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Thesis advisor: Judith Vessey / Purpose: The purpose of this study was to explore the relationships between psychological safety, perception of working in a high reliability organization (HRO) and safety event reporting intentions among pediatric nurses working in acute care. Background: The quality and safety of patient care is dependent upon nurses to report safety events and near-misses in order to address systems’ issues and identify improvement opportunities. To encourage feedback and promote reporting, many health care organizations have adopted the high reliability framework and strategies to promote team psychological safety. A dearth of literature exists on how the pediatric nurse perceives their workplace. This study addressed this gap by measuring the pediatric nurse’s level of psychological safety, perception of whether or not they work in an HRO and their safety event reporting intentions. Methods: Using nonprobability convenience sampling, data were collected from pediatric nurses (N=244) during a one-time, anonymous, 10-minute web-based survey. The survey was distributed to members of the Society of Pediatric Nurses (SPN) and by members of the National Pediatric Nurse Scientist Collaborative (NPNSC) to their respective constituent groups. The online survey comprised of four sections: a demographic form, the Safety Organizing Scale (SOS), the Team Psychological Safety Scale, and the Intention to Report Safety Events Scale. A two-part statistical model was fit using logistic regression and linear regression. Results: Psychological safety was found to have a positive and statistically significant relationship with Intention to Report Safety Events Scores (p<0.01; β=0.274). The findings also revealed that when all other variables were excluded from the statistical model, a positive and statistically significant relationship between HRO perception and safety event reporting intentions (p=0.034) existed. The logistic regression model revealed that the odds of a pediatric nurse achieving the highest safety reporting intention score of 7 increased by a factor of 0.3 with each additional year of practice. Conclusions: The findings demonstrated that a nurse’s perception of whether they work in a high reliability setting and how psychologically safe they feel profoundly effects their attitude towards safety event reporting. This work advances the state of the science by demonstrating how workplace culture, and specifically psychological safety and the HRO framework, influences reporting intentions. The information gained from this study will be useful to organizational leaders and professional groups who seek to improve patient safety reporting systems, communication strategies and existing workplace cultures. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Bakgrund: Inom dagens slutenvård möter legitimerade sjuksköterskor en ökad arbetsbelastning samtidigt som sjuksköterskor förväntas utföra god och säker vård gentemot patienter. Situationen kan resultera i att vårdskador uppstår och patientsäkerheten äventyras.  Syfte: Syftet var att belysa de faktorer som har betydelse för patientsäkerheten inom slutenvården utifrån sjuksköterskors perspektiv. Metod: Litteraturöversikt baserat på 20 artiklar med både kvalitativ och kvantitativ ansats. Resultat: Faktorer som påverkade patientsäkerheten identifierades som ogynnsam Arbetsmiljö, vårdpersonalens Kompetens, Kommunikation, Samarbete inom vårdlaget och Patientsäkerhetskulturen på avdelningen. Slutsats: Det är av vikt att identifiera arbetsrelaterade faktorer för att skapa en bättre arbetsmiljö och förebygga uppkomsten av vårdskador vilket leder till en förbättrad patientsäkerhet och en säker vård. / Background: Registered nurses of today in the inpatient care face increased workload concurrently when nurses are expected to deliver good and safe care for patients. The situation of today´s health care may result in patient safety events and jeopardizing patient safety. Aim: The aim of this study was to describe factors in inpatient care that can have an impact on patient safety. Method: A literature review including 20 articles with both qualitative and quantitative approach was performed. Results: Factors that have an impact on patient safety were identified as unfavorable Work environment, Healthcare workers competence, Communication, Cooperation within the task force and the patient safety culture in the department. Conclusion: It is important to identify work-related factors in order to create a better work environment and prevent patient safety events which leads to improved patient safety and safe care.

[pt] Na indústria da construção, conhecida por sua natureza dinâmica e caótica, muitas vezes há acidentes de trabalho. Os métodos de planejamento existentes que abordam incertezas, no entanto, frequentemente ignoram as variáveis de segurança, e a literatura relevante é escassa. Este estudo introduz um novo método de planejamento de obras focado na influência de ocorrências de segurança na duração do projeto, especificamente em projetos de construção de usinas de energia. A principal hipótese é que eventos de segurança durante a construção afetam significativamente a duração do projeto, levando a cronogramas deficientes quando não considerados no processo de planejamento. Utilizando a teoria de processos estocásticos, particularmente o processo de quase-nascimento e morte, o estudo explora como os estados de segurança influenciam os estados de atraso. Modelos de redes neurais complementam o modelo estocástico para previsão de séries temporais bivariadas derivadas dos estados estocásticos. Dados reais de projetos demonstram que os eventos de segurança, supondo eventos de atraso planejados, são mais do que o dobro do valor dos estados de atraso. A aplicação do modelo estocástico a um projeto real com um atraso planejado de 8 dias indica um estado de segurança mais provável de 19. Os modelos de memória de curto prazo de longo prazo superam os métodos estatísticos na previsão de séries temporais bivariadas, com uma métrica de estimação quadrática média raiz significativamente menor. A abordagem de planejamento de construção híbrida proposta mostra-se adequada para as fases de pré-construção e construção, oferecendo melhores indicadores de tomada de decisão e apoiando a gestão de segurança reativa. / [en] The construction industry, known for its dynamic and chaotic nature, often experiences work accidents. Existing planning methods addressing uncertainties, however, frequently overlook safety variables, and the relevant literature is scarce. This study introduces a novel construction planning method focused on investigating the impact of safety incidents on project duration, specifically in energy infrastructure construction projects. The main hypothesis is that safety events during construction significantly affect project duration, leading to deficient schedules when not considered in the planning process. Utilizing stochastic process theory, particularly the quasi birth and death process, the study explores how safety states influence delay states. Neural network models complement the stochastic model for forecasting bivariate time series derived from safety and delay stochastic states. Real-life project data demonstrates that safety events, assuming planned delay events, are over double the delay states value. Applying the stochastic model to a real project with a planned 8-day delay indicates a most probable safety state of 19. Long short-term memory models outperform statistical methods in bivariate time series forecasting, with a significantly smaller root mean square estimation metric. The proposed hybrid construction planning approach proves suitable for both pre-construction and construction phases, offering improved decision-making indicators and supporting reactive safety management.