Clinical Scenarios
| Scenario 1 | |
| A labouring woman was admitted at 20:00 with an unremarkable history, no identified risk factors and a fetal heart rate tracing demonstrating moderate variability with accelerations and no decelerations. Labour has been progressing slowly. It is now 04:00, and the fetal heart rate tracing has had minimal to absent variability with late decelerations for the past 30 min. Change of position, intravenous fluids and oxygen administration have not changed the FHR tracing. The nurse calls the physician and requests a bedside evaluation. The physician states she does not need to come in to evaluate the patient at this time; she will see the patient at 06:30, prior to making her morning rounds. | |
| Questions (response format—five-point likert-type scale) | Measure |
| If no action is taken, how great is the potential for harm in this situation? (Very Low—Very High) | Harm Index |
| Assume you are the nurse caring for this patient. How likely are you to insist the physician come to evaluate the patient now? (Very Unlikely—Very Likely) | LSI |
| Assume you are not caring for the patient directly, but you have become aware of the situation. How likely are you to step in to help the nurse get the physician to see the patient now? (Very Unlikely—Very Likely) | LSI |
| Assume the patient's physician is someone who has been rude or condescending to you in the past. How much more or less likely are you to step in? (Much less likely—Much more likely) | LSI |
| Assume either you or the original nurse have spoken directly with the physician, who still refuses to come and evaluate the patient. How likely are you to take additional action to resolve the situation? (Very Unlikely—Very Likely) | LSI |
| Scenario 2 | |
| You are talking with a patient in her hospital room when another clinician comes in to start an intravenous line (IV) on the patient. The clinician gathers materials from the supply cabinet, sets them up, and is about to start the IV. The clinician has not washed their hands, and does not appear to be planning to do so. | |
| Questions (response format—5 point likert-type scale) | Measure |
| Assuming the clinician did not wash their hands right before entering the room, how great is the potential for harm in this situation? (Very Low—Very High) | Harm Index |
| Assume the other clinician is a nurse. How likely are you to insist that the nurse wash their hands? (Very Unlikely—Very Likely) | LSI |
| Assume the other clinician is a junior physician. How likely are you to insist the physician wash their hands? (Very Unlikely—Very Likely) | LSI |
| Assume the other clinician is the Chair of the Anaesthesiology department. How likely are you to insist this person wash their hands? (Very Unlikely—Very Likely) | LSI |
LSI, Likelihood of Speaking Up Index.