Page 419 - Encyclopedia of Nursing Research

386 n PATIeNT SAFeTY

standardize and simplify work systems and In a seminal study on leadership, trans-
improve communication to eliminate errors actional leaders were differentiated from the
P and near misses. more potent transformational leaders (Burns,
There has been much research, and 1978). Transactional leadership typifies most
experts at the National Quality Forum (2004) leader–follower relationships; it involves
reviewed the evidence and identified 30 a “you scratch my back, I’ll scratch yours”

evidence-based safe practices that all hos- exchange. In contrast, transformational lead-
pitals should follow (such as unit dosing, ership occurs when leaders engage with their

wrong-site protocols, deep venous thrombo- followers in jointly held goals. This leader-

sis prophylaxis). Implementing them seems ship approach is recommended because it

easy, but it is not. This has led to increased transforms all workers—both managers and

interest in evidence-based practice and dis- staff—in the pursuit of the higher collective
semination and implementation science. The purpose of patient safety and quality care.
latter refers investigating how best to trans- There is increasing consensus that the orga-
late what we know into everyday practices. nizational culture impacts patient safety and
Health care leaders and managers must the quality of care (Gershon, Stone, Bakken, &
strive to create nursing work environments larson, 2004). Important aspects of safety
that promote patient safety through use of evi- cultures include communication, nonhierar-
dence-based management strategies (Sackett, chical decision making, constrained improvi-
Rosenberg, Gray, Haynes, & Richardson, 1996). sation, training, and rewards and incentives
Most clinicians are now exposed to the idea of (Committee on the Work environment for
evidence-based practice, defined as the con- Nurses and Patient Safety, 2004).
scientious, explicit, and judicious integration For more than a decade, research has
of current best evidence to inform clinical documented a strong association between
deci sion making, in their educational cur- lower staffing levels and greater occurrence
ricula. Yet, use of evidence-based practice by of adverse events. Inadequate nurse staff-
nurses in their daily clinical practice is lim- ing has been associated with medication
ited (estabrooks, 1998; Forsman, Rudman, errors (Blegen & vaughn, 1998), patient falls
Gustavsson, ehrenberg, & Wallin, 2010; (Blegen & vaughn, 1998; Krauss et al., 2005;
Kovner, Brewer, Yingrengreung, & Fairchild, Unruh, 2003), spread of infection (Fridkin,

2010) and reflects the gap between research, Pear, Williamson, Galgiani, & Jarvis, 1996;
clinical practice, and quality improvement. Kovner, Jones, Zhan, Gergen, & Basu, 2002;
Organizational barriers such as lack of time Stone, Pogorzelska, Kunches, & Hirschhorn,
and lack of autonomy are viewed as the main 2008), increased mortality (Aiken, Clarke,

barriers to evidence-based nursing prac- Sloane, Sochalski, & Silber, 2002; estabrooks,
tice (Brown, Wickline, ecoff, & Glaser, 2009). Midodzi, Cummings, Ricker, & Giovannetti,
evidence-based management implies that 2005), and failure to rescue (Aiken et al., 2002;
managers, like clinical practitioners, search Needleman, Buerhaus, Mattke, Stewart, &
for, critically appraise, and apply empirical Zelevinsky, 2002). A meta-analysis of 28 stud-
evidence from management research in their ies (Kane, Shamliyan, Mueller, Duval, & Wilt,
practice. In doing so, managers send a clear 2007) that examined registered nurse (RN)
message that research and practice are strongly staffing and patient outcomes link found
connected and can structure work environ- significant association between RN staffing
ments that promote staff confidence and and lower odds of acute-care hospital-related
skill for incorporation of an evidence-based mortality and adverse events, including hos-
approach as the standard for nursing clinical pital acquired pneumonia, unplanned extu-
practice (Barnsteiner, Reeder, Palma, Preston, bation, respiratory failure, and cardiac arrest.
& Walton, 2010; Staffileno & Carlson, 2010). On the basis of the studies included in the