Appleton Institute, CQUniversity Australia, Australia; School of Nursing, Midwifery & Social Studies, CQUniversity Australia, Australia.
School of Nursing, Midwifery & Social Studies, CQUniversity Australia, Australia.
Int J Nurs Stud. 2024 Oct;158:104846. doi: 10.1016/j.ijnurstu.2024.104846. Epub 2024 Jul 1.
Systematic adoption of early warning systems in healthcare settings is dependent on the optimal and reliable application by the user. Psychosocial issues and hospital culture influence clinicians' patient safety behaviours.
(i) To examine the sociocultural factors that influence nurses' EWS compliance behaviours, using a theory driven behavioural model and (ii) to propose a conceptual model of sociocultural factors for EWS compliance behaviour.
A cross-sectional survey.
Nurses employed in public hospitals across Queensland, Australia.
Using convenience and snowball sampling techniques eligible nurses accessed a dedicated web site and survey containing closed and open-ended questions. 291 nurses from 60 hospitals completed the survey.
Quantitative data were analysed using ANOVA or t-tests to test differences in means. A series of path models based on the theory were conducted to develop a new model. Directed or theory driven content analysis informed qualitative data analysis.
Nurses report high levels of previous compliance behaviour and strong intentions to continue complying in the future (M=4.7; SD 0.48). Individual compliance attitudes (β 0.29, p<.05), perceived value of escalation (β 0.24, p<.05) and perceived ease or difficulty complying with documentation (β -0.31, p<.05) were statistically significant, predicting 24% of variation in compliance behaviour. Positive personal charting beliefs (β 0.14, p<.05) and subjective norms both explain higher behavioural intent indirectly through personal attitudes. High ratings of peer charting beliefs indirectly explain attitudes through subjective norms (β 0.20, p<.05). Perceptions of control over one's clinical actions (β -0.24, p<.05) and early warning system training (β -0.17, p<.05) directly contributed to fewer difficulties complying with documentation requirements. Prior difficulties when escalating care (β -0.31, p<.05) directly influenced the perceived value of escalating.
The developed theory-based conceptual model identified sociocultural variables that inform compliance behaviour (documenting and escalation protocols). The model highlights areas of clinical judgement, education, interprofessional trust, workplace norms and cultural factors that directly or indirectly influence nurses' intention to comply with EWS protocols. Extending our understanding of the sociocultural and system wide factors that hamper nurses' use of EWSs and professional accountability has the potential to improve the compliance behaviour of staff and subsequently enhance the safety climate attitudes of hospitals.
A newly developed model reports nurse's personal attitudes, peer influence, perceived difficulties encountered documenting and escalation beliefs all predict early warning system compliance behaviour.
在医疗环境中系统采用早期预警系统取决于用户的最佳和可靠应用。社会心理问题和医院文化会影响临床医生的患者安全行为。
（i）使用理论驱动的行为模型，检查影响护士 EWS 依从性行为的社会文化因素，以及（ii）提出 EWS 依从性行为的社会文化因素概念模型。
横断面调查。
澳大利亚昆士兰州公立医院的护士。
使用便利抽样和雪球抽样技术，符合条件的护士访问了一个专门的网站和包含封闭和开放式问题的调查。来自 60 家医院的 291 名护士完成了调查。
使用方差分析或 t 检验分析定量数据，以检验均值的差异。根据理论进行了一系列路径模型，以开发一个新模型。定向或理论驱动的内容分析为定性数据分析提供了信息。
护士报告过去的依从行为水平较高，并且未来有强烈的继续依从的意愿（M=4.7；SD 0.48）。个人依从态度（β 0.29，p<.05）、感知升级价值（β 0.24，p<.05）和感知依从性（β -0.31，p<.05）与文档记录的难易程度相关，可预测 24%的依从行为变化。积极的个人图表记录信念（β 0.14，p<.05）和主观规范都通过个人态度间接解释更高的行为意向。高同伴图表记录信念评分通过主观规范间接解释态度（β 0.20，p<.05）。对个人临床行为控制的感知（β -0.24，p<.05）和早期预警系统培训（β -0.17，p<.05）直接有助于减少文档记录要求的依从性困难。以前在升级护理时遇到的困难（β -0.31，p<.05）直接影响到升级的感知价值。
基于理论的概念模型确定了影响依从行为（记录和升级协议）的社会文化变量。该模型突出了临床判断、教育、专业间信任、工作场所规范和文化因素等领域，这些因素直接或间接地影响护士遵守 EWS 协议的意愿。更深入地了解阻碍护士使用 EWS 系统和专业责任的社会文化和系统范围的因素，有可能提高员工的依从性行为，并进而增强医院的安全氛围态度。
一个新开发的模型报告了护士的个人态度、同伴影响、记录和升级信念所遇到的感知困难，这些都预测了早期预警系统的依从行为。
