Hospital nurses and physicians' experiences practicing patient safety work to recognize deteriorating patients: a qualitative study.

Abstract

Background: Measures to increase patient safety work aim to prevent patient harm and injuries in hospitals and are a priority worldwide. Several hospitals have implemented various rapid response systems to strengthen patient safety. Knowledge is limited concerning how health professionals interact and how they experience competence development and master emergency situations. The aim of the study was to explore and describe hospital nurses' and physicians' experiences with patient safety work, and the implications of this work for collaboration and competence in a hospital.

Methods: We used a qualitative descriptive design and interviewed 21 nurses and physicians from a hospital in Norway. Data were analysed with systematic text condensation, a four-step thematic cross-case analysis. The study adheres to the COREQ guidelines for conducting qualitative research.

Results: Through analysis, three categories were identified: strengthening a common clinical language for patient deterioration; sharing and transferring competencies across hospital wards and amongst professionals; and balancing time pressure and limited resources. The results showed that the patient safety work contributed to building bridges between health professionals and across hospital levels regarding deteriorating patients. It also provided structure and systematization to the hospital professionals' work with deteriorating patients. However, the results also demonstrated the complexity of maintaining patient safety, pointing to the need to balance limited time and resources in hospital.

Conclusions: The patient safety work presumably provides better emergency care, which may enhance patient safety in hospital. The complexity of hospital work, however, can influence the patient safety performance negatively, requiring health professionals to adopt robust, up-to-date skills and competencies in observing and assessing patient deterioration. In a busy hospital setting, the ability of health professionals to collaborate and communicate is important as they are faced with the challenges of balancing time-pressure and limited resources, which can potentially compromise patient safety work.