Lee Eunhee, De Gagne Jennie C, Randall Paige S, Tuttle Brandi, Kwon Hyunjeong
College of Nursing, Sungshin Women's University, Seoul, Korea.
School of Nursing, Duke University, Durham, North Carolina, USA.
J Adv Nurs. 2024 Nov 4. doi: 10.1111/jan.16592.
To systematically review and synthesise qualitative research on nurses' experiences of speaking up in various contexts and to identify factors facilitating or impeding such a behaviour.
This review was conducted as a qualitative metasynthesis, utilising the qualitative meta-ethnography approach.
A total of 6250 articles were screened. Two reviewers screened titles, abstracts and full texts. A total of 15 studies were included in this review. Researchers conducted a quality appraisal using the JBI critical appraisal checklist for qualitative research. An a priori protocol was created and registered on the Open Science Framework.
Literature searches were conducted in five international bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global) and five Korean databases (RISS, KISS, DBpia, KCI and NDSL).
Three main themes were identified from the 15 studies used in the metasynthesis: (1) decisional complexity of speaking up, (2) motivators for speaking up and (3) barriers to speaking up. Nurses experienced challenges in speaking up. They were, and continue to be, concerned about negative responses. Hierarchy structure and poor work environment were identified as barriers to speaking up; professional responsibility and a supportive atmosphere were identified as facilitators for speaking up.
This review synthesised nurses' experiences of speaking up and influencing factors. Speaking up is crucial for nurses to improve patient safety, as frontline nurses are ideally positioned to observe early indicators of unsafe conditions in healthcare delivery.
Identified motivators and barriers of nurses' speaking-up behaviour offer considerations and opportunities for healthcare leaders and managers. This could lead to improvement in patient safety through the establishment of a safety culture that facilitates nurses' speaking-up behaviour.
The review adhered to the ENTREQ guideline.
No patient or public contribution has been made in this review.
系统回顾和综合关于护士在各种情境下发声经历的定性研究，并确定促进或阻碍这种行为的因素。
本综述采用定性元综合法，运用定性元民族志方法进行。
共筛选6250篇文章。两名评审员筛选标题、摘要和全文。本综述共纳入15项研究。研究人员使用JBI定性研究批判性评价清单进行质量评估。制定了先验方案并在开放科学框架上注册。
在五个国际书目数据库（MEDLINE、Embase、PsycINFO、CINAHL和ProQuest学位论文与全球博硕士论文数据库）和五个韩国数据库（韩国研究信息服务系统、韩国学术期刊数据库、韩国学术数据库、韩国核心期刊数据库和韩国国家数字化科学图书馆）中进行文献检索。
从元综合所使用的15项研究中确定了三个主要主题：（1）发声的决策复杂性，（2）发声的动机，（3）发声的障碍。护士在发声方面面临挑战。他们过去和现在都担心负面反应。等级结构和恶劣的工作环境被确定为发声的障碍；职业责任感和支持性氛围被确定为发声的促进因素。
本综述综合了护士的发声经历和影响因素。发声对于护士提高患者安全至关重要，因为一线护士处于观察医疗服务中不安全状况早期指标的理想位置。
确定的护士发声行为的动机和障碍为医疗保健领导者和管理者提供了思考和机会。这可能通过建立促进护士发声行为的安全文化来提高患者安全。
本综述遵循ENTREQ指南。
本综述未涉及患者或公众参与。
