A Qualitative Exploration of Maternal Patient and Family Perspectives of Patient Safety

Abstract

Maternal deaths in the United States are 26.6% higher than other developed countries. Sixty percent of these deaths are preventable by adopting a culture that promotes patient safety. In a recently developed Safer Culture framework, patients and families are integral members of the organizational safety culture. It is imperative to understand how patients and families perceive safety issues and how they want to engage to promote safety. The purpose of this study was to determine how patients and their families conceptualize patient safety and their role in promoting safe care. Using an ethnographic qualitative approach, we conducted semistructured interviews with a purposive sample of 23 ethnically diverse obstetric patients and their partners from a large academic Level 4 facility. We reviewed transcribed interviews and coded for meaning in a group of four researchers. After redundancy was reached, we conducted a thematic content through group consensus of the relevant themes expressed from exemplars in the data set. Participants perceived patient safety as a partnership with clinicians. A perception of safe caring was based on having their collective physical, emotional, and relational needs and those of their family members met. Central to perceived safe care was trust in their health care providers. Four influences to perceived safe care emerged from the data: (1) patient and family expectations of their outcomes, (2) methods of personalized communication and information exchange, (3) actions of relationship building with the health care team, and (4) positive clinician behaviors in providing care. Patient and family perceptions of safe caring were affected by their previous experiences, especially pregnancy losses and/or perceived harms, ability to prepare for the unexpected, their sense of control in decision making, and speaking up with their concerns. Inherent in promoting a safety culture is promoting a partnership of trust between clinicians and patients based on knowing what patients expect and need, listening and responding to their concerns about past experiences, and collaborating with them and their families. Nurses add to the patient’s perception of safe care by understanding patient expectations, promoting patients’ voice in communication, building a positive relationship, and providing emotional care.