Overview and Summary: Creating a Culture of Safety: The Next Steps

Abstract

Citation: Sitterding, M., (September 30, 2011) and Summary: Creating a Culture of Safety: The Next Steps OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 3, Overview and Summary. DOI: 10.3912/OJIN.Voll6No03ManOS Patient care errors continue to threaten patient safety and erode trust among the public we are privileged to serve. Recent studies have suggested the number and the percentage of adverse events has actually been grossly underestimated. Classen and colleagues (Claussen et al., 2011: Resar, Simmonds, & Haraden, 20061 found that estimates of adverse events among critical care patients indicate 11.3 adverse events/100 Intensive Care Unit days and 2.04 adverse events/patient; these estimates may be as much as ten times greater than previously measured and reported. Sharek and colleagues (2006) discovered an incidence of 74 adverse events/100 admissions in a neonatal critical care unit, and suggested that 56% of all adverse events are preventable. These recent statistics are a call to action for nurses to better understand the culture of patient safety and to identify with greater clarity the unique contribution nurses can make in decreasing adverse events, regardless of whether we work in practice, academe, or policy arenas. Radical change is essential. We need change that dives deeper, away from the tip of the iceberg and toward the core. The articles in this OJIN topic address ways in which nursing can dive deeper into the core of the iceberg/ As a collection these articles describe how the Magnet® nursing excellence framework enables a culture of patient safety; present a new model that describes nursing practice within a culture of safety; explain how nurses can practice within a culture of safety; provide insight about essential roles needed to support a culture of safety; and offer considerations for preparing the next generation of nurses to serve within a culture of safety. The relationship between nursing excellence and a culture of patient safety is illustrated by Swanson and Tidwell as they detail their Magnet Journey. These authors describe each Magnet Component (ANCC, 2008) and provide explicit examples of structures, processes, and outcomes in alignment with a culture of patient safety. Approaches that enhance effective communication through intentional nurse-physician collaborates are described and cited as factors contributing to both Magnet status and a culture of patient safety. The authors clearly illustrate how the Magnet Recognition Program provides an exemplary framework for nursing excellence, one that is in direct alignment with a culture of patient and workplace safety. Morath introduces readers to the Dynamic Systems Model (DSM), a model that describes the interaction between individual benefit and system benefit and illustrates the impact of this interaction on the culture of patient safety. One underlying assumption of the DSM is that as individual benefit increases, the system benefit decreases. Morath explains how the individual nurse and the system work within an envelope of boundaries that include operations/workload, financial, and safety factors. The model is used to describe the potential for migration into unsafe practices, for example through work-arounds that decrease task time yet increase the potential for error, and to suggest reasons for failure to recognize subtle warning signs. Sammer and James present the nursing unit leader role through a fictional lens describing what happened in a hospital lacking a culture of patient safety and what an optimal culture of safety environment could look like in an exemplary culture of patient safety. The authors masterfully narrate the story of a fictional patient within a fictional facility with a fictional team to illustrate the link between elements of the story and the subcultures of patient safety, as descried by Sammer, Lykens, Singh, Mains, and Lackan (2010). Paramount to the practice setting is academic preparation for the next generation of nurses to recognize and to practice within a culture of safety. …