Sustainability is a complex system of interaction between a hospital, individual,
community, and environmental factors that is required to work in harmony to keep a
patient healthy. With the complexities that exist within healthcare, the nurse leader is
required to ensure that the care environment, processes and the safety behaviours
required from nurses to provide safe healthcare is in place and sustained to contribute
to the enhancement of patient safety, whilst in the care of the diverse nursing
workforce. The aim of the study is to develop an action plan to sustain best safety
culture practices for improved patient outcomes in hospitals with a culturally diverse
nursing workforce.
Methodology: A multiple method design was utilised to study the safety culture and
positive work environment (hospital climate) that exists among culturally diverse
nurses and how it is managed by the nurse managers in order to identify and describe actions that can be included in an action plan to sustain best safety culture practices
for improved patient outcomes. Purposeful and convenience sampling methods were
used in the study. Two hospitals, with a very diverse nursing workforce were
purposefully selected to participate in the study. Pretesting of the questionnaire and
e-Delphi embedded assessment validation instrument were done by participants not
part of sample groups. Phase 1: The Hospitals outcomes data for nursing admission
assessment within 24-hours, falls and hospital acquired pressure ulcer incidences and
hand hygiene rates were collected on a checklist. Phase 2: Two questionnaires (1) nurses capturing: biographical data and culture, patient safety (nursing admission
assessment within 24-hours, falls and HAPU and hand hygiene), and safety culture
and positive work environment (hospital climate); (2) nurse managers capturing:
biographical data and culture, patient safety (nursing admission assessment within 24-
hours, falls and HAPU and hand hygiene), safety culture and Positive Work
Environment (hospital climate) and just culture practices. Phase 3: the Draft e-Delphi
action plan with embedded assessment validation instrument was developed. Phase
4: The panel experts selected to validate the e-Delphi draft action plan with embedded
assessment validation instrument in pre-determined rounds.
Data analysis: Phase 1: The outcomes data was displayed in bar graphs and
illustrated that (1) the nursing admission assessment within 24 hour period not been
sustained over time for the medical, surgical, paediatric and critical care areas; (2) a
hundred and sixty two fall incidence; (3) ninety six HAPU incidences and (4) hand
hygiene rate of between 80-94% being reported. Phase 2: A participation rate of
46.33% by nurses and 73.91% by nurse managers were achieved. The data for the 2
questionnaires indicated the need to include 54 action statement to address the
culture, patient safety, hospital climate (PWE), safety culture and just culture gaps
identified. Phase 3: the e-Delphi draft action plan developed based on literature review
and data from phase 1 and phase 2. Phase 4: 100% participation rate was achieved.
Consensus was reached within two rounds that the 54 action statements are essential
and important for patient safety and identified the responsible persons required
enacting on action statement and timeframe required to complete action.
Recommendation: The Action Plan to enhance a sustainable Culture of Safety to
improve patient outcomes were decided by panel experts. Plan to disseminate the
plan among the CNO for implementation. / Health Studies / D. Litt. et Phil. (Health Studies)
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:unisa/oai:uir.unisa.ac.za:10500/26185 |
| Date | 12 1900 |
| Creators | Haskins, Helena Elizabeth Maria |
| Contributors | Roets, L. |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 1 online resource : color illustrations, color graphs, application/pdf |
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