A cultura de segurança na área nuclear é definida como o conjunto de características e atitudes da organização e dos indivíduos que fazem que, com uma prioridade insuperável, as questões relacionadas à proteção e segurança nuclear recebam a atenção assegurada pelo seu significado. Até o momento, não existem instrumentos validados que permitam avaliar a cultura de segurança na área nuclear. Em vista disso, os resultados da definição de estratégias para o seu fortalecimento e o acompanhamento do desempenho das ações de melhorias tornam-se difíceis de serem avaliados. Este trabalho teve como objetivo principal desenvolver e validar um instrumento para a avaliação da cultura de segurança de organizações nucleares, utilizando o Instituto de Pesquisas Energéticas e Nucleares como unidade de pesquisa e coleta de dados. Os indicadores e variáveis latentes do instrumento foram definidos utilizando como referência modelos de avaliação de cultura de segurança da área da saúde e área nuclear. O instrumento de coleta de dados proposto inicialmente foi submetido à avaliação por especialistas da área nuclear e, posteriormente, ao pré-teste com indivíduos que pertenciam à população pesquisada. A validação do modelo foi feita por meio da modelagem por equações estruturais utilizando o método de mínimos quadrados parciais (Partial Least Square - Structural Equation Modeling PLS-SEM), no software SmartPLS. A versão final do instrumento foi composta por quarenta indicadores distribuídos em nove variáveis latentes. O modelo de mensuração apresentou validade convergente, validade discriminante e confiabilidade e, o modelo estrutural apresentou significância estatística, demonstrando que o instrumento cumpriu adequadamente todas as etapas de validação. / The safety culture in the nuclear area is defined as that assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety and protection issues receive the attention warranted by their significance. Until now, there are no validated instruments to evaluate the safety culture in the nuclear area. This fact makes it difficult to assess the results of strategies for its strengthening and of the improvement actions. The main objective of this work was to develop and validate an instrument for the evaluation of the safety culture of nuclear organizations, using the Instituto de Pesquisas Energéticas e Nucleares as a research unit and data collection. The indicators and latent variables of the instrument were defined using health and nuclear area models of safety culture evaluation as reference. The data collection instrument initially proposed was submitted to the evaluation by nuclear area experts and, subsequently, to the pretest with individuals who belonged to the researched population. The validation of the model was performed through structural equation modeling using the Partial Least Square - Structural Equation Modeling - PLS-SEM method in the SmartPLS software. The final version of the instrument was composed by forty indicators distributed in nine latent variables. The measurement model showed convergent validity, discriminant validity and composite reliability, and the structural model showed statistical significance. Therefore the overall model has successfully accomplished all the validation steps.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-11T19:12:25Z No. of bitstreams: 1 JanainaCamara.pdf: 5238566 bytes, checksum: 315196ee1d6c8740cc082be8f0f1de11 (MD5) / Made available in DSpace on 2017-05-11T19:12:25Z (GMT). No. of bitstreams: 1 JanainaCamara.pdf: 5238566 bytes, checksum: 315196ee1d6c8740cc082be8f0f1de11 (MD5) Previous issue date: 2016-03-23 / The patient safety culture in the hospital environment is listed as one of the phenomena that can provide an effective and safe care. There is a need that the safety culture should be measured in order to determine the strengths and fragile points for patient safety. This study aimed to evaluate the patient safety culture from the perception of the nursing team in a Renal Transplant Unit. It is a descriptiveexploratory with a quantitative approach, conducted with 25 participants in renal transplant unit of a public teaching hospital in the city of São Luís, Maranhão, Brazil. The data collection occurred during the months of May and June 2015, by means of the application of the questionnaire Hospital Survey on Patient Safety Culture - HSOPSC. Descriptive statistics was used to classify the dimensions in areas of strong and weak, and inferential statistics to test the instrument reliability Cronbach Alpha, to the characteristics of the participants the Chi-Square test, mean and frequency, and the correlation of the dimensions of the Spearman Correlation Coefficient. The study considered fully the ethical and legal precepts of Resolution no. 466/12. The Cronbach Alpha calculated ranged from 0.13 to 0.97, demonstrating the instrument reliability. In relation to the participants the majority were 10 nurses (40%), female 23(92%), 12 (48%) concluded lato sensu graduate, age was 9 (36%) between 36 and 40 years, 11 (44%) worked in the institution from 11 to 15 years, 12 (48%) have between 11 and 15 years in the unit and 20 (80%) work of 20 to 39 hours per week. As far as the classification in variable working unit, the dimension 'team work within units “presented the highest percentage of positive answers in 100 (77%), being considered the single area of strength for patient safety. Already the predominantly fragile area for patient safety was the dimension “Non punitive responses to errors” of 75 (24%) responded positively. In relation to the variable hospital organization, only the dimension “internal transfers and passages on duty” portrayed highest score of 100 (57%) with positive responses. For the variable outcome measures, the two dimensions showed percentages bitterly negative, “general perception of patient safety “with 100 (45%) and “frequency of notified events” was the most negative percentage of all sizes corresponding to 75 (58%). As the most significant correlation was demonstrated between the variables unit of work and organizational structure, in the association of dimension “organizational learning and continuous improvement” with “team work between the units” (r = 0.70453,  - Value = <0. 0001). The study highlights the existence of a culture of punishment and guilt, underreporting of events, work overload which are the main challenges for safe care. / A cultura de segurança do paciente no ambiente hospitalar é elencada como um dos fenômenos que pode proporcionar um cuidado eficaz e seguro. Há necessidade de que a cultura de segurança seja mensurada, a fim de determinar os pontos fortes e frágeis para a segurança do paciente. Objetivou-se avaliar a cultura de segurança do paciente a partir da percepção da equipe de enfermagem em uma Unidade de Transplante Renal. Este é um estudo descritivo-exploratório, de abordagem quantitativa, realizado com 25 participantes, na Unidade de Transplante Renal de um hospital público de ensino, na cidade de São Luís, Maranhão. A coleta de dados ocorreu entre os meses de maio e junho de 2015, por meio da aplicação do questionário Hospital Survey on Patient Safety Culture - HSOPSC. Utilizou-se a estatística descritiva para classificar as dimensões em áreas fortes e frágeis, e a estatística inferencial para testar a confiabilidade do instrumento Alpha de Cronbach. Utilizou-se para as características dos participantes o teste Qui-Quadrado, média e frequência, e na correlação das dimensões o Coeficiente de Spearman. O estudo considerou integralmente os preceitos éticos e legais da Resolução nº 466/12. O Alpha de Cronbach calculado variou de 0.13 a 0.97, demonstrando confiabilidade do instrumento. Em relação aos participantes, a maioria eram enfermeiras - 10 (40%); sexo feminino - 23 (92%); 12 concluíram pós-graduação lato sensu (48%), 9 tinham (36%) entre 36 e 40 anos, 11 trabalham na instituição de 11 a 15 anos (44%), 12 possuem entre 11 e 15 anos na unidade (48%) e 20 trabalham de 20 a 39 horas por semana (80%). Quanto à classificação na variável Unidade de trabalho, a dimensão “Trabalho em equipe dentro das unidades” apresentou o maior percentual de respostas positivas - 100 (77%), sendo considerada a única área de força para a segurança do paciente. Já a área predominantemente frágil para a segurança do paciente foi a dimensão “Respostas não punitivas aos erros”, em que, de 75, 24% responderam positivamente. Em relação à variável Organização hospitalar, apenas a dimensão “Transferências internas e passagens de plantão” retratou resultado mais elevado, de 100 (57%) com respostas positivas. Para a variável Medidas de resultados, as duas dimensões apresentaram percentuais prementemente negativos, “Percepção geral da segurança do paciente” com 100 (45%) e “Frequência de eventos notificados” com o percentual mais negativo de todas as dimensões, correspondendo a 75 (58%). Quanto à correlação mais significativa, foi evidenciada entre as variáveis Unidade de trabalho e Estrutura organizacional, na associação da dimensão “Aprendizado organizacional e melhoria contínua” com “Trabalho em equipe entre as unidades” (r  = 0,70453,  - valor = <0. 0001). O estudo destacou a existência de uma cultura de punição e culpa, subnotificação de eventos e sobrecarga de trabalho, os quais constituem os principais desafios para o cuidado seguro.

Objective: The objective of this study is to examine relations between patient safety culture and processes of care, specifically, how patient safety culture influences the prevention of patient falls. The purpose of this inquiry is to identify the barriers and facilitators that can advance an inpatient rehabilitation facility to become a high reliability organization and advance interdisciplinary teamwork. Method: A qualitative phenomenological approach was conducted and an interpretive phenomenological analysis explored the experiences of frontline staff with regard to patient safety culture and fall prevention. The study utilized semi-structured interviews with 24 frontline staff from three inpatient rehabilitation hospitals. Participants were selected using purposive sampling and individually interviewed. Results: Findings revealed barriers and facilitators for each dimension of patient safety culture that drive fall prevention. Teamwork within and across disciplines, such as between nursing and therapy, affect how they communicate with one another. Issues related to staffing were the most common concerns amongst nursing staff; especially the issue of staffing ratio and patient acuity. Leadership played a role in supporting the culture of safety and holding staff accountable. Conclusion: Fall prevention requires collaborative efforts between nursing and therapy in an inpatient rehabilitation setting. Dimensions of patient safety culture such as good teamwork, effective communication, adequate staffing, nonpunitive response to errors, and strong leadership support are essential in maintaining a high reliability process for adaptive learning and reliable performance.

Este estudo tem o objetivo de validar um instrumento (questionário) em português do Brasil para avaliação de cultura de segurança de alimentos (CSA). O cenário do estudo foi composto por áreas de manipulação de alimentos prontos para consumo de uma rede de lojas de hipermercado (RLH). A empresa possuía 2204 colaboradores de manipulação de alimentos em 28 lojas hipermercado. Foi realizada uma revisão da literatura científica nacional e internacional para identificar qual instrumento se adequa melhor segundo a realidade brasileira para autoavaliação da percepção dos colaboradores que manipulam alimentos a respeito da CSA. Os critérios para escolha do instrumento foram a disponibilidade do questionário para ser avaliado, a explicação dos elementos que compõem a CSA, itens condizentes com o dia a dia de manipulação de alimentos e limite de até 50 itens. Um instrumento de 31 itens e escala Likert de sete pontos foi escolhido. O processo de validação do instrumento baseou-se no trabalho de Borsa et. al. (2012) que estabeleceram seis passos: tradução do instrumento para o novo idioma, síntese das versões traduzidas, avaliação da síntese por experts, avaliação pelo público- alvo, backtranslation (retradução) e estudo piloto. Uma entrevista com um responsável pela segurança de alimentos da RLH foi coletada para obter outra fonte de informação sobre a CSA. O instrumento foi aplicado em 383 participantes de 15 lojas da RLH. Após a aplicação empírica do instrumento na RLH sucederam-se análises estatísticas descritivas e multivariadas dos dados. O instrumento foi validado para diagnosticar CSA em português brasileiro após as etapas descritas. Os resultados das respostas do instrumento demonstraram que a CSA possui tendência positiva. A entrevista corroborou as respostas dos participantes e mostrou uma CSA desenvolvida. / This study aims to validate an instrument (questionnaire) in Brazilian Portuguese for assess food safety culture (FSC). The study scenario was composed of ready-to-eat food handling areas of a hypermarket chain network (HCN). The company had 2204 food handling workers in 28 hypermarket stores. A review of national and international scientific literature was carried out to identify which instrument is best suited to the Brazilian reality for the self-assessment of food handlers\' perception of FSC. The criteria for choosing the instrument were the availability of the questionnaire to be evaluated, the explanation of the elements that make up the FSC, items consistent with the day to day food handling and limit of up to 50 items. An instrument of 31 items and a seven-point Likert scale was chosen. The validation process of the instrument was based on the work of Borsa et. al. (2012), which established six steps: translation of the instrument into the new language, synthesis of translated versions, evaluation of synthesis by experts, evaluation by the target audience, backtranslation and pilot study. An interview with an HCN food safety representative staff was collected for another source of information about FSC. The instrument was applied to 383 participants from 15 HCN stores. After the empirical application of the instrument in the HCN, descriptive and multivariate statistical analyzes of the data were succeeded. The instrument was validated to diagnose FSC in Brazilian Portuguese after the steps described. The results of the instrument responses showed that the FSC has a positive trend. The interview corroborated participants\' responses and showed a FSC developed.

Safety culture has been demonstrated to be a key factor in high-reliability organizations (HROs), yet healthcare has not achieved a safety culture as seen in HROs despite decades of effort. Student nurses are enculturated into their profession during their pre-licensure education. This period offers an excellent opportunity to teach students the values, norms, and practices of safety culture. However, little is known about the state of safety culture in schools of nursing. The purpose of this study was to examine the state of patient safety culture as perceived by students in pre-licensure nursing programs in the US using a modified version of the Hospital Survey on Patient Safety Culture (HSOPSC). The School of Nursing Culture of Safety Survey (SON-COSS), the modified instrument created for this study, was administered electronically to a sample of pre-licensure nursing students (N=539) drawn from membership in the National Student Nurses Association (NSNA). The SON-COSS was found to maintain its reliability and validity for use in pre-licensure nursing students. Perceptions of patient safety culture ranged from 81.6% to 23% positive for the 10 dimensions of patient safety culture measured by the SON-COSS. The highest percent positive dimensions for this study were Faculty Support for Patient Safety (81.6%), Teamwork Within Groups (78.3%), and Faculty Expectations and Actions Promoting Patient Safety (68.6%). The lowest percent positive dimensions for this study were Frequency of Events Reported (47.3%), Communication Openness (34%), and Nonpunitive Response to Error (23%). Participants in this study perceived patient safety culture significantly lower for eight of the 10 dimensions measured by the SON-COSS compared to aggregate national data from the HSOPSC (AHRQ, 2016). Only Faculty Support for Patient Safety (81.6%) was significantly higher than the corresponding dimension in the HSOPSC. The results of this survey indicate that students recognize the importance of safety to their faculty, but they do not perceive the presence of a just culture, an essential prerequisite for a culture of safety. This study provides a reliable and valid instrument to measure safety culture in schools of nursing and baseline data to understand the state of safety culture in this population.

<p>Syftet med denna jämförande studie är att söka förklaringsfaktorer till varför hälso- och sjukvård respektive civilflyg har utvecklats olika i säkerhetstänkande. Frågeställningen är huruvida de statliga tillsynsmyndigheternas förutsättningar och arbetssätt har betydelse för säkerhetskulturen i respektive tillsynsverksamhet. Till förutsättningarna hör författningarna - skiljer sig dessa åt? Myndigheternas arbetssätt, dvs. tillsynens utformning – vilken betydelse har den?</p><p>Resultaten visar att säkerhetsrelaterade författningar inom civilflyget är tydligare jämfört med hälso- och sjukvården. Inom civilflyget anges tydligt hur säkerhetsarbetet ska organiseras, till skillnad mot hälso- och sjukvården.</p><p>Tillsynsmyndigheternas arbetssätt påverkas av skillnader i författningarnas utformning. Luftfartsstyrelsen kan påverka de flygsäkerhetsrelaterade resurserna vid en flygplats. Socialstyrelsen har små möjligheter att påverka sjukvårdens bemanning.</p><p>Genom civilflygets föreskrifter har man uppnått strikt följsamhet mot upprättade rutiner. Miljön för avvikelserapportering är icke-bestraffande. Felhandlingar förebyggs genom övningar och repetitionsutbildningar. Socialstyrelsen saknar bemyndigande i utbildningsfrågan.</p><p>Tillståndsplikten inom civilflyget har sannolikt främjat säkerhetsutvecklingen, så även det internationella samarbetet.</p><p>Slutsatsen är att utformningen av författningarna har betydelse för tillsynsmyndigheternas möjligheter att påverka säkerhetsutvecklingen inom respektive tillsynsområde. Bristen på tydlighet i författningarna kan förlångsamma sjukvårdens utveckling mot ökande patientsäkerhet.</p> / <p>The aim of this comparative study is to find explanations to why healthcare and civil aviation have developed differently regarding safety culture. The question at issue is: Which significance do prerequisities and work procedures of governmental supervisory authorities have for the development of safety culture in the two areas of supervision, respectively. Among prerequisities are the constitutions – do they differ? Among work procedures are the design of the supervision – which role does it play?</p><p>Results show that constitutions relating to safety issues in civil aviation are more distinct as compared to health care. In civil aviation, it is clearly stated how the security work should be organized, in contrast to health care. The work procedures of supervisory authorities are affected by differences in the wording of constitutions. The Swedish Civil Aviation Authority is able to influence the staffing of an airport. The National Board of Health and Welfare has only minor possibilities to influence the staffing within health care.</p><p>By application of the regulations of civil aviation, strict compliance to established local routines has been achieved. The environment for reporting of adverse events is blame-free. Human errors are prevented by drills and recurrent educations. The National Board of Health and Welfare has no authority in educational issues. The licence duty of civil aviation has probably facilitated the development of safety culture. The same holds true for the international collaboration within civil aviation.</p><p>The conclusion is that the wording of constitutions is important for the ability of supervisory authorities to influence the development of safety culture within the two investigated fields of supervision, respectively. The lack of clarity in the wording of constitutions and regulations within health care might slow down the development of safety culture.</p>

There are certain organizations that manage to handle risk in such a successful way that they almost stay error-free, in spite of the fact that they daily face the risks of accidents. These organizations are usually given the name High Reliability Organizations (HRO). While the most common example is that of a nuclear plant the variety of what organizations can fit into the category is extensive. The purpose of this study is to describe safety culture and theories about HRO and how these can be found in practise within an organization. This qualitative research uses influences of ethnography in its method. The ethnographical approach was picked due to the field of the study and the cultural context in which it is set. The results of the study identify a number of elements sorted into four themes. These themes are deemed compatible or non-compatible with relevant existing theories. While most of the results match, the issue of routine-based work is not coherent with leading theories of HRO. An effort in making an alternative explanation proposing a balance between routines and mindfulness is taken on the subject.

Safety is very important for our society. In contrast, it is hard to define what this term really means. Nevertheless, one area that is considered important for safety involves accident prevention. Many methods exist within this area which aims at preventing accidents from happening. One accident prevention method is called ‘The Safety Scanning Tool (SST)’. The study conducted in this thesis aimed at exploring whether the SST could improve the safety understanding of experts from the domain of aviation. The term ‘safety understanding’, as it is used in this thesis, refers to the understanding of central scientific concepts underlying safety. These concepts relate to the area of accident prevention and they were the results of a literature study on safety. Thus, the safety understanding was addressed on two levels of abstraction. The first general abstraction level concerned the basic assumptions for studying an organization’s safety culture relating to Schein’s (1992) framework cited by Guldenmund (2000). This relates to the area of accident prevention in a more general way. The second more specific abstraction level regarded 21 different safety issues important for accident prevention. These originated from the area of resilience engineering. Furthermore, this study was structured as a field experiment using a pre-post test and a within-group design.  In order to measure the different experts’ safety understanding, the data were gathered with the help of two surveys before and after the experts’ used the SST. The SST was applied to two groups of experts. In the first group, they were six people, and, in the second 16. The questions in the surveys were created with the help of the above mentioned literature study on safety. The results were analyzed with the help of the statistics program SPSS. In addition, the results were analyzed with the help of sources from academic literature. These were used in order to determine whether there was an improvement of the safety understanding or not. Based on the results from this study, it can be concluded that undergoing the SST caused several improvements of the experts’ safety understanding. These improvements were found in both groups of experts and on both abstraction levels of the safety understanding. However, one result relating to the basic assumption level in the second group of experts could be interpreted both as an improvement and as a decrease of the safety understanding. The results of this study indicate not only that the SST has the ability to detect safety problems in an early state, before they can develop to the outcome of an accident. It has also the ability to enhance its user’s safety understanding relating to factors important for accident prevention.

China Steel Corporation (CSC) has introduced OHSAS 18001 system since 2000, and has acquired good performance and credits, but it seems hard to get further progress in performance. One of the major reasons is that industrial safety awareness does not take root in every employer¡¦s mind. So it is important to make an all-purpose safety concept environment. In 2011, Safety-Caring program was put into action plant widely to build safety culture. This study focuses on the effect of safety management by promoting safety caring activities in steel-making plant. It hopefully improves the safety performance through verification of practical experiment according to theoretical analysis. The study processes and conclusion are as followings: 1. Two rounds of questionnaires were issued; the first one was done about one year later of safety caring project started, this questionnaire was to understand the effect of safety caring program in steel plant. The second one was to evaluate the key factors of success to run safety caring program, and the later questionnaire was issued about five months later following the first one. 2. The culture of CSC is based on the kindheartedness and humanity priority. So safety caring program is suitable to build an all-purpose safety culture in CSC. 3. The results from the two rounds of questionnaires show the highly approval of safety caring program. The successive safety education, the promise of the authority, the proclamation of the labor union and steel plant, and the safety knowledge sharing consistently promoted, therefore, the safety performance is getting higher. 4. The major factors of running safety program are: active safety caring, the promise of the authority, personal safety knowledge, the proclamation and the support of the labor union, and the notification performance of steel-making plant. The factor of the promise of the authority is the most outstanding. On the other hand, the following factors are not so obvious, such as: safety management system, safety feeling, service leading, commanding leading, rewards and punishments, working pressure, and income satisfaction. 5. The more the safety caring is done, the more approval of safety program, and the more willingness to obey the safety rules. It is evident that keeping the promotion of safety activities can lower the industrial accidents.

<p>There are certain organizations that manage to handle risk in such a successful way that they almost stay error-free, in spite of the fact that they daily face the risks of accidents. These organizations are usually given the name High Reliability Organizations (HRO). While the most common example is that of a nuclear plant the variety of what organizations can fit into the category is extensive.</p><p>The purpose of this study is to describe safety culture and theories about HRO and how these can be found in practise within an organization.</p><p>This qualitative research uses influences of ethnography in its method. The ethnographical approach was picked due to the field of the study and the cultural context in which it is set.</p><p>The results of the study identify a number of elements sorted into four themes. These themes are deemed compatible or non-compatible with relevant existing theories. While most of the results match, the issue of routine-based work is not coherent with leading theories of HRO. An effort in making an alternative explanation proposing a balance between routines and mindfulness is taken on the subject.</p>