgroundAn estimated 5 million U.S. children experience parental incarceration. A limited number of studies have examined the impact of parental incarceration on the child(ren) and family from the perspective of the incarcerated parent.MethodsA convenience sample of 26 parents incarcerated in an urban county jail were interviewed. Parents were asked about how their incarceration has affected their child(ren). Glaser and Strauss's constant comparative method was used for analysis.ResultsFive major themes were identified including parental incarceration creates a significant hardship on most children and families; there are many barriers for parents to communicate and maintain relationships with their children while incarcerated; incarcerated parents experience many challenges understanding and navigating the criminal justice system; the pervasive cycle of incarceration; and the need for more programs and services.ConclusionParents generally perceive that their incarceration negatively impacts their children and family in a multitude of ways and express concern about their children's health and safety. Inmates have concrete suggestions for programming and policy changes that they believe would benefit their relationship with their children and lessen the negative impact of their incarceration on their children.ImplicationsThis study offers insights into the perceived challenges children and families face during parental incarceration in jail. The results provide both correctional facilities and community organizations with concrete ideas for how to better support families experiencing incarceration.

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