Nurses Perception of Patient Safety Culture in ARAR Hospitals - Essay Example

Nurses Perception of Patient Safety Culture in ARAR Hospitals Affiliation Nurses Perception of Patient Safety Culture in ARAR Hospitals Part 1: Introduction 1.0) Background & Significance According to El-Jardali, Dimassi, Jamal, Jaafar, and Hernadeh (2011), patient safety is a major determinant of quality of care and is, therefore, one of priorities of any healthcare centre across the globe. El-Jardali et al. (2011) communicated that the development of effective interventions are closely related to the understanding of the critical organizational and individual limits, requiring a culture that can overcome the barriers for the implementation of measures of organizational behavior, to promote the analysis of adverse events and to collect the derivable lessons (Effken et al., 2011). Unruh and Zhang (2012) described that achieving an adequate safety culture is mentioned as the first of the 30 safe practices by the National Quality Forum of the United States. It also establishes its measurement capital as a recommendation (Unruh & Zhang, 2012). According to David, Alati, Ware, and Kinner (2013), patient safety is then placed in the perspective of an overall higher quality. Because it depends on multiple components acting in the system, it must be addressed through the adoption of clinical practices that the US government allows to focus on planning and management of health services, the needs of the citizens, emphasizing the role and responsibility of all professionals working in health care (David et al., 2013). Sammer, Lykens, Singh, Mains, and Lackan, (2010) said that strengthening the skills of professionals is in fact a core value, as well as, training constitutes an indispensable instrument to ensure the delivery of safe and effective care. In recent years, many educational initiatives have been undertaken, albeit with different types and different ways (Sammer et al., 2010). Dauphine (2012), explained that these experiences lead us to reflect on the need to reach a level homogeneous skills and knowledge that will improve the implementation of strategies for safety patients nationwide. According to Riahi (2011), the goal is to offer it to all the health professionals, regardless of role, the professional and the care setting, an opportunity for training in specific field of patient safety and clinical risk management and the Regions, autonomous Provinces and companies, to whom falls the task of developing further training programs, a valuable tool, the logic of improving the quality and safety of care (Riahi, 2011). Based on Buerhaus, Auerbach, Staiger, and Muench’s (2013) research, patient safety is one of the essential policies that hospitals and clinics across the globe must practice, religiously. It is so because a good culture of patient safety (PS) is key to avoiding, where possible, the emergence of effective adverse effects, encourage reporting and learning errors and implement strategies to avoid recurrence (Buerhaus et al., 2013). In our country and within the area, to promote clinical excellence, the ministry of health must create a plan to establish objectives of the strategy towards improving patient safety and to promote and develop patient safety among professional and as action project to study the perception of the professionals towards the PS (Reiman et al., 2010). Becher and Visovsky (2012) identified that the measurement of PS allows healthcare professionals to know the situation baseline from which they can prioritize improvement actions and regular repetition. The measure also allows analyzing the effectiveness of these actions and rethinking strategies. The evaluation is in itself an intervention that displays the institutions interest in know and prioritize the patient safety practices (Becher & Visovsky, 2012). The research will be of benefit due to the following: 1- Policymaker when doing policy and procedure for TQM 2- Administrators to implement the procedure and create a safety culture. 3- The nurses to increase their perception of patient safety culture and generate nursing knowledge. 4- The future researcher to use the same design and add new information to the literature. The findings of this study will be used as the baseline data for future intervention studies and will add to the knowledge of patient safety culture nationally and internationally. 1.1) Statement of the Problem According to the Joint Commission (2008a), as of January 2009, all accredited hospital nursing units were mandated to implement the components of a culture of safety; the mandate addresses the healthcare work environment that is too often characterized as chaotic with inadequate or inappropriate communication and conflict that hinders the culture of safety initiatives. Although the new Joint Commission mandate has been in effect for eight years, there is a lack of research related to the influence of a culture of safety educational interventions among nursing staff. Therefore, todays nursing scholars are challenged to assess nursings perspectives on the culture of safety that can prevent adverse events and harm to patients. A culture of safety must be encouraged that changes the social context from an untrusting blame approach to a trusting approach that encourages healthcare staff to share information about safety issues and what can be done to promote a safer healthcare environment (Bae, 2011). Nursing practice faces many challenges related to conflict in the work environment and integration of a culture of safety (Alemán, de Gea, & Mondéjar, 2011). Lack of clear communication, lack of evidence of teamwork and collaboration, inadequate management of patient care errors, lack of mutual trust among health care workers and conflict contribute to nurses job dissatisfaction and feeling overstressed. Ultimately, this, affects their ability to provide safe, quality, and humane care (Fujita et al., 2013). In addition, Patterson et al. (2010) discussed that the nursing shortage is no secret to stakeholders and has become a larger concern in the past decade, causing hospital administrators and nurse leaders to become more conscious of the quality and safety of the staff work environment and its impact on the workforce. Ginsburg et al. (2010) emphasized those understanding nurses perceptions on the current work environment and patient safety is critical in the current healthcare environment, not only for endurance of healthcare agencies, but also in prevention of workplace conflict and bullying, increasing staff retention, and the provision of exceptional and appropriate patient care. Research into conflict in the workplace environment, as well as, rich descriptions of how such conflict is occurring has provided an understanding of the seriousness of the problems in the workplace (Ginsburg et al., 2010). However, there is a lack of research on staff perceptions of a culture of safety and their knowledge of safety measures in Arar hospitals. Therefore, research is needed to understand how nursing staff perceive the current work environment as it relates to a culture of safety in clinical practice, as well as, patient safety in the north hospitals. 1.2) Purpose of the Study The study aims to understand nurses perceptions of patient safety culture in Arar hospitals and to explore the factors that are associated with these perceptions. The findings of this study will be used as the baseline data for future intervention studies and will add to the knowledge of patient safety culture nationally and internationally. 1.3) Research Questions The specific research questions are: What are the nurses perceptions of hospital patient safety culture in Arar hospitals? What factors are associated with those perceptions? How that perception is is associated with patient safety culture? 1.4) Research Variables The research variables of this study are as follows: Independent Variables. Nurses characteristics, nursing management factors, organizational factors Dependent Variables. Nurse’s perceptions of Patient safety culture 1.5) Definition of Terms 1.5.0) Conceptual Definitions. Patient safety is conceptually defined as the freedom from accidental or preventable injuries produced by medical care (Agency for HealthCare Research and Quality, 2008a) Safety culture is conceptually defined as "the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organizations health and safety management" (Health & Safety Commission, 1993) It is a set of common understandings of the group members in viewing patient safety. Patient safety culture in this study was operationalized and measured by the Hospital Survey on Patient Safety Culture (HSPSC) that was developed under the sponsorship of the U.S. Agency for Healthcare Research and Quality (AHRQ, 2008a). 1.5.1) Operational Definitions. The following operational definitions will be used in this study: (a) a culture of safety is operationally defined by measurement with the Hospital Survey on Patient Safety (HSOPS) (Barnsteiner, 2011). Arar is defined as “city located in the northern region of the kingdom of Saudi Arabia. Part 2: Conceptual Framework The conceptual framework of this study is developed based on a review of the relevant literature. Patient safety culture is the key variable in this study. It is defined as nurses shared values, beliefs, and behavioral norms towards patient safety (Hewitt et al., 2010). Three sets of factors have been identified for exploration as factors that may be associated with nurses perceptions of patient safety culture: nurses personal characteristics, nurse managers characteristics, and the organizational characteristics. Nurses personal characteristics include age, years of experience, levels of education, positions, as well as their professional titles. Managers characteristics include managers safety commitment, leader-member exchange, and the perceived trustworthiness of managers (Wessels et al., 2010). Organizational characteristics include the staffing levels, safety training programs, patient safety policies, as well as prioritization of patient safety. Table 1: Diagram for conceptual framework. Part 3: Literature Review The measures and actions aimed at safety of care and medical procedures, and the protection of patients who undergo them, represent an integral and essential health professions, particularly the medical and dental care (Larsen & Zahner, 2011). On this premise, the Orders of the Provincial Medical and dental surgeons and the Federation National, state auxiliary organizations, aim to address the issue of human error, and responsibilities, as part of professional practice, including in relation to the corresponding forms of compensation. Kobayashi, Takemura, and Kanda (2011) emphasized the importance of security and the role of positive error is it also clearly established art. 14 of the new Code of Medical Ethics (2009), requiring medical attention detection, reporting and evaluation of errors in order of improving the quality of care (Timmel et al., 2012) Sorra and Dyer (2010) also included that the preliminary step for a peaceful approach to the problem is, therefore, on the principle that the error handling is a professional activity in the strict sense, and that the error declared may be incentive to improve the professional, adopting a concept of clinical governance as an impetus to improve the organization through the most appropriate use of professional procedures (Sorra & Dyer, 2010). Moreover, while from the point of view seems jurisprudential set the concept of fault single professional as guilt, out of context and organizational structure in which it plays performance, becomes ever more urgent need for a mapping error in national and regional levels, possible only through statutory procedures, and they become part and essential feature of their professional function of collecting and reporting errors on the part of professionals (Larsen & Zahner, 2011). Therefore, doctors and dentists Italians, believing that the promotion of safety represents a citizens right and duty of professionals as a factor determining the benefits paid, put to the attention of the institutions and all involved some concrete proposals, which together constitute a kind of Ten Commandments and Safety Clinical Risk Management, on three main lines of approach to the systematic complex problem: the level of organization, the level of training, the level of Responsibility he last years have been, for the nursing scene, full of changes that have changed the picture radically innovated and responsibility of nurse practitioners in the citizen and the community (Thomas & Zumbo, 2012). The demand for quality and personalized care services is increasingly on the rise; it, thus, increases the level of competence and responsibility of the nurse against of the patient, the times require trained professionals, able to compete as a team multidisciplinary and are able to give guarantees on their actions, as aware of consequences arising from their decisions and how to conduct interventions (Smits et al., 2012). In this logic it is proposed with this training methodology FAD Blend that each nurse - in any industry and area of the country works - can understand the root of the origins of clinical risk in all its facets, at his own modes of prevention and control, developments in the ethical component in risk management, including the value of communication and stakeholder engagement, internalize the meaning of "Respond to ...", knowing that safety in health care today has become a common priority and essential, involving the organization, workers, and citizens (Riahi, 2011). 3.0) Organizational Culture and Safety Culture Definitions of organizational culture are abundant in the literature (Schein, 1985). A common theme of definitions emphasizes the shared, taken-for-granted, often invisible or unspoken ideas, values, and beliefs held by the members of the group or organization. The phrase "the way we do things around here" frequently arises within organizational culture. Schein (1985a) has defined organizational culture as the straightforward convictions and postulations that members of the group share. Based on Schein (1985a, 1995b), many elements may reflect the organizations culture, such as the observed behavioral regularities when people interact, the norms that evolve in working groups, the dominant values espoused by an organization, the formal philosophy of an organization, the rules of the game for getting along in the organization, the feeling or climate that is conveyed by the physical layout, and the shared meanings that are created by group members as they interact with each other. But they are not the essence of the organizational culture (Schein, 1985). The essence of an organizations culture is those taken-for-granted, often invisible basic assumptions and beliefs that are shared by members of an organization. Schein (1985) proposes a three-level model of organizational culture. These levels include artifacts, values, and basic underlying assumptions. Artifacts are the surface level of culture; values are the middle level of culture, and the basic underlying assumptions are the most inner level of culture (Schein, 1985). 3.1) Patient safety The National Patient Safety Foundation has defined patient safety as the avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the processes of health care (Stelfox, Palmisani, Scurlock, Orav, & Bates, 2006). IOM has defined the patient safety as freedom from accidental injury (IOM, 1999, p.58). AHRQ (2008a) has also defined the patient safety as the freedom from accidental or preventable injuries produced by medical care. Estimating injury is more feasible and productive than measuring medical error as many errors have simply not been reported by health care professionals (Smith, 2011). 3.2) History of Patient Safety Based on Simon, Muller, and Hasselhorn (2010), the modern patient safety movement in the U.S. began with the New England Journal of Medicines first publication of the Harvard Medical Practice Study (MPS) in 1991(Simon et al., 2010). The study examined 30,000 inpatient medical records in acute care hospitals in New York State in 1984. The results showed that 3.7% of hospitalized patients suffered an adverse event. Of these injuries, 14% were serious, and 69% events were preventable (Mayer et al., 2011). However, the findings of this study were largely ignored both by the public and health professionals. As per Shin (2009), the release of the IOM report in 1999 "To Err is Human" was a milestone of the modern patient safety movement. The IOM report had three important effects (Shin, 2009). First, it raised the awareness of the patient safety issue both for the public and for health care professionals. Second, it urged a number of stakeholders into action, particularly, Congress. In 2001, Congress appropriated $50 million annually to the AHRQ for patient safety research. Congress also authorized AHRQ to lead national patient safety research and education. Third, it impelled hospitals to make the changes necessary for patient safety. Sexton et al. (2011) emphasizes that, since the IOM report, a tremendous effort has been made by health care professionals, administrators, managers, and government officers in different types of organizations. The Veterans Health Administration (VA) has established the VA National Center for Patient Safety and four patient safety research centers. It has also "implemented non-punitive reporting, use of computerized order entry systems, bar coding, and other initiatives" (Sexton et al., 2011). The National Quality Forum (2003) has focused on developing a consensus process that has generated standards for evidence-based safe practices, as well as, standards for nursing care (NQF, 2003).The Joint Commission (2014), has committed major resources to patient safety. It has adopted the methods of unannounced accreditation audits and required hospitals to implement new safe practices known as National Patient Safety Goals (JC, 2014). The Institute for Healthcare Improvement (2003) has been the most powerful force behind changes for safety. Over the decades, IHI has helped many hospitals redesign their systems for safety with focuses on medication safety, intensive care, cardiac care, and other treatments. It has also helped train the safe practices for thousands of doctors, nurses, pharmacists, and administrators (IHI, 2003). In 2005, IHI initiated a national effort named, "100, 000 Lives Campaign," requiring the hospital in the US to band together to save 100,000 lives in 18 months by adopting a few simple changes in their care to reduce needless deaths in hospital (Maxson, Derby, Wrobleski, & Foss, 2012). Over 3100 hospitals joined, and the results were extremely inspiring: a reduction in mortality of 122,000 patients was reported despite some controversies with the calculation of the figure. The American Nurses Association (ANA) has also launched many quality and safety initiatives. The development of nursing-sensitive quality indicators to empirically evaluate the safety and quality of patient care was one example (Larsen & Zahner, 2011). As per Shultz (2013) now, every US hospital has some sort of a safety program as required by JC, and many are trying to build the blameless and forgiveness cultures that encourage staff to report errors and allow systems to identify and analyze the system as well as personal failures (Schultz, 2013). More importantly, thousands of nurses, doctors, therapists, and pharmacists have become much more alert to safety. They are making many changes, aiming to create a safer health care system and to avoid needless deaths or injuries to patients (Kobayashi et al., 2011). 3.3) Patient Safety Culture Schein (1995) elaborated that the patient safety is a critical component of health care quality. As health care organizations continually strive to improve, there is a growing recognition of the importance of establishing a patient safety culture (Schein, 1995). The theoretical definition of patient safety culture in this study is directly quoted from the HSC (1993) as mentioned previously. The definition has served as the basis for the development of Hospital Survey on Patient Safety Culture Instrument (AHRQ, 2014b). It is worth to notice here that, HSC is not defining patient safety culture, but rather safety culture and AHRQ is using that definition to define patient safety culture. 3.4) Important parameters of a research study According to Pant and Joshi (2011), it is important to address the parameters that are of importance to the study. The sample is an important part of the research study, and a research study cannot be completed without an appropriate sample size. However, the sample cannot be too large or too small. Hence, there must be a balance in the size of the sample. The sample also has to be selected based on its availability. That is; the persons who are ready to be part of the study are chosen to participate (Pant & Joshi, 2011). Such are the factors that determine the method of sample selection as per the needs of the research. The collection of data constitutes an intricate part of any research study. If the data collection is plagued by errors, then, the research study is bound to give false results that are misleading. Data collection involves prior communication to the various stakeholders who are in-charge of the areas from which the data shall be collected. After the communication and verification of permission to proceed with the data collection, the questionnaire is administered to the study participants. The analysis of the data makes use of various statistical methods depending on the requirements of the study. Usually, various statistical programs are on hand to analyze the data collected. Such statistical programs include SPSS, Minitab, or Microsoft Excel just to name but a few. The choice of the analytical program is influenced by the reliability of the program, ease of use, how compatible is it to the data obtained and the aims of the study. It is from the analysis that the findings are obtained. The findings are to be discussed in accordance to the study’s main aim or question and related with past research studies to evaluate the dimension the study’s main aim or question takes. The issue of reliability and validity of the research study is paramount. A research study may be published; however, it does not imply that it is reliable and valid. Thus, the validity of the research study is associated to the level up to which the research study is connected to the whole design of the research study. Hence, the study does not move away from the question it seeks to answer. On the other hand, the reliability of the research study determines how well the research findings answer the study’s question. Can the findings be relied on for further research? Or is there need for further study to answer the gaps that are evident in the study? (Pant & Joshi, 2011). Part 4: Methodology 4.0) Research design The study is to be carried out as a quantitative research where the researcher shall make use of numeric indices in both data collection and data analysis. In line with this, a survey research design will be employed. Through the survey, the perceptions of identified group of people shall be used to represent the overall perception of the people within the larger population. Survey will be used to enable the researcher include as many respondents in the study as possible. 4.1) Sample The population of the study shall include nurses registered in Arar hospitals. It is, however, expected to produce a very large number that will be difficult to handle within the time frame of the research. In effect, a sample size that is a representation of the population shall be set. The population will include 300 nurses selected from the hospitals. In order for the right participants to be utilized in the study, the selection process will be based on time. That is, for how long has the individual participant worked in Arar. Thus, the inclusion criteria will be for respondents to have practiced in Arar hospitals for a minimum of five years. It will be the only selection criteria used to obtain the participants. Nevertheless, the participants must be freely willing to participate in the study. It is expected that many nurses will be willing to participate. Hence, the study shall make use of a type of randomization and sampling technique known as purposive sampling. The sample size set of the study is 300 in number, hence, in accordance with the purpose of this study, which is to comprehend the perceptions nurses have towards the culture of patient safety in hospitals in Arar, the number of participants per hospital shall be limited to include at least one participant from each hospital in Arar. It will ensure representation of all hospitals in Arar that is important to determine the overall perception of nurses in Arar hospitals. 4.2) Instruments The research shall make use of a questionnaire as the data collection instrument. The questionnaire is a sample from the World Health Organization (WHO) used in collecting nurses’ perception on patient safety. The questionnaire that is used as a data collection instrument is structured in such a way that the nurse participants will give their knowledge on issues pertaining to the safety of patients in the hospital they work. Due to time issues, the questionnaire has been structured in such a way that it takes around 10-15 minutes to complete. Thus, ensuring brevity and clarity in the given feedback. Notably, it gives the participant the liberty to decide if to answer a question or not. The questionnaire is divided into nine sections. Depending on the section, the number of questions vary per section from one question to eighteen questions. Some of the questions are open-ended, while the rest are scaled from one in which the participant strongly disagrees to one in which the participant strongly agrees with the question.. Hence, the questionnaire is not limited to a certain type of questions or scale. The reliability and validity of the questionnaire is an important concept in the study. One, the questionnaire is a proven tool as it has been previously used by the WHO to gather data. According to Bourdeaudhuij et al. (2004), the compatibility of the questionnaire to the purpose of the study is essential. That is; the questionnaire has to give data relevant to the study’s purpose. The questionnaire will be checked for reliability through test and retest. Test and re-test will involve giving the participants the same questionnaire after some time to determine the similarity of the results obtained in the initial administration. It will be delivered by mail through the official email address of the hospitals. 4.3) Data collection procedure Data collection will begin after all necessary permission has been secured from the hospitals and the consent of respondents has been sought. The data collection will be through the use of email, whereby, the researcher shall mail the questionnaire and corresponding instructions to the respondents. Respondents will have ten working days to complete them and return them to the researcher failure to which, the researcher shall send out personnel to collect the filled out questionnaire form from their workstations. Doing so will ensure a high response rate. 4.4) Human subjects’ protection A consent form will be delivered to respondents. Respondent identities shall be anonymous, and their information shall be confidential. It will be done by using an email address that is accessible only to the researcher. All information from the email will be deleted after the study. Part 5: Data Analysis Methods The researcher shall make use of quantitative data analysis. Quantitative data analysis has been noted to be effective for allowing the empirical presentation and analysis of data. The reason being that the data analysis often depends on the use of standardized and statistical tools which can easily be verified for accuracy and authenticity (Clifford & Clark, 2004). More specifically, the SPSS software shall be used to analyze the outcomes of the questionnaire. Why the SPSS software? The SPSS software shall be used as it is quick and offers simplicity in its basic operation ability. The software also offers a large array of graphs that one can choose from depending on their suitability with the purpose of the study. There shall be two major components of the data analysis. These are presentation of findings and interpretation of findings. Under the presentation, the researcher shall use various graphical representations that will be produced from the SPSS software in the form of pie charts and bar charts. The presentation shall be done to follow the objectives of the study. It means that the researcher shall divide the questions in the questionnaire into themes to relate to the objectives. In the second part of the data analysis, the data presented shall be interpreted in the context of the research objectives so that it will be possible to understand how the respondents perceive the issues raised in the objectives of the study. As a quantitative study, the interpretation shall make use of mathematical indices such as mean, percentages, and ratios. The above analysis procedure shall be used as it offers an easier means of dissecting the findings into assortments that can be easily understood by the reader and other researchers who may want to utilize the research in their studies. Part 6: Applicability to nursing 6.0) Nursing practice As far as nursing practice is concerned, the outcomes of the study will be useful in understanding the current state of patient safety in Arar hospitals in terms of where the patients are least protected and where the patients need protection most. Once it is achieved, nurses are expected to adopt new professional attitudes that are patient-centered and seek to better protect the patients. 6.1) Nursing education Nursing education is important in instilling acceptable theoretical perspectives of practice in nursing students. Even though it would be admitted that the issue of theory-practice continues to militate against the application of nursing theories, it is expected that the study will be a basis of constructing theory about the best professional principles that must be put in place to uphold the safety of patients who use Arar hospital facilities. 6.2) Nursing research The proposed study shall be the beginning point in understanding patient safety in Arar hospitals better. Based on the conclusions of the study, future researchers in the area of nursing may have new ideas to literature where they can decide to expand or restudy. It means that, in terms of nursing research, the study is going to be a conceptual framework to be used for advanced research. 6.3) Nursing administration Nursing administrators have been at the forefront of enforcing professional nursing practices. 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