Patient safety culture is a key component to the quality of health services. This study aims to analyze the attitudes and perceptions of professionals working directly or indirectly in the care of the hospitalized patient regarding the patient safety culture. This is a cross-sectional study, conducted in 2014, with professionals in the field of health and support services in seven hospitals in Santa Maria, Rio Grande do Sul, Brazil. As a research tool, used the Brazilian version of the Safety Attitudes Questionnaire (SAQ) and sociodemographic and labor issues of workers. Data were organized in Epiinfo 6.04® program, and doubled entered independently. After the correction of errors and inconsistencies, conducted the analysis in PASW Statistic® program, using descriptive and analytical statistics. The cutoff for positive assessment of safety culture was ≥ 75 points. The SAQ was measured by the total score and its six areas. As a result, participated in the study 2,634 professionals, having female predominance (72.6%), aged between 19 and 38 years (50.9%), working in mixed shifts (45.1%), contact the patients (71.6%), which did not have another job (79.9%) and have no overtime work (66.2%). The internal consistency of the SAQ was 0.90. The total score SAQ ranged from 13.9 to 97.9, with an average of 70.1 and a mean of 68.4 (± 13.4). Positive evaluation is evidenced in the fields working as a team and Climate Job satisfaction, with an average of 75 and 90 respectively, indicating that, as much as there are difficulties in the workplace, professionals expressed happiness for what they do, valued colleagues and the place in which they worked. The other areas negatively rated for safety culture (<75). The Hospital Management Perception domain had the lowest score (average 60). When the two professional groups being compared (health and support), we identified little variability in the assessment of areas, although the support of professionals tend to lower scores. The results presented should not be analyzed in isolation, but as backings for the enactment of improvement initiatives in order to improve the quality of patient care and professionals. / A cultura de segurança do paciente é um componente fundamental para a qualidade dos serviços de saúde. Este estudo objetiva analisar as atitudes e percepções dos profissionais que atuam direta ou indiretamente no cuidado ao paciente hospitalizado, acerca da cultura de segurança do paciente. Trata-se de um estudo transversal, realizado em 2014, com profissionais da área da saúde e dos serviços de apoio de sete instituições hospitalares de Santa Maria, Rio Grande do Sul, Brasil. Como instrumento de pesquisa, utilizou-se a versão brasileira do Questionário de Atitudes de Segurança (SAQ) e questões sóciodemogáficas e laborais dos trabalhadores. Os dados foram organizados no programa Epiinfo 6.04®, com dupla digitação independente. Após a correção de erros e inconsistências, realizou-se a análise no programa PASW Statistic®, utilizando-se da estatística descritiva e analítica. O ponto de corte para avaliação positiva da cultura de segurança foi ≥ 75 pontos. O SAQ foi mensurado pela pontuação total e pelos seus seis domínios. Como resultados, participaram do estudo 2.634 profissionais, com predomínio do gênero feminino (72,6%), com idade entre 19 e 38 anos (50,9%), atuantes em turnos mistos (45,1%), em contato com os pacientes (71,6%), que não possuíam outro emprego (79,9%) e não faziam horas extras (66,2%). A consistência interna do SAQ foi 0,90. O escore total do SAQ variou entre 13,9 e 97,9, com mediana de 70,1 e média de 68,4 (±13,4). Evidenciou-se avaliação positiva nos domínios Clima de trabalho em equipe e Satisfação no trabalho, com mediana de 75 e 90 respectivamente, indicando que, por mais que existam dificuldades nos ambientes de trabalho, os profissionais manifestaram o gosto pelo que fazem, valorizaram os colegas e o setor em que trabalhavam. Os demais domínios apresentaram avaliação negativa para a cultura de segurança (<75). O domínio Percepção de Gerência do Hospital obteve o resultado mais baixo (mediana 60). Ao serem comparadas as duas categorias profissionais (saúde e apoio), identificou-se pouca variabilidade na avaliação dos domínios, embora os profissionais do apoio tendam a escores mais baixos. Os resultados apresentados não devem ser analisados isoladamente, mas como subsídios para a implementação de iniciativas de melhorias, a fim de aprimorar a qualidade da atenção ao paciente e aos profissionais.

Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / The purpose of this study was to explore United States school foodservice directors’ attitudes about food recalls and to determine recall practices in school foodservice operations. An online survey was used for data collection and consisted of three sections: attitudes, self-reported behaviors, and demographics. Content validity of the instrument was measured by three experts who examined the survey prior to pilot testing. The survey was pilot tested with 14 school foodservice directors and state agency personnel. Statistical analysis was completed using SPSS (v. 20.0). Internal consistency of the attitude scale was measured using Cronbach’s Alpha. All scales had a reliability coefficient greater than 0.70. The survey was randomly distributed to 4,049 school foodservice directors across the U.S. A total of 690 school foodservice directors (17%) completed the survey, with 567 being usable. Respondents rated attitudes on a 5-point scale, strongly disagree (1) to strongly agree (5). Principle components factor analysis was used to identify two factors: perceived importance and perceived likelihood of possessing a recalled product. Perceived importance was rated very high (M=4.8, SD=0.5), while perceived likelihood of possessing a recalled product was rated much lower (M=1.7, SD=0.8). Self-reported behaviors were evaluated on a 5-point scale, never (1) to very often (5). Overall, respondents reported positive behaviors related to responding to a recall. When dividing behaviors into three factors, behaviors regarding communication with state agency and vendors about food recalls (M=4.1, SD=0.6), use of recall systems (M=3.6, SD=1.0), and practices of responding to a recall (M=4.7, SD=0.4) were frequently reported. Multiple regression analysis was used to explore relationships between attitudes and behaviors of school foodservice directors towards food recalls, and their demographic characteristics. Predictors of attitudes were found to be certification, work experience, and prior experience with a food recall. Predictors of behaviors were found to be perceived likelihood of possessing a recalled product, educational level, prior experience with a food recall, and size of district. Federal and state agency personnel can use the results of this study in developing programs to improve food recall practices as well as school foodservice directors for improving recall practices in schools.

Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective. The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews. The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV). The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.

Doctor of Philosophy / Department of Human Nutrition / Valentina M. Remig / Preventing foodborne illness and promoting safe food practices among all age groups is a high priority, particularly for college students because little about their food safety awareness and food handling practices has been reported. The research aim was to evaluate food safety attitudes, beliefs, knowledge, and self-reported practices of current upper-division college students, and to determine whether a three-module interactive educational intervention, developed for this study, positively influenced these variables. Comparisons between health and non-health majors were made. Two methods of data collection were used with volunteer health and non-health majors: focused food safety discussion groups during academic year 2004-05, and a pre-experimental design. Prior to engaging in either method, students completed an on-line food safety questionnaire (FSQ), adapted from a telephone survey used at K-State with older adults. The FSQ was administered again to those in the pre-experimental design group one week after exposure to the food safety educational intervention. Five weeks later, the FSQ was administered to determine whether changes in attitudes, beliefs, knowledge, and self-reported practices persisted over time. Focused food safety discussion group responses were qualitatively evaluated. Pre-experimental statistical analyses included Wilcoxin Signed Rank, Friedman, Mann-Whitney U, Chi Square tests, and Spearman rho. Focused discussion group findings indicated that students perceived themselves at low risk for foodborne illness; few used food thermometers; students without health backgrounds mimicked undesirable home practices; and students stated being open to changing non-recommended behaviors. Pre-experimental findings showed the effects of intervention were improved food safety attitudes, beliefs, and knowledge, with the strongest effects seen in health majors. Students' FSQ attitude scores increased from 114 to 122 (P<0.001), FSQ belief scores increased from 86 to 98 (P<0.001), and FSQ knowledge scores increased from 11 to 13 (P<0.001). Intervention resulted in some improved food safety self-reported practices for health majors but not non-health majors. Intervention module post-test scores improved significantly for all students; health majors had greater increases. Conclusions. Focused food safety discussion groups were useful for obtaining food safety information from college students; educational intervention improved college students’ food safety attitudes, beliefs, and knowledge and for health majors, some self-reported practices improved.

Traffic fatalities and injuries among young drivers as a result of road crashes constitute a serious public health problem. The ultimate goal of traffic safety work in Sweden has been formulated in Vision Zero, which includes an image of a future in which no one will be killed or seriously injured in traffic crashes. Therefore, it is unacceptable that young learner and novice drivers are involved in road crashes that result in fatalities or severe injuries. Driver education is an important tool to increase the probability that young drivers actually take their share of the responsibility for Vision Zero by obeying traffic rules and driving as safely as possible. The general aim of the work underlying this thesis was to determine the potential of driver education to reduce road traffic crashes involving young drivers, particularly in Sweden. Paper I examined the relationship between the way in which the education is carried out and the outcome of the driving test. Paper II explored whether there are any gender‐related differences regarding driving practicing, the outcome of the license tests, and involvement in crashes during the first year of licensure. Paper III evaluated the reform that made it possible for learner drivers to start practicing from 16 years of age in terms of its effects on crashes involving young novice drivers. In paper IV, the focus was on investigating crashes during practice and comparing the results with the corresponding situation for novice divers during their first two years of licensure. Paper V assessed an insight‐based educational approach aimed at inducing young drivers to make better use of vehicle‐related safety equipment. The findings of two of the studies (papers III and IV) showed that, in Sweden, taking advantage of the possibility to start practicing behind the wheel from the age of 16 years had a beneficial effect seen as reduced crash involvement among those young drivers. In paper V, it was revealed that using an insight‐based educational approach can have a positive influence on learner drivers’ knowledge of and attitudes towards the use of car safety equipment (e.g., safety belts). In paper I, it was found that it is difficult to explain why 18–24‐year‐olds pass or fail the driving test on the basis of background variables and information concerning how they had practiced driving. Paper II showed that, for females, training pursued in a more structured manner did not seem to be beneficial for the outcome of the license tests, and that males aged 18–24 were involved in 1.9 more injury crashes per 1,000 drivers than females during their first year of licensed driving. Suggestions are given that can be used to develop the Swedish licensing system in a way that will increase the potential of driver education to reduce traffic crashes among young drivers. These ideas comprise aspects such as the following: persuading the youngest learner driver population to start practicing as early and as much as possible; the learning period should be better organized, which includes improved agreement between the goals of the national curriculum, the content/process of driver education, and the design of the license tests; professional instruction of learners in both the theory and the practice of driving should be a more prominent component of driver education; and parts of the Swedish licensing system should be made mandatory to help solve the problems of young drivers and to fulfil he goals of the national curriculum. / <p>On the date of the defence the status of article II was: In press.</p>

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