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Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
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2014 (English)In: BMC nursing, ISSN 1472-6955, Vol. 13, no 1, p. 39-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization's culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety.

METHODS: The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis.

RESULTS: Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses' patient safety culture. Half of these subcategories were shared.

CONCLUSIONS: Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses' and nurse assistants' patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions about patient safety within and between different professional groups.

Place, publisher, year, edition, pages
2014. Vol. 13, no 1, p. 39-
National Category
Clinical Medicine Nursing
Identifiers
URN: urn:nbn:se:liu:diva-115378DOI: 10.1186/s12912-014-0039-5PubMedID: 25435809OAI: oai:DiVA.org:liu-115378DiVA, id: diva2:795116
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2018-04-12
In thesis
1. Patient Safety - Cultural Perspectives
Open this publication in new window or tab >>Patient Safety - Cultural Perspectives
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Shared values, norms and beliefs of relevance for safety in health care can be described in terms of patient safety culture. This concept overlaps with patient safety climate, but culture represents the deeprooted values, norms and beliefs, whereas climate refers to attitudes and more superficial manifestations of culture. There may be numerous subcultures within an organization, including different professional cultures. In recent years, increased attention has been paid to patient safety culture in Sweden, and the patient safety culture/climate in health care is regularly measured based on the assumption that patient safety culture/climate can influence various patient safety outcomes.

Aim: The overall aim of the thesis is to contribute to an improved understanding of patient safety culture and subcultures in Swedish health care.

Design and methods: The thesis is based on four studies applying different methods. Study 1 was a survey that included 23,781 respondents. Data were analysed with quantitative methods, with primarily descriptive results. Studies 2 and 3 were qualitative studies, involving interviews with a total of 28 registered nurses, 24 nurse assistants and 28 physicians. Interview data were analysed using content analysis. Study 4 evaluated an intervention intended to influence patient safety culture and included data from a questionnaire with both fixed and open-ended questions, which was answered by 200 respondents.

Results: A key result from Study 1 was that professional groups differed in terms of their views and statements about patient safety culture/ climate. Registered nurses and nurse assistants in Study 2 were found to have partially overlapping norms, values and beliefs concerning patient safety, which were identified at individual, interpersonal and organizational level. Study 3 found four categories of values and norms among physicians of potential relevance for patient safety. Predominantly positive perceptions were found in Study 4 concerning the Walk Rounds intervention among frontline staff members, local managers and top-level managers who participated in the intervention. However, there were also reflections on disadvantages and some suggestions for improvement.

Conclusions: According to the results of the patient safety culture/ climate questionnaire, perceptions about safety culture/climate dimensions contribute more to the rating of overall patient safety than background characteristics (e.g. profession and years of experience). There are differences in the patient safety culture between registered nurses and nurse assistants, which imply that efforts for improved patient safety must be tailored to their respective values, norms and beliefs. Several aspects of physicians’ professional culture may have relevance for patient safety. Expectations of being infallible reduce their willingness to talk about errors they make, thus limiting opportunities for learning from errors. Walk Rounds are perceived to contribute to increased learning concerning patient safety and could potentially have a positive influence on patient safety culture.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 70
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1608
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-147278 (URN)10.3384/diss.diva-147278 (DOI)9789176853672 (ISBN)
Public defence
2018-05-14, Bella Donna, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Note

Mindre typografiska fel är korrigerade i den elektroniska versionen. / Minor typographic errors are corrected in the electronic version.

Available from: 2018-04-12 Created: 2018-04-12 Last updated: 2018-04-26Bibliographically approved

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Danielsson, MaritaNilsen, PerCarlfjord, Siw

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