Exploring the intersection between safety culture and hospital nursing practice

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] Patient safety is a matter of great concern to consumers, healthcare providers, and health services researchers. Within hospital organizations, bedside nurses provide care to patients within a complex environment, relying on a culture of safety to support their efforts to keep patients safe. Because little is known about this work of nursing, a Structuration Theory of Safety Culture was used to frame an exploration of 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. Utilizing the grounded theory methods of constant comparative analysis and theoretical sampling, interviews were conducted with bedside nurses from multiple units of a single U.S. hospital for purposes of explicating this process. Findings revealed that the participants managed the inherent risks of hospitalization through a process of risk assessment and recognition, prioritization, and a variety of protective interventions in order to prevent harm to patients. Nurse participants felt an organizational and professional responsibility to protect patients from risks emanating from the patient, environment, and staff. Further research is needed to examine the nursing concept of patient safety and explore this process in detail.