# “Awakening consciousness”: Safe Care Linkage Theory From a Mixed Perspective—A Constructivist Grounded Theory Study

## TL;DR

This study explores how healthcare professionals, older adults, and caregivers understand and implement safe geriatric care, developing a new theory called 'Awakening consciousness–Safe care linkage theory'.

## Contribution

The study introduces a novel grounded theory explaining how safety awareness is awakened among geriatric care stakeholders to improve patient safety.

## Key findings

- The 'Awakening consciousness–Safe care linkage theory' includes four levels: concept-motivation, environment-institution, practice-interaction, and balance-choice.
- The theory provides a framework for understanding and addressing unsafe care crises in geriatric care settings.
- Findings suggest the theory can guide efforts to improve safety by redesigning management processes and awakening stakeholder awareness.

## Abstract

To explore how healthcare professionals, older adults, and caregivers across different contexts conceptualize and implement safe care and develop a substantive theory that reflects their perspectives.

Geriatric care is delivered in a model of ongoing change, with healthcare professionals, older adults, and caregivers highlighting its impact on patient safety. However, there is a shortage of literature on how all care stakeholders conceptualize safe geriatric care.

Constructivist grounded theory methodology was employed in this study. Between February 2023 and September 2024, semistructured interviews were conducted. Twenty‐five healthcare professionals, 24 inpatients, 19 care workers, and 18 family members from ten hospitals and one primary health center within China participated in the study. Data analysis included initial coding, focused coding, and theoretical coding using constant comparative, memo writing, and field notes.

The substantive theory to emerge from this study was named “Awakening consciousness–Safe care linkage theory.” This theory is informed by four levels: (a) Concept‐motivation level: Generating intrinsic driving force; (b) environment‐institution level: Building a safe care ecosystem; (c) practice‐interaction level: Practicing safe care behavior pattern; and (d) balance‐choice level: Counterbalance the unsafe care crisis. These four levels form the linkage response to implementing safe care for older adults in the hospital, and together with the escort strategy (safety criteria) and progression mechanism (feeling safe) emerging in the data, constitute the linkage ecology of safe care.

The study presents the process of awakening the safety awareness of care stakeholders within geriatric care. Understanding the nature and interrelation of safe care linkage theory could direct practitioners, researchers, and policy‐makers in better efforts to improve the safety of geriatric care. This substantive theory also provides comprehensive theoretical support for future interventions and research to form a safe care ecosystem.

The substantive theory provides a theoretical basis for understanding the complex nature of safe care, which illustrates the unsafe care crisis care stakeholders encounter, the criteria they obey, the strategies they use, and the influences of these strategies to practice safe care in complicated situations. Findings will assist nursing leaders in identifying areas to improve care safety and developing and integrating more effective strategies by redesigning optimal management processes to awaken care stakeholders’ safety awareness and take actions suited to the linkage mechanism of a safe care ecosystem.

Trial Registration: Chinese Clinical Trial Registry: ChiCTR 2300067421