The Relationship Between Just Culture, Trust, and Patient Safety
Linda Ann Paradiso DNP, RN, NPP, NEA-BC; Nancy Sweeney PhD, APRN, BC
- Sigma Affiliation
- Epsilon Chi
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Top Visiting Cities
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Paradiso, Linda Ann by View
Popular Works for Paradiso, Linda Ann by Download
OBJECTIVES: This study explored the difference in the perception of trust between nurse leaders and direct care nurses in a Just Culture, and the impact this may have on patient safety related to voluntary reporting of patient care issues.
BACKGROUND: Medical errors are the third leading cause of death in the United States, and nurses can have a significant impact in reducing those deaths. Hospitals are imperfect systems where nurses have competing demands, where they are forced to improvise and develop work arounds. This autonomy creates illusions that systems are effective. Direct care nurses possess the unique ability to identify errors due to their proximity to the patient. The primary barrier to reporting errors is the negative organizational response and the risk of discipline. Just Culture is an environment where organizations are accountable for the systems they design, and foster an analysis of the incident, not the individual. If nurses perceive their treatment is not just, they may drive valuable safety-related information underground. Organizations must strive to understand the nature and scope of errors, actively redesign faulty systems, and value voluntary error reporting.
METHODS: An anonymous survey was conducted in a large, urban teaching hospital to determine the relationship of trust and Just Culture. All direct care nurses and nurse leaders (1580 participants) were recruited.
RESULTS: This study revealed that there was a statistically significant difference between the direct care nurses’ and nurse leaders’ perceptions of trust and Just Culture within the organization. The majority of direct care nurses did not perceive that they will be given a fair and objective follow up process, or that the hospital will investigate the event fairly. When involved in an incident, direct care nurses perceived that they would be blamed, and feared disciplinary action.
CONCLUSIONS: The findings offer practical implications to developing a trusting and Just Culture. An understanding of strengths and weaknesses can assist nurse leaders to ensure a fair and balanced approach to incident investigation. A Just Culture is not a blame-free culture, but a balanced accountability. Leaders need to look beyond the error, to the systems in which direct care nurses work, and the behavioral choices they make within these systems. When attitudes and behaviors are aligned, then the approach to performance improvement becomes the standard work of all staff.
|Type||DNP Capstone Project|
|Review Type||Peer-review: Single Blind|
|Research Approach||Quantitative Research|
Patient Safety Culture;
|CINAHL Subject(s)||Organizational Culture;
Health Care Errors;
Quality of Health Care
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Showing items related by title, author, creator and subject.
Paradiso, Linda Ann (2017-10-23)Nurses are error identifiers. Barriers to reporting are negative response and risk of discipline. Organizations with a Just Culture are accountable for systems they design and analysis of incidents not individuals. Direct ...
Rainer, Jennifer BoiceObjective: The purpose of this study was to understand speaking up behavior among RNs. Background: Speaking up is the use of one’s voice to share information or alert those in authority of one's concerns about patients, ...
Hall, Nicole J.; Graf, Cheryl (2017-06-14)Purpose: The purpose of this research study is to further develop the understanding of factors that influence patient safety as they relate to nurses speaking up when faced with concerns through examination of archival ...
Relationship Between Nursing Leadership and Quality of Care in ICUs: Mediating Through Patient Safety Culture Liu, Jia-li; You, Li-ming; Zheng, Jing; Liu, Ke; Liu, XuThis was a cross-sectional study, collecting 459 nurse surveys from 22 ICUs in China. Results suggest that nurse managers supportive leadership is beneficial for building patient safety culture that foster high-quality ...
Are Institutions Educating Baccalaureate Students to Feel Comfortable Speaking Up for Patient Safety? Walsh, Catherine; Hall, Nicole J.Speaking up is recognized as a duty that nurses have and as a means to improve patient safety yet there are barriers to it being utilized. There is an opportunity to educate nursing students so they are more comfortable ...