Improving collaboration and patient safety by encouraging nurses to speak-up: Overcoming personal and organizational obstacles through self-reflection and collaboration.

摘要

According to the statistics contained in the Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 2000), hospitals are dangerous places. According to the report, more than 98,000 people die in United States hospitals due to preventable medical error. A lack of effective communication has been identified as the major cause of inadvertent patient harm (Leonard, Graham, & Bonacum, 2004).Collaboration has been studied in healthcare research as an opportunity for improving ineffective communication styles between nurses and physicians (Vazirani, Hays, Shapiro, & Cowan, 2005 Weiss & Davis, 1985 Wells, Johnson, and Salyer, 1998 Baggs and Schmidt, 1988). Collaboration is an important component in transforming the current healthcare delivery system and making hospitals safer (Page, 2004) the American Association of Critical-Care Nurses (AACN) has recommended that nurses be relentless in pursuing and fostering true collaboration as part of the solution for reducing preventable medical error (American Association of Critical-Care Nurses, 2005).It is the premise of this research project that collaboration cannot occur until nurses, the largest number of primary stakeholders in healthcare delivery, adopt speaking-up, defined as using voice to make known to someone---with positional power or authority---specific information or knowledge that is privately held (Detert & Edmondson, 2006), as an essential function of providing quality nursing care.A quasi-experimental research design was used to evaluate the impact of an intervention designed to increase speaking-up behaviors and collaboration among nurses. Registered nurses were recruited from two similar acute care hospitals that belong to the same parent organization. One hospital self-selected as the control site and the other as the intervention site. The sample consisted of: (a) control group: 87 registered nurses of whom 51 participated in the posttest data collection, and (b) intervention group: 58 registered nurses of whom 53 participated in the posttest.At baseline, all participants completed the following surveys: (a) a demographic questionnaire, (b) the Collaborative Practice Scale (Weiss and Davis, 1985), (c) the Speak-up Measure (Premeaux and Bedeian, 2003), and (d) the List of Individual Nurse Behaviors Used to Impact Patient Safety. Nurses in the control group received no intervention. Nurses in the intervention group participated in an educational training module based on Donabedian and Lewian Theory, and Frierian philosophy. A month after baseline data collection, both the control group and the intervention group went online to complete the same surveys that were used at the baseline data collection process.After controlling for baseline differences between the intervention and control groups, the results of the intervention group revealed a significant increase in the scores of the Speak-Up Measure (p=.001), the Collaborative Practice Scale (p=.005), and the List of Individual Nurse Behaviors Used to Impact/Promote Patient Safety (p=.0015).This quasi-experimental study demonstrated that an educational intervention focused on increasing speak-up behaviors in nurses can increase nurses' perception of his/her ability to speak-up, collaborate, and impact patient safety. One month post-baseline, nurses who completed the educational intervention saw an increased array of behavior options available to them in situations when they felt that patient safety was in jeopardy.