Thesis advisor: Callista Roy / Problem: Nurses act as safety nets, protecting patients from harm through the identification, interruption and recovery of medical errors and adverse events but we need to know more about ways to learn from safety events. This study aimed to address a gap in our understanding of how the PRISM Program affects nurses’ attitudes of safety culture, awareness of the recovery of medical errors, and practice as they relate to patient safety and error prevention. Participants: Critical care nurses in a large academic hospital from intervention (n=95) and control (n=90) units were surveyed pre and post-implementation of the PRISM Program. Intervention unit nurse response rates were 46% pre-survey and 41% post-survey. Control unit nurses' response rates were 38% for pre-survey and 31% for post-survey responses. A total of 42 (44%) intervention unit nurses participated in the PRISM Program. Methods: A pre/post-test design with an intervention and control unit was used to evaluate the effects of the PRISM Program on nurses’ responses on the Safety Attitude Questionnaire (SAQ) and the Recovery of Medical Error Inventory (RMEI) over a three month period. Nurses responded to questions about the impact on their practice. Findings: Analysis demonstrated a significant decrease in the SAQ working conditions post-survey subscale scores and significant findings in the main effects, decreased SAQ subscales: teamwork, job satisfaction, safety climate and perceptions of hospital management. The RMEI did not produce any significant findings. Comments provided insight into some nurses’ participation in the program and the impact on their practice. Implications: A significant decrease in post-survey scores indicate that informed nurses had a more critical view of safety culture and the environment they work in. Nurses expressed a desire to further use surveillance and additional manual checks that placed increased accountability and responsibility for their role in using strategies to keep patient safe and prevent errors and patient harm. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Research over the past 30 years suggests that sport can provide a context in which children are subjected to several forms of maltreatment. Various countries, regions, sports and individual organisations have responded to this evidence, causing a proliferation of methods used to safeguard children from harm. However, one approach that is yet to be considered is the safety culture approach. This is despite its potential to address all of the potential risk factors of child maltreatment in sport, and its evidenced ability to tackle a wide range of safety concerns in fields as far-reaching as healthcare, aviation and energy production. Based on this, the aim of this thesis was to conceptualise safety culture in sport from a child safeguarding perspective. A total of 45 interviews and 7 focus groups were conducted with participants from five organisations which differed on the grounds of size, mission and geographical location. Data was analysed using thematic analysis. Findings suggested that safety culture in sport is influenced by the presence and nature of; safety management systems, committed leadership and stakeholder engagement. Findings also suggested that these factors have an interconnected relationship, which influences the nature and strength of the safety culture. These factors and their subsequent safety culture were also found to be influenced by a multitude of internal and external contextual factors. Therefore, the findings of this thesis are used to present the Safety Culture Model for Safeguarding Children. This is the first of its kind as both a model of safety culture in sport, and a safety culture model that specifically relates to safeguarding children. Practical implications and avenues for future research are also presented.

Em um ambiente corporativo, depois de algum tempo, as pessoas sabem a quem recorrer quando necessitam de ajuda ou de algum conhecimento que não dispõem, caracterizando um contexto de múltiplas influências entre pessoas ou redes de relacionamentos. Desta forma, o trabalho proposto, teve como objetivo identificar os atores da rede de relacionamentos, que exercem maior influência no comportamento de segurança. Para isso, fomos buscar na literatura estudos de abordagens teóricas e práticas, que utilizassem conceitos sócio-antropológicos, de preferência trabalhos com enfoque na área nuclear, que possuíssem questionários de cultura de segurança, devidamente testados e avaliados por métodos estatísticos. Como resultado, identificamos inúmeros atributos que podem caracterizar uma cultura de segurança positiva e, extraímos quatro daqueles que mais apareciam nos diversos estudos. A partir daí, concebemos as questões que nos possibilitassem mapear e entender as redes sociais que influenciam sobre a formação e manutenção destas características. Então, aplicamos nossa pesquisa no âmbito do IPEN-CNEN-SP, no qual utilizamos a técnica de pesquisa tipo bola de neve para mapeamento das redes sociais de compartilhamento de idéias, bem como aplicamos também o questionário para mapear as crenças dos atores com significativo grau de influência (obtido a partir do levantamento de redes de influências). Embasado em técnicas de análise de redes sociais, obtivemos subsídios para comprovação de que as redes dos atores mais influentes são relevantes na formação de cultura de segurança do IPEN-CNEN-SP. / In a corporative environment, after a while, people know to whom to turn to when they require help or some knowledge non available at their disposal, characterizing a context of multiple influences among people or relationship network. This way, the proposed work had as objective to identify actors, from relationship network that exerts a higher influence in safety behavior. For this, we researched in the literature studies on theoretical and practical approaches, which would use social-anthropological concepts, especially works with approach in nuclear area, provided with questionnaires on safety culture, strictly tested and assessed via statistical methods. This resulted in the identification of a lot of attributes able to characterize a positive safety culture and from them extracting four of the most shown in various studies. From now on, there were conceived questions for making viable the mapping out and the understanding of social network responsible for influencing the building-up and the maintenance of these characteristics. So, it was applied in our research, within IPEN-CNEN-SP extent, the snowball type as research technique, for the mapping out of social network toward ideas sharing, as well it was applied the questionnaire intended for mapping out actors believes with a significant influence degree (obtained from influences network survey). Based in social network analyses techniques, we obtained subsides for proving that network from actors the most influent are relevant for the building-up of IPEN-CNEN-SP safety culture.

Em um ambiente corporativo, depois de algum tempo, as pessoas sabem a quem recorrer quando necessitam de ajuda ou de algum conhecimento que não dispõem, caracterizando um contexto de múltiplas influências entre pessoas ou redes de relacionamentos. Desta forma, o trabalho proposto, teve como objetivo identificar os atores da rede de relacionamentos, que exercem maior influência no comportamento de segurança. Para isso, fomos buscar na literatura estudos de abordagens teóricas e práticas, que utilizassem conceitos sócio-antropológicos, de preferência trabalhos com enfoque na área nuclear, que possuíssem questionários de cultura de segurança, devidamente testados e avaliados por métodos estatísticos. Como resultado, identificamos inúmeros atributos que podem caracterizar uma cultura de segurança positiva e, extraímos quatro daqueles que mais apareciam nos diversos estudos. A partir daí, concebemos as questões que nos possibilitassem mapear e entender as redes sociais que influenciam sobre a formação e manutenção destas características. Então, aplicamos nossa pesquisa no âmbito do IPEN-CNEN-SP, no qual utilizamos a técnica de pesquisa tipo bola de neve para mapeamento das redes sociais de compartilhamento de idéias, bem como aplicamos também o questionário para mapear as crenças dos atores com significativo grau de influência (obtido a partir do levantamento de redes de influências). Embasado em técnicas de análise de redes sociais, obtivemos subsídios para comprovação de que as redes dos atores mais influentes são relevantes na formação de cultura de segurança do IPEN-CNEN-SP. / In a corporative environment, after a while, people know to whom to turn to when they require help or some knowledge non available at their disposal, characterizing a context of multiple influences among people or relationship network. This way, the proposed work had as objective to identify actors, from relationship network that exerts a higher influence in safety behavior. For this, we researched in the literature studies on theoretical and practical approaches, which would use social-anthropological concepts, especially works with approach in nuclear area, provided with questionnaires on safety culture, strictly tested and assessed via statistical methods. This resulted in the identification of a lot of attributes able to characterize a positive safety culture and from them extracting four of the most shown in various studies. From now on, there were conceived questions for making viable the mapping out and the understanding of social network responsible for influencing the building-up and the maintenance of these characteristics. So, it was applied in our research, within IPEN-CNEN-SP extent, the snowball type as research technique, for the mapping out of social network toward ideas sharing, as well it was applied the questionnaire intended for mapping out actors believes with a significant influence degree (obtained from influences network survey). Based in social network analyses techniques, we obtained subsides for proving that network from actors the most influent are relevant for the building-up of IPEN-CNEN-SP safety culture.

Studies have found links between physician relationships with nurses, patient safety culture, and patient outcomes, but less is known about a similar link between physician relationships with allied health professionals (AHPs), patient safety culture, and patient outcomes. The purpose of this exploratory quantitative, survey study was to investigate whether physician interactions with AHPs contribute to improved patient-safety culture, AHP empowerment, and self-efficacy. Based on a theoretical framework consisting of structural empowerment, psychological empowerment, and self-efficacy, it was hypothesized that self-efficacy is predicted by structural and psychological empowerment and self-efficacy predicts a positive patient safety culture. The AHP Survey of Physician Collaboration was constructed using psychometrically sound items from instruments that have studied similar phenomena. A purposive sample with 95 respondents consisted of occupational and physical therapists currently working in hospitals. Pearson Product-Moment correlation, standard multiple regression analysis, independent groups t-tests, and one-way between groups analyses of variance were employed. Although the survey results did not indicate a statistically significant relationship between psychological empowerment and patient-safety culture, findings in this study indicated that patient-safety culture has a significant positive correlation with structural empowerment and self-efficacy. Structural empowerment and self-efficacy were found to significantly predict patient-safety culture. The results did not show differences based on gender, profession, age, or years of service. By illustrating the nature of the relationship between physicians and AHPs, the results of this study can affect social change through enhancing the ability to reduce the number of preventable negative health outcomes in hospitals.

The purpose of this study was to investigate the safety culture and safety behaviors of metropolitan professional firefighters. A validated and reliable safety culture survey was used to assess the safety culture of a metropolitan fire department. A safety behavioral checklist was created and used to assess the safety behaviors of professional fire fighters. The sample for the study included 156 firefighters from a metropolitan fire department in North Carolina. A Pearson correlation was used to determine if there was a significant relationship between safety culture and safety behaviors. ANOVA and t-tests were used to determine if significant differences existed in safety culture and/or safety behavior on selected demographic factors. Data analysis revealed a significant correlation between safety culture and safety behavior. Results indicated the more positive safety culture is viewed, the more likely the firefighter is to practice safe behaviors. Findings also indicate that demographic factors such as education, marital status, work experience, and dependent status have no significance on how firefighters view safety culture and on the safety behaviors of firefighters. Data analysis did indicate a marginal significance in safety culture by participants who reported being moderately or severely injured ‘on the job’.

Quality in pharmacies includes aspects such as error management and safety issues. The objective of this thesis was to explore these aspects of quality in Swedish community phar-macies. The specific aims were to compare a paper-based and a web-based reporting system for dispensing errors, regarding reporting behaviour and data quality. The impact of an intervention; a technical barrier, for preventing dispensing errors was evaluated. A survey tool, the Safety Attitudes Questionnaire (SAQ), was adapted to Swedish pharmacies and used to describe the safety culture in these pharmacies. The potential relationship between safety culture and dispensing errors was also explored. Data was retrieved from the paper- and web-based reporting systems, semi-structured interviews as well as from a survey, using SAQ. The change in reporting system for dispensing errors increased the reporting of errors and enhanced the completeness of reported data. The web-based system facilitated follow-up and identification of preventive measures, but was associated with implementation problems. The intervention was associated with a significant decrease in the overall number of dispensing errors and, specifically, reports on errors with the wrong strength, and errors caused by registration failure in the pharmacy computers. The Swedish version of the survey tool, SAQ, demonstrated satisfying psychometric properties. No correlation between the SAQ Safety Climate dimension and dispensing errors was seen, while a positive relationship between the SAQ Stress Recognition dimension and dispensing errors was established. A number of other pharmacy characteristics, such as number of dispensed prescription items and employees, displayed positive relationships with dispensing errors. Staff age demonstrated a negative relationship with dispensing errors while other demographic variables such as national education background showed a positive relationship.

Background: Surgical site infections are commonly occuring within healthcare, especially in Africa. Good hygiene is the most effective way in which to reduce and prevent infection, compliance however is often low or insufficient. Aim: The Aim of the study was to observe intraoperative compliance to basic hand hygiene in the operating theatre, the secondary aim was to investigate the surgical teams views on patient safety by using a survey on patient safety culture. Method: The design is a quantitative observational study. Through participant observation information was gathered on compliance to basic intraoperative hygiene routines in operating theatres in Mozambique. Operating personnel were then asked to complete a survey on patient safety culture. Result: None of the work elements were performed in complete compliance to WHO’s guidelines at all times. The operating theatre personnel’s views on Patient Safety Culture showed the highest percentage of positive responses was the dimensions “Teamwork Within Hospital Units” and “Organisational Learning- Continous improvement”. The dimensions with the least positive response was “Nonpunitive Response To Error” and “Staffing”. When comparing compliance to basic hygiene and the results of the patient safety culture survey a medium relation was found, where the staff who gave the most positive response to the survey also complied better to the WHO’s hygiene guidelines. Conclusions: Compliance to basic hygiene during the intraoperative phase in the operating theatre in Mozambique, Maputo was often insufficient. There was a medium strong relation between the staffs views on patient safety and their compliance to basic hygiene. This implies that working with the staff’s attitudes concerning patient safety could improve hygiene compliance resulting in reduced number of surgical site infections.

In the ten year period between 2004 and 2013 the UK lost 13 operational, and one non-operational, firefighters at fires, a relatively large number in relation to previous losses. These fatalities occurred during a period in which fire fatalities of members of the public were at an all‐time low but fire and rescue services (FRS) and their staff were being accused in the media of becoming risk averse. This research was focussed on investigating the risk attitudes and safety culture in the English fire and rescue services. The research question asked how the safety culture manifests itself in the English fire and rescue service and what are its implications? A mixed approach to the research was adopted utilising both quantitative and qualitative methods. The research strategy was inductive using a multiple case study. A safety culture questionnaire was designed and then piloted in one FRS with the responses being subjected to a factor analysis the results of which indicated there were four dimensions: management, procedures, competence, and work pressures. The final version of the questionnaire was then distributed across five FRSs from which 845 were returned, of which 823 were used in a series of statistical analyses. Two independent variables were used in the analysis; the first consisted of the individual FRSs, the second consisted of three groups based on Schein’s three generic subcultures of executive, designer and operator. These were aligned with principal officers (PO), senior officers (SO), and Watch based (WB) staff respectively. The analysis of the completed questionnaires indicated that the WB group had a negative attitude towards their FRS safety culture, while the SO and PO groups had a more positive attitude with the PO the most positive. All three groups were significantly different to each other. In conducting the qualitative part of the mixed methods the researcher rode with three Watches at a station in each of three FRSs to observe the behaviour of WB staff and attending SOs at incidents and during their daily activities. During the course of the fieldwork nineteen members across all of the participating FRSs were interviewed, and twenty‐four focus groups were conducted. What was clear was that the competence based training system was not popular with WB staff who believed it to be too bureaucratic, whilst SOs and POs believed that it had not fulfilled their expectations of what it would deliver. There were also concerns expressed that the promotion system, associated with the competence‐based training, was producing managers and not the leaders required on the incident ground. It was concluded that safety culture within the FRS is associated with the systems, policies and procedures reflective of FRS management’s level of risk tolerance producing a rule-based decision‐making bureaucracy; this level of risk tolerance then influences how operational firefighters operate on the incident ground. In the world of the operational firefighter a typical incident, which by its very nature is a temporary event, is laden with uncertainty, complexity and in which all the potential risks may not yet have been identified with decision‐making being focussed on problem‐solving. FRS personnel find themselves operating in a risk climate in which they build temporary command structures, construct temporary processes and controls reflecting the incident commander’s risk appetite for the purpose of moving towards operating in a safety climate in which to resolve the incident. The combination of the FRS’s safety culture and the operational firefighter’s risk climate determine what the researcher has defined as the FRS operational culture.

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