The purpose of this grounded theory study is to examine how organizational context (communicated structures of rules and resources) constrain and enable individual hospital staff nurses'ability to keep patients safe. Patient safety is a significant problem with extensive human and healthcare costs. To date, the interaction between organizational structures and the actions of individual nurses to keep patients safe has been neglected in safety culture research. Thus, consistent with AHRQ's mission to improve the quality, safety, efficiency, and effectiveness of healthcare, the specific aim of this study is to describe the process by which hospital staff nurses (agents) keep patients safe, while constrained/enabled by sets of safety rules and resources (safety culture structures) in the organization. This study is framed using Structuration Theory;a cross-sectional, qualitative design will be used. Consistent with grounded theory methodology, data collection, analysis, and sampling will be simultaneous and reciprocal, allowing for grounding in the data through constant comparative analysis and theoretical sampling. Semi-structured interviews will be conducted with an initial sample of ten hospital staff nurses at a Midwest academic medical center. These interviews will be used to elicit narratives about patient safety experiences. Simultaneous with data collection efforts, incoming data will be analyzed using grounded theory methods. Sampling beyond the initial participants will be theoretical and based on emerging data categories and identification of gaps in the emergent theory. When theoretical saturation is reached, the categories will be integrated into a substantive grounded theory of the process used by nurses to keep patients safe within the safety culture of an organization. Long-term benefits from this study include advancement of knowledge about how safety culture influences nursing practice, which in turn will allow tailored modifications of safety cultures to promote increased safety for patients.
Results of the proposed research will advance knowledge about safety and safety culture in hospitals. Specifically, this study will provide information about how nurses keep patients safe in hospitals, as well as how hospitals might improve or strengthen their safety culture to better enable nurses to keep patients safe.
