Building patient safety in intensive care nursing Patient safety culture, team performance and simulation-based training

2 " It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm ". Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: A descriptive and explorative design with quantitative and qualitative methods was used. In Study I, 220 registered nurses (RNs) from ten intensive care units (ICUs) responded to the questionnaire: Hospital Survey on Patient Safety Culture. Studies II-IV were based on a team training programme with the use of laboratory high-fidelity human simulation. In Studies II-III, a convenience sample of 53 RNs from seven ICUs and ten RNs from an intensive care nurse postgraduate programme (II) were included. Quantitative data were analysed through the use of statistics (I-III). In Study IV, 18 RNs who had participated in the simulation-based team training programme were interviewed, and the data were analysed with a qualitative content analysis. Main findings: The RNs had positive perceptions of the outcome of the ICUs' overall patient safety culture; though, incident reporting was found as an area with potential for improvement. Dimensions found with potential for improvement at the unit level were feedback and communication about errors and organizational learning-continuous improvement, and at the hospital level, hospital management support for patient safety and teamwork across hospital units. Differences in RNs' perceptions were found between different types of ICUs and between hospitals. The dimensions at the unit level were identified as predictors for the two outcome dimensions (I). The RNs were highly satisfied with simulation-based learning and mostly agreed with the statements about self-confidence in learning. The RNs were generally positive in their evaluation of the implementation of the educational practice and the simulation design/development. Differences in RNs perceptions were found with regard to scenario roles, prior simulation experience and area of intensive care practice (II). The expert raters assessed the teams' performance in a cardiac arrest situation as advanced novice or competent. Differences were also found between the expert raters' assessments and the RNs' self-assessments (III). One main category emerged to illuminate the RNs' perceptions of simulation-based team training for building patient safety in the ICU: " Regular training increases awareness of clinical practice and acknowledges the importance of structured work in teams ". Three generic categories were found: " realistic …