Exploring the intersection between safety culture and hospital nursing practice

描述（由申请人提供）：这项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）如何约束和使个别医院工作人员护士的能力，以保持病人的安全。患者安全是一个重大问题，涉及大量的人力和医疗成本。到目前为止，组织结构和护士个人的行动之间的相互作用，以保持病人的安全一直被忽视的安全文化研究。因此，符合AHRQ的使命，以提高医疗保健的质量，安全性，效率和有效性，本研究的具体目的是描述的过程中，医院工作人员护士（代理）保持病人的安全，同时约束/启用的安全规则和资源（安全文化结构）的组织。本研究采用结构化理论框架，将采用横断面定性设计。与扎根理论方法相一致，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建立数据基础。半结构化访谈将进行初步样本的10名医院工作人员护士在中西部学术医疗中心。这些访谈将用于引出患者安全性经历的叙述。在数据收集工作的同时，将使用扎根理论方法分析收到的数据。最初参与者之外的抽样将是理论性的，并基于新兴的数据类别和新兴理论中的差距。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基础理论中。这项研究的长期益处包括提高对安全文化如何影响护理实践的认识，这反过来又将允许对安全文化进行有针对性的修改，以促进患者的安全性。

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.