Sustainability is a complex system of interaction between a hospital, individual, community, and environmental factors that is required to work in harmony to keep a patient healthy. With the complexities that exist within healthcare, the nurse leader is required to ensure that the care environment, processes and the safety behaviours required from nurses to provide safe healthcare is in place and sustained to contribute to the enhancement of patient safety, whilst in the care of the diverse nursing workforce. The aim of the study is to develop an action plan to sustain best safety culture practices for improved patient outcomes in hospitals with a culturally diverse nursing workforce. Methodology: A multiple method design was utilised to study the safety culture and positive work environment (hospital climate) that exists among culturally diverse nurses and how it is managed by the nurse managers in order to identify and describe actions that can be included in an action plan to sustain best safety culture practices for improved patient outcomes. Purposeful and convenience sampling methods were used in the study. Two hospitals, with a very diverse nursing workforce were purposefully selected to participate in the study. Pretesting of the questionnaire and e-Delphi embedded assessment validation instrument were done by participants not part of sample groups. Phase 1: The Hospitals outcomes data for nursing admission assessment within 24-hours, falls and hospital acquired pressure ulcer incidences and hand hygiene rates were collected on a checklist. Phase 2: Two questionnaires (1) nurses capturing: biographical data and culture, patient safety (nursing admission assessment within 24-hours, falls and HAPU and hand hygiene), and safety culture and positive work environment (hospital climate); (2) nurse managers capturing: biographical data and culture, patient safety (nursing admission assessment within 24- hours, falls and HAPU and hand hygiene), safety culture and Positive Work Environment (hospital climate) and just culture practices. Phase 3: the Draft e-Delphi action plan with embedded assessment validation instrument was developed. Phase 4: The panel experts selected to validate the e-Delphi draft action plan with embedded assessment validation instrument in pre-determined rounds. Data analysis: Phase 1: The outcomes data was displayed in bar graphs and illustrated that (1) the nursing admission assessment within 24 hour period not been sustained over time for the medical, surgical, paediatric and critical care areas; (2) a hundred and sixty two fall incidence; (3) ninety six HAPU incidences and (4) hand hygiene rate of between 80-94% being reported. Phase 2: A participation rate of 46.33% by nurses and 73.91% by nurse managers were achieved. The data for the 2 questionnaires indicated the need to include 54 action statement to address the culture, patient safety, hospital climate (PWE), safety culture and just culture gaps identified. Phase 3: the e-Delphi draft action plan developed based on literature review and data from phase 1 and phase 2. Phase 4: 100% participation rate was achieved. Consensus was reached within two rounds that the 54 action statements are essential and important for patient safety and identified the responsible persons required enacting on action statement and timeframe required to complete action. Recommendation: The Action Plan to enhance a sustainable Culture of Safety to improve patient outcomes were decided by panel experts. Plan to disseminate the plan among the CNO for implementation. / Health Studies / D. Litt. et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / Caring relationships established between nurse managers and staff nurses promote positive work environments. However, research about staff nurses' perceptions of nurse manager caring behaviors is limited. A 94-item Caring Assessment Tool-Administration (CAT-adm©) was developed to measure staff nurses' perceptions of nurse managers' caring behaviors; however, it lacked robust psychometric testing. This study was undertaken to establish the CAT-adm© survey as a reliable and valid tool to measure staff nurses' perceptions of nurse managers' caring behaviors. The Quality-Caring Model® (QCM®) served as the theoretical framework. Specific aims were to 1) evaluate construct validity of the CAT-adm© survey by describing factors that account for variance in staff nurses' perceptions of nurse manager caring, 2) estimate internal consistency, and 3) conduct item reduction analysis. Four research questions were: 1) Will the factor structure of observed data fit an 8-factor solution? 2) What is the internal consistency reliability of the CAT- adm©? 3) What items can be reduced while maintaining an acceptable factor structure? and 4) What are staff nurses' perceptions of nurse manager caring behaviors? A cross-sectional descriptive design was used. A sample of 703 staff nurses from Midwestern, Midatlantic and Southern Regions of the U.S. completed the CAT-adm© survey electronically. Analysis included Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), univariate analysis, and descriptive statistics. CFA did not support an 8-factor solution. EFA supported a two-factor solution and demonstrated significant shared variance between the two factors. This shared variance supported a one-factor solution that could conceptually be labeled Caring Behaviors. Random selection reduced the scale to 25-items while maintaining a Cronbach's Alpha of .98. Using the new 25-item scale, the composite score mean of staff nurses' perceptions of nurse manager caring behaviors indicated a moderately high level of caring. Suggestions for nursing administration, nurse manager practice, leadership, education and for future research were given. The new 25-item CAT-adm© survey has acceptable reliability and validity. The 25-item CAT-adm© survey provides hospital administrators, nurse managers, and researchers with an instrument to collect valuable information about the caring behaviors used by nurse managers in relationship with staff nurses.