Date on Master's Thesis/Doctoral Dissertation

12-2019

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Nursing

Degree Program

Nursing, PhD

Committee Chair

Polivka, Barbara

Committee Co-Chair (if applicable)

Abusalem, Said

Committee Member

Abusalem, Said

Committee Member

Clark, Paul

Committee Member

Odom-Foren, Janet

Author's Keywords

normalization of deviance; culture of safety; operating room

Abstract

Patient safety in the operating room is a prodigious responsibility of OR nurses as the OR environment is complex and laden with risk, which increases surgical patients’ risk for adverse events. The dissertation presents the topic of patient safety in the operating room (OR), the concept of normalization of deviance, and a mixed-methods study with an exploratory sequential design that involved three phases. The dissertation comprises of five chapters. Chapter One presents an introductory overview of the salience of patient safety as well as its relevance to the unique environment of the OR. Chapter Two presents a concept analysis of normalization of deviance, which may be defined as the adoption of substandard practices, which typically occurs after a period of absence of adverse events. Chapter Three presents Phase 1, which is the qualitative study that sought to examine primary OR safety concerns, explore the occurrence of normalization of deviance, and examine barriers and facilitators to the adherence to safety standards. Ten interviews with OR nurses were conducted. Chapter Four presents Phase 2, which is the quantitative study that sought to examine the strength and association of relationships between the length of OR nurse experience, OR nurse engagement and OR culture of safety . Data were collected from 96 OR nurses from an online platform. Chapter Five presents Phase 3 of the study that synthesized the findings of engagement, and OR culture of safety. Data were collected from 96 OR nurses from an online platform. Chapter Five presents Phase 3 of the study that synthesized the findings of both the previous phases. The study findings demonstrate that normalization of deviance occurs in the OR. Barriers to adherences to safety standards and reasons for normalization of deviance include productivity pressure, complacency related to length of experience, social pressures, generalized complacency, and negative acculturation. Facilitators to the adherence to safety standards and protective factors against normalization of deviance include OR nurse engagement and supportive managerial relationships with OR nurses. In addition, OR nurse engagement was a significant predictor of OR culture of safety. It is imperative to acknowledge and mitigate barriers to the adherence to patient safety. It is also necessary to promote and encourage facilitators to the adherence to safety standards, such as OR nurse engagement and supportive managerial relationships with OR nurses.

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