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Intensive care unit nurses’ perceptions of safety after a highly specific safety intervention

¹ Department of Family Medicine, University of Cincinnati, Cincinnati, OH, USA
² Inpatient Evaluation Center, Veterans Affairs Medical Center, Cincinnati, OH, USA
³ Department of Psychology, Xavier University, Cincinnati, OH, USA
⁴ Veterans Affairs Medical Center, Institute for the Study of Health, University of Cincinnati, Cincinnati, OH, USA
⁵ Inpatient Evaluation Center, Veterans Affairs Medical Center, Department of Medicine, Pulmonary Critical Care Division, University of Cincinnati, Cincinnati, OH, USA

Correspondence to:
N C Elder, Department of Family Medicine, University of Cincinnati, PO Box 670589, Cincinnati, OH 45267, USA; eldernc{at}fammed.uc.edu

ABSTRACT
Background: It is unknown if successful changes in specific safety practices in the intensive care unit (ICU) generalise to broader concepts of patient safety by staff nurses.

Objective: To explore perceptions of patient safety among nursing staff in ICUs following participation in a safety project that decreased hospital acquired infections.

Method: After implementation of practices that reduced catheter-related bloodstream infections in ICUs at four community hospitals, ICU nurses participated in focus groups to discuss patient safety. Audiotapes from the focus groups were transcribed, and two independent reviewers categorised the data which were triangulated with responses from selected questions of safety climate surveys and with the safety checklists used by management leadership on walk rounds.

Results: Thirty-three nurses attended eight focus groups; 92 nurses and managers completed safety climate surveys, and three separate leadership checklists were reviewed. In focus groups, nurses predominantly related patient safety to dangers in the physical environment (eg, bed rails, alarms, restraints, equipment, etc.) and to medication administration. These areas also represented 47% of checklist items from leadership walk rounds. Nurses most frequently mentioned self-initiated "double checking" as their main safety task. Focus-group participants and survey responses both noted inconsistency between management’s verbal and written commitment compared with their day-to-day support of patient safety issues.

Conclusions: ICU nurses who participated in a project to decrease hospital acquired infections did not generalise their experience to other aspects of patient safety or relate it to management’s interest in patient safety. These findings are consistent with many adult learning theories, where self-initiated tasks, combined with immediate, but temporary problem-solving, are stronger learning forces than management-led activities with delayed feedback.