Data from: Comparing safety climate for nurses working in operating theatres, critical care and ward areas in the UK: a mixed methods study

Objectives: The main aim of the study was to explore the potential sources of variation and understand the meaning of safety climate for nursing practice in acute hospital settings in the UK. Design: A sequential mixed methods design included a cross-sectional survey using the Safety Climate Questionnaire (SCQ) and thematic analysis of focus group discussions. Confirmatory Factor Analysis (CFA) was used to validate the factor structure of the SCQ. Factor scores were compared between nurses working in operating theatres, critical care and ward areas. Results from the survey and the thematic analysis were then compared and synthesised. Setting: A London University. Participants: 319 registered nurses working in acute hospital settings completed the SCQ and a further 23 nurses participated in focus groups. Results: CFA indicated that there was a good model fit on some criteria (χ2 = 1683.699, df 824, p < 0.001; χ2/ df = 2.04; RMSEA = 0.058) but a less acceptable fit on Comparative Fit Index (CFI) = 0.804. There was a statistically significant difference between clinical specialisms in Management Commitment (F [4,266] = 4.66, p = 0.001). Nurses working in operating theatres had lower scores compared with ward areas and they also reported negative perceptions about management in their focus group. There was significant variation in scores for Communication across clinical specialism (F [4,266] = 2.62, p = 0.035) but none of the pair-wise comparisons achieved statistical significance. Thematic analysis identified themes of Human Factors, Clinical Management and Protecting Patients. The System and the Human Side of Caring was identified as a meta-theme. Conclusions: The results suggest that the SCQ has some utility but requires further exploration. The findings indicate that safety in nursing practice is a complex interaction between safety systems and the social and interpersonal aspects of clinical practice.研究目的：本研究旨在探究英国急性医院护理实践场景下安全氛围的潜在变异来源，并明晰其在护理实践中的内涵。研究设计：采用序贯混合研究设计，包含基于安全氛围问卷（Safety Climate Questionnaire, SCQ）的横断面调查，以及对焦点小组讨论结果的主题分析。本研究运用验证性因子分析（Confirmatory Factor Analysis, CFA）对SCQ的因子结构进行效度验证。研究对比了手术室、重症监护室及普通病房三类岗位护士的因子得分，并对问卷调查与主题分析的结果进行对比与整合。研究场所：英国伦敦某大学。研究对象：共计319名在急性医院环境执业的注册护士完成了SCQ问卷，另有23名护士参与了焦点小组访谈。研究结果：验证性因子分析结果显示，部分拟合指标下模型表现出良好的适配性（χ²=1683.699，自由度df=824，p<0.001；χ²/df=2.04；近似误差均方根RMSEA=0.058），但比较拟合指数（Comparative Fit Index, CFI）仅为0.804，拟合效果未达可接受标准。不同临床专科护士在管理承诺维度上存在统计学显著性差异（F[4,266]=4.66，p=0.001）：手术室护士的得分显著低于普通病房护士，且其在焦点小组访谈中也表达了对所在科室管理的负面感知。不同临床专科护士在沟通维度上的得分同样存在显著差异（F[4,266]=2.62，p=0.035），但任意两组间的事后两两比较均未达到统计学显著性水平。主题分析提炼出“人为因素”“临床管理”与“保护患者”三大核心主题，同时识别出“照护的系统维度与人文维度”作为元主题。研究结论：本研究结果表明SCQ具备一定的应用价值，但仍需开展进一步的探索与完善。研究发现，护理实践中的安全是安全系统与临床实践的社会人际层面之间的复杂交互过程。