Exploring nurses’ perspectives on patient safety culture in neonatal intensive care units: a phenomenological study

TL;DR

This study explores how neonatal nurses in Saudi Arabia view patient safety culture in NICUs, identifying factors that help or hinder safe care.

Contribution

The study provides novel insights into patient safety culture in NICUs from the perspective of nurses using a phenomenological qualitative approach.

Findings

Systemic barriers like staffing shortages and communication gaps negatively impact patient safety in NICUs.

Positive factors such as teamwork, leadership support, and peer mentoring enhance patient safety and outcomes.

Emotional and ethical challenges like fear of blame and moral distress were identified as critical aspects of safety culture.

Abstract

The neonatal intensive care unit (NICU) is a stressful environment that makes it challenging for neonatal nurses to adhere to safe care for neonates. However, little research has focused on explaining patient safety culture (PSC) in the NICU. Therefore, this study used in-depth qualitative methods to explore the concept of PSC and its dimensions from the perspectives of nurses working in the NICU.

This study used a phenomenological descriptive qualitative design. Data was collected through in-depth semi-structured interviews with 15 NICU nurses working in Riyadh, Kingdom of Saudi Arabia. The participants were selected through purposive sampling, and the data were analysed using the deductive approach.

Analysis of the interviews revealed 10 main themes and 33 sub-themes related to the concept of patient safety culture in the NICU. Main themes, such as communication, teamwork, effective handoffs and transitions, and positive leadership, had a positive impact on patient outcomes and minimizing risks. Alternately, inadequate staffing and workload were seen to have a negative impact on patient safety and quality of care.

The findings revealed systemic barriers (staffing shortages, workload, communication gaps) and facilitators (teamwork, leadership support, peer mentoring). Furthermore, brings out emotional and ethical dimensions of safety such as fear of blame, moral distress when unable to deliver optimal care). Moreover, offers practical recommendations for tailored interventions in NICUs that involve education, training, teamwork, implementing daily huddles, continuous practice, encouraging open reporting and non-punitive safety climates, all of theses lead to safety enhancement.