The concept of safety in healthcare tends to differ from one individual patient to another (Ekwall, 2013).Safety is not only maintained by healthcare workers in their practices but patients also have become quite responsible to maintain their own safety irrespective of other’s safe practices. However, in case of the patients, the concept of safety is vivid and is not as simple as in case of the healthcare professionals.
Different patients with different diseases and different experiences have developed their own concept of safety that they rely on and hence it becomes extremely difficult for healthcare professionals to understand the different perspectives of safety of different individuals (Browall et al., 2013). This is extremely important to be known by healthcare staffs in the healthcare system so that they can provide maximum patient satisfaction and maintain dignity and autonomy. This essay will look at the paper Rhodeset al., 2016 which covers the issue of relative concept of patient’s safety and its implications on nursing practices and healthcare.
The capability of making a sense by an individual can be defined as the development of awareness of an individual about his/her surroundings. This is called sensemaking in Rhodes et al., 2016. It can be accepted as the cognitive information processing activity that also involves the emotional and embodied aspects of an individual’s livings (Michtalik et al., 2013). It might occur on several occasions where a person’s sense-making capability may make him/her believe a concept of safety that may vary with healthcare professionals and therefore it becomes important that healthcare staff develop ideas and knowledge about it. Setting a set of primary care parameters centers the main research question that they had set therefore is that how they develop a particular perception about how patients perceive their experiences in the primary healthcare settings. They have also set up the aim to develop an understanding of the sense-making capability of the patients and how that shaped their idea and knowledge about safety. This will in turn help the searchers to resonate the findings of researchers like Doherty and Saunders to understand about how patients in hospitals undergo their sense making capabilities and also their concept of safety. This would ultimately help the healthcare professions to develop their knowledge about the patient’s needs and demands and will shape their services in a way that will provide best patient satisfaction(Doyle, Lennox & Bell, 2013)
The research design and the methods:
The method that was selected by the researcher was a qualitative method where they elected 14 males and 24 females of varied backgrounds having different age, carer status, education level and socioeconomic and ethnic background so that a wide variety of data and conceptions of participants can be involved. Interviews were conducted in patients’ personal homes for about 30 minutes to two hours. No closed questions were asked and participants were requested to discuss their concept on the topic of safety. Answers were coded and transcribed. Separate categories were set after the transcripts were entered into NVivo10 (qualitative data software package; Brisbane, QS International) followed by thematic analysis and following grounded theory techniques the codes were extensively analyzed and at first sixty four codes were analyzed. From these codes seven themes were selected which were systems safety, communication safety, medical safety, timely access, flexibility in the interpretation of rules and holistic care and relationship continuity. From this part, the themes were further categorized into main three themes which include organizational and systems-level tensions constraining safety, trust and psycho-social aspects of professional-patient relationships and choice, continuity, access and the temporal underpinnings for safety. Reanalysis if the data had been conducted using the Weik’s framework. This helped the researchers to understand the sense making around patient safety in primary care centre (Maitilis & Christiansen, 2014). This method was the best in this case as it had included different types of patients of different gender age and social backgrounds and therefore had helped to involve a wide variety of ideas and perceptions into the research. As open end questions were asked, the patients were free to discuss their concept without any inhibition and as a result, clarity in their responses could be maintained (Ozok et al., 2014)
Findings and relevance to contemporary nursing policy and practice:
Patient’s conception of safety was very complex to understand as they clearly made it evident that it is not an apolitical conception being a unified objective but is a contestable, contingent, fluid and negotiable accomplishment. Patients were found to be more comfortable in discussing the concept through their experiences rather than defining them in definite words. Aspects of primary healthcare (like approachability) were considered as an important feature in conception of safety (Ozok et al., 2013). Researchers have stated this because a circumstantial situation which might be safe for one patient may be less safe for another and also with the practitioner. The healthcare systems should be more transparent as that will help them to gain more knowledge about a particular intervention – such as why it is provided, what the benefits are and what the disadvantages are and as well as many others. This had led them to believe that they should take informal strategies to provide their own safety as they believe that the concept of safety defined by the policy makers and clinicians are never made clear to the patients (Soininen et al., 2013). Many patients gave importance to their own negative experiences of the past that makes them believe that they should be themselves proactive and cautious about their own safety. Their feeling of disempowerment and devaluing made them take action based on their anticipation and practiced their own safety. Moreover it was also seen that, unlike Doherty’s (Doherty is the scientist on whose the paper was which we analysed was based) belief which suggested that patients should have entire trust on doctors who are taking the responsibility of caring for them, patients were mostly comfortable to allow their own judgments to speak up while interacting with their doctors about the interventions, and this was mainly due to negative experiences. Although patients were aware of the gap in medical knowledge they have, they were most likely to be concerned for their own safety rather than being completely relying on professionals. It was also found that lack of trust in doctors, fear of judgments by them an also presumptions about guidelines that constrain clinicians inhibit patients to sort for medical advice which in turn affects their safety (Allen, Braithwaite, Sandall, & Waring, 2016).
Such gap in interactions with the healthcare professionals may have negative consequence on their own health. Although the patient develops a sense of psychosocial safety for themselves but this cannot bring the best results. Often experienced patients may take decisions that might be harmful for them (Nygren et al., 2013). Therefore it is extremely important for the establishment of a transparent relationship between the patients and the healthcare professionals. Both the parties should be cooperating with each other providing proper and relevant information and clearing out differences which will help in developingan environment where the concept of safety will be constant for both of them (Mitchell et al., 2015)
The article provides important information about patient ideas about safety. The paper is clear and concise. It concludes thatsensemaking capabilities of both the healthcare professional and patients lead them to develop different concepts of safety in healthcare. As a result patient’s concept of safety is different and this often may lead to chaotic situations when the healthcare staff fail to provide patient satisfaction. Hence it is important to overcome the issues with proper collaborative practices and informing patients to bridge the gap and maintain a transparent relationship.
Allen, D., Braithwaite, J., Sandall, J., & Waring, J. (2016). The sociology of healthcare safety and quality (1st ed.). Malden, MA: Wiley Blackwell.
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Ekwall, A. (2013). Acuity and anxiety from the patient's perspective in the emergency department. Journal of emergency nursing, 39(6), 534-538.
Maitlis, S., & Christianson, M. (2014). Sensemaking in organizations: Taking stock and moving forward. The Academy of Management Annals, 8(1), 57-125.
Michtalik, H. J., Yeh, H. C., Pronovost, P. J., &Brotman, D. J. (2013). Impact of attending physician workload on patient care: a survey of hospitalists. JAMA internal medicine, 173(5), 375-377.
Mitchell, I., Schuster, A., Smith, K., Pronovost, P., & Wu, A. (2015). Patient safety reporting: a qualitative study of thoughts and perceptions of experts 15 years after ‘To Err is Human’. BMJ QualSaf, bmjqs-2015.
Nygren, M., Roback, K., ?hrn, A., Rutberg, H., Rahmqvist, M., &Nilsen, P. (2013). Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils. BMC health services research, 13(1), 52.
Ozok, A. A., Wu, H., Garrido, M., Pronovost, P. J., &Gurses, A. P. (2014). Usability and perceived usefulness of personal health records for preventive health care: A case study focusing on patients' and primary care providers' perspectives. Applied ergonomics, 45(3), 613-628.
Rhodes, P., McDonald, R., Campbell, S., Daker?White, G., & Sanders, C. (2016).Sensemaking and the co?production of safety: a qualitative study of primary medical care patients. Sociology of Health & Illness, 38(2), 270-285.
Soininen, P., V?lim?ki, M., Noda, T., Puukka, P., Korkeila, J., Joffe, G., &Putkonen, H. (2013).Secluded and restrained patients' perceptions of their treatment. International journal of mental health nursing, 22(1), 47-55.