Garay Sandra, Haeger Mathias, Kühnlein Laura, Sulmann Daniela, Suhr Ralf
Zentrum für Qualität in der Pflege (ZQP), Center for Quality in Care, Reinhardtstraße 45, 10117 Berlin, Germany.
Int J Nurs Stud Adv. 2023 Feb 9;5:100119. doi: 10.1016/j.ijnsa.2023.100119. eCollection 2023 Dec.
Recognizing safety risks and promoting safe care is essential for care dependent people and should be an integral part of the overall preventive endeavors while providing care. The term 'safety culture' describes efforts regarding the acknowledgement and reduction of safety risks. Enhanced safety culture in health care organizations can be associated with a lower incidence of missed nursing care and adverse events.
Identify strategies to enhance safety culture in long-term care settings and describe factors facilitating or inhibiting the process from the available evidence.
This systematic review is a narrative description of intervention studies.
CINAHL and MEDLINE were searched in May 2020 using terms such as safety culture, safety climate, intervention development. Gray literature was searched between May and September 2020. An additional search in Cochrane Library was conducted in September 2022. Only intervention studies feasible to enhance the safety culture were included. Intervention study criteria were met when an organized, planned action to prevent or change a specific behavior took place and when this action was transparently and systematically evaluated. The screening, data extraction, and rating processes were conducted by two researchers independently. The ROBINS-I tool was utilized to assess the risk of bias of the studies.
Seven intervention studies were included, all evaluated with a critical risk of bias. Strategies found to enhance the safety culture in care settings include collegial exchange of experiences and learnings, integration of staff's perceptions, external facilitation, staff training, and a structured, multi-step procedure of the intervention process. Some studies were unable to show statistically significant enhancement in safety culture from the interventions implemented. Factors facilitating the implementation of interventions include good connections and trust between staff and managers, and the manager's active support of the project goals, as well as targeting achievable ideas considering time and resources. Time pressure, heavy workloads and high staff turnover may inhibit the process.
All included studies had a high risk of bias, and possible effects must be considered accordingly. Overall, there was considerable heterogeneity in interventions aiming to enhance safety culture. Despite these aspects, promising approaches are training staff's knowledge and competencies regarding open communication and teamwork as part of a multifaceted program. Future research would benefit from participative, carefully developed, comprehensively evaluated interventions for enhancing safety culture, specifically within in-home care settings.
The review was not pre-registered but described on the website of the Center for Quality in Care.
Participatory change management & staff training help ensure momentum & trust in endeavours to enhance safety culture in long-term care.
识别安全风险并促进安全护理对于依赖护理的人群至关重要，并且应该成为提供护理时整体预防工作的一个组成部分。“安全文化”一词描述了关于认识和降低安全风险的努力。医疗保健机构中强化的安全文化可能与护理缺失和不良事件的发生率降低相关。
确定在长期护理环境中强化安全文化的策略，并根据现有证据描述促进或阻碍该过程的因素。
本系统评价是对干预研究的叙述性描述。
2020年5月在CINAHL和MEDLINE数据库中进行检索，使用了安全文化、安全氛围、干预开发等术语。2020年5月至9月检索了灰色文献。2022年9月在Cochrane图书馆进行了额外检索。仅纳入了可行的旨在强化安全文化的干预研究。当发生有组织、有计划的预防或改变特定行为的行动，并且该行动经过透明且系统的评估时，即符合干预研究标准。筛选、数据提取和评分过程由两名研究人员独立进行。使用ROBINS-I工具评估研究的偏倚风险。
纳入了七项干预研究，所有研究的评估均存在高偏倚风险。在护理环境中发现的强化安全文化的策略包括同事间的经验和知识交流、整合员工的看法、外部促进、员工培训以及干预过程的结构化多步骤程序。一些研究未能显示所实施的干预措施在安全文化方面有统计学上的显著增强。促进干预措施实施的因素包括员工与管理人员之间良好的联系和信任、管理人员对项目目标的积极支持，以及考虑时间和资源制定可实现的想法。时间压力、繁重的工作量和高员工流动率可能会阻碍这一过程。
所有纳入的研究都有很高的偏倚风险，必须相应地考虑可能的影响。总体而言，旨在强化安全文化的干预措施存在相当大的异质性。尽管如此，有前景的方法是作为多方面计划的一部分，培训员工关于开放沟通和团队合作的知识和能力。未来的研究将受益于参与性强、精心制定、全面评估的强化安全文化的干预措施，特别是在家庭护理环境中。
该评价未预先注册，但在护理质量中心的网站上进行了描述。
参与式变革管理和员工培训有助于确保在长期护理中强化安全文化的努力具有动力和信任。
