Study On The Application Of Nursing Safety Barriers And Its Effect On Patient Safety

Objectives:1 Developing the patient safety culture assessment questionnaire of the clinical nursing staff.2 Using the questionnaire to assess the status quo of the patient safety culture in the research unit.3 Constructing a comprehensive and effective nursing safety barrier system for the unsafe factors in the nursing fields. 4 Evaluating the effect of the implemented nursing safety barrier system.Methods:PartⅠ: Developing the patient safety culture assessment questionnaire:1 The draft of the questionnaire was formed by reviewing the literature and implementing the semi-structured interview, and then revised it through Delphi Method and pilot test with small sample.2 The preliminary test was conducted in 388 clinical nursing staff, who were selected with the stratified random sampling method. The questionnaire was revised for the second time by item discrimination, analysis of correlation, analysis of internal consistency and factor analysis.3 The questionnaire was tested with a sample of 757 clinical nursing staff from 42 clinical departments in order to examine its psychometric characteristics, and then the formal questionnaire came into being.PartⅡ: Constructing the nursing safety barriers, and evaluating its effects.The adverse events of the research unit in recent years and the relevant literatures were reviewed in order to construct some targeted nursing safety barriers. After that, we evaluated its implemented effect through comparing with the incidence of the adverse events before and after its constructing, the survey of patient safety culture was also carried out to make clear the meaning and future development of the current nursing safety management.Results:1 The preliminary version of the questionnaire includes 36 items belonging to 8 dimensions. The Cronbach's a coefficient was 0.875 for the whole questionnaire and 0.658～0.890 for the dimensions. The test-retest reliability was 0.778, and the content validity of the whole questionnaire was 0.974.2 The nursing safety barriers include nursing safety management barriers and patient safety physical barriers. Comparing 2009 with 2010, the number of the nursing adverse event was dropped from 48 to 21, and the incidence of the adverse events was changed from 0.85‰to 0.32‰.3 The mean score of patient safety culture was 3.83±0.38, which was in high-middle level. The score of the continuous improvement, supervisor's safety leadership, teamwork climate and hospital management support got the higher points, which were all more than 4 point, However, the score of adverse event reporting and fear of blame were both under 3 point, and which were considerably lower than any other dimensions.Conclusions:1 The application of nursing safety barriers is of great importance to improve patient safety, enhance the level of nursing safety management, increase the nurses'ability to avoid and manage risk and build the hospital culture of safety.2 The questionnaire of patient safety culture is a reliable and valid instrument to assess the clinical nursing staff of the research unit.3 The overall status of patient safety culture was in the positive level, and the support of management and continuous improvement showed a distinct advantage, however, the fear of blame, adverse event reporting and staffing were in the weak areas, so the nursing managers should pay attention to these weak areas.