Exploring the intersection between safety culture and hospital nursing practice

描述（由申请人提供）：本扎根理论研究的目的是研究组织环境（规则和资源的沟通结构）如何约束和使医院员工护士个体保护患者安全的能力。患者安全是造成大量人力和医疗成本的重大问题。迄今为止，在安全文化研究中，组织结构与护士个体保护患者安全的行为之间的相互作用一直被忽视。因此，与AHRQ提高医疗保健质量、安全、效率和有效性的使命一致，本研究的具体目的是描述医院工作人员、护士（代理人）在受到组织内安全规则和资源（安全文化结构）的约束/支持的情况下保证患者安全的过程。本研究以结构理论为框架；将采用横断面定性设计。与扎根理论方法论相一致，数据收集、分析和抽样将是同时和相互的，允许通过不断的比较分析和理论抽样来扎根数据。半结构化访谈将在中西部学术医疗中心的10名医院工作人员护士的初始样本进行。这些访谈将用于引出关于患者安全经验的叙述。在数据收集工作的同时，传入的数据将使用接地理论方法进行分析。最初参与者之外的抽样将是理论性的，并基于新出现的数据类别和识别新出现的理论中的差距。当达到理论饱和时，这些类别将被整合到护士在组织的安全文化中保持患者安全的过程的实质性接地理论中。这项研究的长期好处包括提高关于安全文化如何影响护理实践的知识，这反过来将允许对安全文化进行量身定制的修改，以提高患者的安全性。

DESCRIPTION (provided by applicant): The purpose of this grounded theory study is to examine how organizational context (communicated structures of rules and resources) constrain and enable individual hospital staff nurses' ability to keep patients safe. Patient safety is a significant problem with extensive human and healthcare costs. To date, the interaction between organizational structures and the actions of individual nurses to keep patients safe has been neglected in safety culture research. Thus, consistent with AHRQ's mission to improve the quality, safety, efficiency, and effectiveness of healthcare, the specific aim of this study is to describe the process by which hospital staff nurses (agents) keep patients safe, while constrained/enabled by sets of safety rules and resources (safety culture structures) in the organization. This study is framed using Structuration Theory; a cross-sectional, qualitative design will be used. Consistent with grounded theory methodology, data collection, analysis, and sampling will be simultaneous and reciprocal, allowing for grounding in the data through constant comparative analysis and theoretical sampling. Semi-structured interviews will be conducted with an initial sample of ten hospital staff nurses at a Midwest academic medical center. These interviews will be used to elicit narratives about patient safety experiences. Simultaneous with data collection efforts, incoming data will be analyzed using grounded theory methods. Sampling beyond the initial participants will be theoretical and based on emerging data categories and identification of gaps in the emergent theory. When theoretical saturation is reached, the categories will be integrated into a substantive grounded theory of the process used by nurses to keep patients safe within the safety culture of an organization. Long-term benefits from this study include advancement of knowledge about how safety culture influences nursing practice, which in turn will allow tailored modifications of safety cultures to promote increased safety for patients.