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      Differences in Perceptions of Patient Safety Culture between Charge and Noncharge Nurses: Implications for Effectiveness Outcomes Research

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          Abstract

          The implementation of evidence-based practice guidelines can be influenced by nurses' perceptions of the organizational safety culture. Shift-by-shift management of each nursing unit is designated to a subset of staff nurses (charge nurses), whom are often recruited as champions for change. The findings indicate that compared to charge nurses, noncharge nurses were more positive about overall perceptions of safety ( P = .05) and teamwork ( P < .05). Among charge nurses, significant differences were observed based on the number of years' experience in charge: perception of teamwork within units [ F(3, 365) = 3.52, P < .01]; overall perceptions of safety, [ F(3, 365) = 4.20, P < .05]; safety grade for work area [ F(3, 360) = 2.61, P < .05]; number of events reported within the last month [ F(3, 362) = 3.49, P < .05]. These findings provide important insights to organizational contextual factors that may impact effectiveness outcomes research in the future.

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          Most cited references57

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          The Impact of Nursing Work Environments on Patient Safety Outcomes

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            Patient safety climate in 92 US hospitals: differences by work area and discipline.

            Concern about patient safety has promoted efforts to improve safety climate. A better understanding of how patient safety climate differs among distinct work areas and disciplines in hospitals would facilitate the design and implementation of interventions. To understand workers' perceptions of safety climate and ways in which climate varies among hospitals and by work area and discipline. We administered the Patient Safety Climate in Healthcare Organizations survey in 2004-2005 to personnel in a stratified random sample of 92 US hospitals. We sampled 100% of senior managers and physicians and 10% of all other workers. We received 18,361 completed surveys (52% response). The survey measured safety climate perceptions and worker and job characteristics of hospital personnel. We calculated and compared the percent of responses inconsistent with a climate of safety among hospitals, work areas, and disciplines. Overall, 17% of responses were inconsistent with a safety climate. Patient safety climate differed by hospital and among and within work areas and disciplines. Emergency department personnel perceived worse safety climate and personnel in nonclinical areas perceived better safety climate than workers in other areas. Nurses were more negative than physicians regarding their work unit's support and recognition of safety efforts, and physicians showed marginally more fear of shame than nurses. For other dimensions of safety climate, physician-nurse differences depended on their work area. Differences among and within hospitals suggest that strategies for improving safety climate and patient safety should be tailored for work areas and disciplines.
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              Nurses relate the contributing factors involved in medication errors.

              Understanding the processes by which nurses administer medication is critical to the minimization of medication errors. This study investigates nurses' views on the factors contributing to medication errors in the hope of facilitating improvements to medication administration processes. A focus group of nine Registered Nurses discussed medication errors with which they were familiar as a result of both their own experiences and of literature review. The group, along with other researchers, then developed a semi-structured questionnaire consisting of three parts: narrative description of the error, the nurse's background and contributing factors. After the contributing factors had been elicited and verified with eight categories and 34 conditions, additional Registered Nurses were invited to participate by recalling one of the most significant medication errors that they had experienced and identifying contributing factors from those listed on the questionnaire. Identities of the hospital, patient and participants involved in the study remain confidential. Of the 72 female nurses who responded, 55 (76.4%) believed more than one factor contributed to medication errors. 'Personal neglect' (86.1%), 'heavy workload' (37.5%) and 'new staff' (37.5%) were the three main factors in the eight categories. 'Need to solve other problems while administering drugs,''advanced drug preparation without rechecking,' and 'new graduate' were the top three of the 34 conditions. Medical wards (36.1%) and intensive care units (33.3%) were the two most error-prone places. The errors common to the two were 'wrong dose' (36.1%) and 'wrong drug' (26.4%). Antibiotics (38.9%) were the most commonly misadministered drugs. Although the majority of respondents considered nurse's personal neglect as the leading factor in medication errors, analysis indicated that additional factors involving the health care system, patients' conditions and doctors' prescriptions all contributed to administration errors. Identification of the main factors and conditions contributing to medication errors allows clinical nurses and administration systems to eliminate situations that promote errors and to incorporate changes that minimize them, creating a safer patient environment.
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                Author and article information

                Journal
                Nurs Res Pract
                Nurs Res Pract
                NRP
                Nursing Research and Practice
                Hindawi Publishing Corporation
                2090-1429
                2090-1437
                2012
                22 March 2012
                : 2012
                : 847626
                Affiliations
                University of Michigan School of Nursing, Ann Arbor, 48109 MI, USA
                Author notes

                Academic Editor: John Daly

                Article
                10.1155/2012/847626
                3324150
                22548163
                5fe877d1-ca76-4db9-ab35-a568f216b048
                Copyright © 2012 Deleise Wilson et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 October 2011
                : 15 January 2012
                : 15 January 2012
                Categories
                Research Article

                Nursing
                Nursing

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