Safety culture and nurse-sensitive outcomes / Danielle M. Olds.

Format:

Book

Manuscript

Thesis/Dissertation

Author/Creator:

Olds, Danielle M.

Contributor:

Lake, Eileen T., advisor.

University of Pennsylvania.

Language:

English

Subjects (All):

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Academic Dissertations as Topic.

Medical Subjects:

Academic Dissertations as Topic.

Local Subjects:

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Physical Description:

x, 157 pages : illustrations ; 29 cm

Production:

2010.

Summary:

Adverse events and errors in healthcare have become a major cause of morbidity and mortality. Although some industries have a long history of developing a safety culture to prevent errors, this is a relatively new strategy in healthcare. The purpose of this study was to determine predictors of hospital safety culture and the relationships between safety culture and safety grade with outcomes using the practice environment as a benchmark. A linked dataset of 21,730 nurse survey responders from 688 hospitals was used. The patient sample was 1,010,298 for 30-day in-hospital mortality and length of stay and 3,473,127 for decubitus ulcers and post-operative pulmonary embolism/deep vein thrombosis (PE/DVT). A reliable safety culture scale was created for comparisons with a single-item safety grade measure and practice environment score as measured by the Practice Environment Scale of the Nursing Work Index. The practice environment was a stronger predictor of safety culture compared to hospital structural characteristics and nursing resources. In multivariate analyses, a higher hospital practice environment score and a higher safety grade were both associated with reduced risk of 30-day in-hospital mortality, reduced length of stay, increased likelihood of "Excellent" quality rating, and decreased likelihood of emotional exhaustion. Percent positive safety culture score had similar associations with these outcomes, except it was not predictive of length of stay. Decubitus ulcers and post-operative PE/DVT were not significantly associated with practice environment, safety culture, or safety grade. Overall, the percent positive safety culture score and safety grade performed similarly to the practice environment score in predicting outcomes. The results of this study indicate that a stronger safety culture is related to better patient and nurse outcomes. Further, a single-item safety grade question maybe a useful and valid way to quickly assess hospital safety. As hospitals seek to improve their safety culture, resources should not be diverted from improving the nurse practice environment. While there is ample evidence that a better nurse practice environment is related to improved outcomes, the research related to safety culture is just beginning to be developed.

Notes:

Adviser: Eileen T. Lake.

Thesis (Ph.D. in Nursing) -- University of Pennsylvania, 2010.

Includes bibliographical references.