Ginsburg Liane, Norton Peter G, Casebeer Ann, Lewis Steven
School of Health Policy and Management, York University, Toronto, ON, Canada.
Health Serv Res. 2005 Aug;40(4):997-1020. doi: 10.1111/j.1475-6773.2005.00401.x.
To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture.
Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control).
A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop.
Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture.
A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554.
Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.
设计一项培训干预措施，然后测试其对护士领导者患者安全文化认知的影响。
加拿大两家多院区教学医院中担任临床领导职务的356名护士（护士经理以及教育工作者/临床护理专家）（研究组和对照组）。
采用带有前测和后测的准实验非处理对照组设计对患者安全培训干预措施进行前瞻性评估。研究组中担任临床领导职务的护士被邀请在6个月内参加两场患者安全研讨会。研究组和对照组的人员在培训前以及第二次研讨会结束4个月后完成了测量患者安全文化和改进型领导力的调查。
以个体护士临床领导者作为分析单位。对安全文化项目进行探索性因素分析；采用重复测量方差分析和配对t检验来评估培训干预措施对感知安全文化（三个因素）的影响。分层回归分析考察了人口统计学因素、改进型领导力以及培训干预措施对护士领导者安全文化认知的影响。
研究组在三项安全文化指标中的一项上显示出具有统计学意义的改善（p<0.001），而对照组在一项安全文化指标上出现了显著下降（p<0.05）。发现改进型领导力能够解释所有三项患者安全文化指标中相当大比例的方差；参加研讨会能够解释三项安全文化指标中一项的相当大比例的方差。三个完整分层回归模型的总R²范围在0.338至0.554之间。
为护士领导者精心开展的培训举措有助于培育安全文化。然而，组织领导对改进的支持对于培育安全文化也至关重要。培训干预措施和领导支持共同作用可能会对患者安全文化产生最显著的影响。
