Moving with care: challenges and opportunities for supporting patient safety in ward nurses

Abstract

Healthcare has been increasingly effortful in guaranteeing the safety of patients during hospital stay over the last three decades. However, improvements in patient safety are coming to a halt, while the Dutch healthcare system internally struggles with the current practice of accountability. Against this background, the theories of Safety-II and Resilience Engineering have gained significant interest.

A fundamental notion of Safety-II and Resilience Engineering is that work in practice (work-as-done) can significantly differ from how it is initially imagined (work-as-imagined). How this relationship unfolds for patient safety in hospitals is however unclear. By means of ethnography and action research, this dissertation examined the relationship between quality and safety instruments in hospitals and hospital wards, in contrast to the activities and perspectives of nurses creating patient safety on a single ward and clinical leadership, managers and quality advisors in the hierarchical structures of the hospital.

The relationship between quality and safety instruments and the creation of safe care in practice was found to be situated and disproportionate, and therefore ambiguous to the creation of patient safety. Future research is encouraged to approach both viewpoints to work in harmony using participative methods, rather than viewing both as distinct issues to be solved.