published_or_final_version / Nursing Studies / Master / Master of Nursing

Indiana University-Purdue University Indianapolis (IUPUI) / The ability to improve the safety of patient care delivery is dependent on the safety culture, or the norms surrounding reactions following an error, the learning that takes place, and the proactive strategies in place to prevent future errors. While measurement of patient safety culture is now common in the United States (US) using instrument specifically developed for US healthcare organizations, no measurements of safety culture had been conducted at Hamad Medical Corporation in the State of Qatar, a Middle Eastern country; nor were valid or reliable instruments available. The purpose of this study was to assess registered nurses’ perceptions of the safety culture in the units where they provide nursing care at Hamad Medical Corporation using a modified version of the Agency for Healthcare Research and Quality (AHRQ) patient safety culture an instrument (Hospital Survey of Patient Safety Culture). Eight hundred surveys were distributed to all randomly-selected nurses from eight targeted clinical services with a response rate of 57%. Survey results were compared with those from US hospitals using the original AHRQ survey. Ranking of subscales for this study in terms of strengths and areas needing improvement were almost identical to the ordering of US hospital results, with teamwork within units ranked highest and indicating a strength; and the subscale non-punitive response to error the lowest and indicating an area for improvement. Positive response rates in terms of safety culture for this study were generally lower on most subscales compared to the US results and may reflect the intensity of patient safety improvement activity in the US over the last eight years in response to the Institute of Medicine’s report on medical errors in 1999. Results from this study provide a baseline measurement for safety culture at Hamad Medical Corporation and beginning adaptation of an instrument that can be used in other Middle Eastern healthcare organizations in the future.

Submitted in Fulfillment of the Requirements of the Degree of Doctor of Technology: Nursing Sciences, Durban University of Technology, Durban, South Africa, 2012. / Introduction While investigating alleged unprofessional conduct involving nurses, SANC collects a wealth of information which is used as the basis upon which to determine the nurses’ guilt or innocence in respect of unprofessional conduct. No evidence exists that such information is ever used to determine how similar acts of unprofessional conduct could be prevented and/or be used in mitigating the impact of such acts on patient safety. Given that nurses have most interaction with patients, there is much to learn from practice breakdown involving nurses. Methods A four phase cross sectional sequential exploratory mixed method approach using a modified soft system methodology (SSM) methodology was utilised to develop a framework for the integrated management of practice breakdown. Purposive sampling was followed to select five districts in KwaZulu-Natal for inclusion in the study. In addition Operational Nursing Managers, members of the Professional Conduct Committee of the South African Nursing Council, and representatives of organised labour were purposively sampled. Qualitative data regarding causes and current practices in the management of practice breakdown in the nursing profession was gathered from key groups via focus groups, and individual phone calls. Then a survey instrument used to test the elements of the emerging theory was developed. Finally, a framework for integrated management of practice errors is suggested. Results The study found that practice breakdown was a product of both environmental factors such as fallible managerial decisions, and unintended acts committed by nurses. In addition, the types of errors and consequences of error management were identified. Finally, conditions requisite for the integrated approach in the management of practice breakdown were identified and used to develop a framework for an integrated approach in the management of practice breakdown in nursing. Conclusion Creation of a positive practice environment for nurses is requisite for an integrated approach in the management of practice breakdown. / Appendices only available in the Hard copy of the Thesis / D

Nurse managers are essential in providing safe and effective patient care. The nurse manager position is a professional role necessary for the overall success of a hospital, clinic, or home health agency. The national education minimum for the initial entry to practice for registered nurses in the United States varies from diploma-training school to collegiate education at Associate, Bachelor, and Masters levels. Other professional healthcare workers need a Doctoral degree upon entry into practice. Nurse managers who lead multidisciplinary teams of other professionals are not required to achieve higher academic credentials in the United States beyond the initial entry to practice minimum. This study examined the relationships among nurse manager education levels, leadership style, and empowerment. It explored how the nurse managers' levels of education and empowerment correlate to the patient safety chain of transformational leadership that leads to a safety culture. Additionally, the variable Magnet designation was examined. The investigation was an observational one-sample study design (N = 142). An electronic survey was used to assess perceived leadership style, empowerment, and safety culture. Data were collected on professional social media platforms, including LinkedIn. Additionally, Nurse managers at the 2022 ANCC Magnet/Pathways Conference were approached to complete the online survey. The investigation results suggest that education does not influence leadership style or empowerment; however, this study's findings suggest that nurse managers with an undergraduate degree are significantly more effective in their leadership abilities than nurse managers with graduate degrees (p =.036). In this investigation, Doctoral-prepared nurse managers were more likely to use a transactional form of leadership than Bachelor or Masters prepared nurse managers (p = .029). The participants' empowerment levels were lower than in similar nurse manager studies before 2020. This finding may be a post-pandemic symptom. Moreover, nurse managers who work in Magnet–designated facilities are more likely to perceive their work environment as safe (p = .006). Magnet status was additionally associated with nurse managers' ability to create success and influence their team (p = .037). The ANCC Magnet and Pathways Programs may blueprint an effective, safe nursing service.

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