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The main research question that guided the study was: What are the perceptions of the nephrology nurses of patient safety and patient safety culture, solutions, and best practices within the nephrology nurse practice settings? The study presented in the article is a qualitative national study aimed at determining the patient safety culture issues, the potential solutions to the problems of patient safety and culture, and the necessary resources needed for improving current situation (Kear & Ulrich, 2015).
The problem that the article’s study focuses on is the ways that the US hospitals can employ to improve patient safety cultures in order to reduce the high patient mortality that occurs in the hospitals due to current inadequate level of such culture. Kear and Ulrich state: “While many efforts were made to improve patient safety, by 2009, it was obvious that assuring patient safety required a major culture change that made patient safety a core value,” (2015, p.113). Consequently, patient safety culture is the core problem of the study, and its significance is that it determines the mortality rates of the hospitalized patients. According to Leape et al. (2009), creating positive patient safety cultures became a major priority for improving the quality care that the patients receive.
Description of Findings
The independent variables for the qualitative study are patient safety and patient safety culture. The study describes the perceptions of the nurses of these variables. According to Kear and Ulrich (2015), the study’s objective was to collect data on both the positive and negative perceptions of the participants of the concepts of patient safety and patient safety culture. Therefore, the perceptions of the participants indicate their views on the factors that either undermine or promote patient safety and patient safety culture at their workplaces.
The study uses the mixed survey method that utilizes an online survey tool employed to assess the culture of patient safety within the nephrology setting. It utilizes both the open- and closed-ended questions (Kear and Ulrich, 2015). Since the study was conducted within the nephrology department, all the respondents of the study were the Registered Nurses (RNs) who worked in the nephrology setting (Kear & Ulrich, 2015). The researchers collected the data online by sending e-mails that invited the participants to engage in the study. Consequently, the participants gave their consent to participate in the study by filling the online survey. The survey did not require the participants to indicate their names or identify their employers. These were methods for maintaining confidentiality during the study (Kear & Ulrich, 2015).
The total number of participants in the final sample was 929. 249 of them (26.8%) were managers or administrators. 487 (52.4%) of the participants were Registered Nurses who worked as direct care givers. 50 of the participants were APRN/NP, while 84 participants were nurse educators (Kear & Ulrich, 2015). The average number of working years for the RNs was 23.53, while the average number of working years for the nephrology nurses was 18.22. However, not all the participants answered all the questions, with 13 participants (1.4%) not giving any response to the survey (Kear & Ulrich, 2015).
The study utilized two tools for patient safety survey: The AHRQ quantitative survey questions and two open-ended questions that it used to collect the qualitative data. For example, in the open-ended questions, the researchers required the participants to state and explain the patient safety and patient safety culture that caused concern and how the issue was resolved (Kear & Ulrich, 2015).
The research established that staffing was the major patient safety issue. It found that staffing was “inadequate and unsafe” (Kear & Ulrich, 2015 p. 116). For example, one of the respondents stated that the hospital she worked in had been understaffed from 2011. Consequently, the hospital had the wrong ratio of nurses to patients, which was an issue that implied that a few nurses attended too many patients. A nurse spent little time on the bedside of a patient due to understaffing (Kear & Ulrich, 2015).
Another patient safety culture issue was a lack of event reporting. Nurses feared to report the errors that they committed at work because they were afraid that the managers could take punitive measures against them. As a result, they did not correct the errors, and it was the main issue that undermined the safety of the patients.
The participants also reported working for long hours and lapses in communication as factors they perceived to undermine patient safety at their workplaces. One of the participants reported that under the acute care settings, nurses could even work for 30-36 hours continuously, while another nurse stated that working for 14 hours each day for 3 days in a raw was exhausting (Kear & Ulrich, 2015). The communication lapses that a participant identified included staffs vacating the treatment room without notifying each other, the dialysis unit failing to give the post-hospitalization reports, and the occurrence of coordination and communication failures between the dialysis and nephrology departments (Kear & Ulrich, 2015).
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Furthermore, the participants reported training concerns, infection control issues, and compliance challenges as factors affecting patient safety in their units. For example, there was a need for more thorough training in HD, especially for the new dialysis staff. A participant reported that her coworkers skipped the infection control practices believing that the administrators would not detect such mistakes (Kear & Ulrich, 2015). The participants also gave responses on the matters of the solutions/best practices. They identified such factors as non-punitive or transparent event reporting, improved methods of administering medication, the strategies for fall reduction, and scheduled safety huddles or safety meetings (Kear & Ulrich, 2015).
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