1.1 Statement of the Problem
The intensive care unit (ICU) is a unique organizational entity for clinical activities and intensive cares that operated and integrated within the hospital. Valentin, (2011) defined ICUs as a setting that provides close monitoring and support of critically ill or failing vital functions among patients that have potential to endanger life and require an adequate diagnostic measures, medical and surgical treatment as to improve outcomes. Serious medical errors, potentially unsafe practices and hazardous conditions are likely contributing to the incidents of errors within the worksite. According to the statement of Batat et al., (2011) ICUs are sites of the highest rate contribute to medical errors and it is essential for the human resource manager to identify the cause of this error and maintaining a safe environment in order to provide professional way in dealing and prevent those errors.
Generally, Intensive Care Unit is considered as a high hazardous place that associated with high risk of mortality and morbidity. ICUs is one of the healthcare setting which is required for learning and innovation environment where safety is a main component in providing a safe environment for staffing and patients too. Pertaining to this statement, several studies suggest that errors and adverse events are common in ICUs therefore nurses have to be aware of factors that can affect patient safety in these settings.
Further, understanding the perception of patient safety culture is one of the ways to impact both organization and outcomes of patient care. Safety culture, defined as a product of the individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment, style, and performance of a healthcare organization (Allen & Homer, 2010) is particularly significant in ICUs where the ill nature of patients, heavy workload, stressful environments and lack of expertise can cause risk to patients’ safety.
In addition, assessing nurses’ safety attitude as to identify the strengths and area for improvement that could benefit to hospital management in considering to create a safety culture and conducive working environment. This study will provide useful benchmarking for nursing leaders and organization as to assist the hospital in nurses’ retention.
1.2 Purpose of Study
The purpose of the study is to identify nurses perception (which includes knowledge and practices) of patient safety in the intensive care units and to determine if there is any significant association between nurses’ perceptions of patient safety and demographic factors (training, work experience) in the intensive care units.
1.3 Theoretical Framework
Social Learning theory also known as Social Cognitive Theory (SCT) by Bandura (1977) framework was used as in influence throughout for this study. Bandura highlighted that learning is a social process and a direct experience which occurs upon observing, imitating and modelling another individual. In this study, SCT has been used to assess nurses’ perception of patient safety in an intensive care setting. The framework focusses on how an individual understands, predicts and changes behaviour by observing which leads on how the observers acts when they face with similar situation.
Bandura’s SCT consists of three parts that revolves and influences each other are (1) environmental factors, (2) personal factors and (3) behaviour. The aspects of SCT is that observers learn from the model’s action; thus provokes responses such as acquiring skills, knowledge, behaviour and value that is relevant. SCT emphasizes interactions between the observer, the surrounding environment and their behaviours is reciprocal.
Championing of the SCT occurs when the observer practices the Bandura’s 4 Principles of Social Learning; attention, retention, reproduction and motivation. The observer (nurse) first has to be focussed on the task conducted, while observing the nurse will have to internalise information which will then be used as a response later on. Followed by reproduction, is when the nurse applies the information observed (behaviour, skills or knowledge) when required, which will improve over practices and physical rehearsals. Motivation and reinforcement from others will be a driving force for followed practices.
Bandura’s SCT collaborated with the 4 principles of social learning will is indeed the ideal framework for this study as nurses’ perception of patient safety in the intensive care units can only be established when the nurse has the right perception which will allow them to perform safe practices to promote and enhance patient safety in the intensive care setting. Therefor it becomes a responsibility for every nurse to perform safe practices and be a role model among each other.
The illustration of SCT framework is showed in Figure 1.1.
Figure 1.1: SCT framework
The illustration of 4 Principles of Social Learning is showed in Figure 1.2.
Figure 1.2: 4 Principles of Social Learning
1.4 Conceptual Definition
The ability to see, hear, or become aware of something through the senses. The conscious mental registration of a sensory stimulus using the critical characteristics of sensation, selection, assimilation, and interpretation (Mcdonald, 2012).
1.4.2 Patient safety
Nursing care that reduces the risk of adverse events related to medical care across a range of diagnoses or conditions. Avoiding injuries to patients from the care that is intended to help them. Prevention of errors and adverse effects to patients associated with health care (World Health Organization, 2017).
1.4.3 Intensive care units
A hospital facility for provision of intensive nursing and medical care of critically ill patients, characterized by the quality and quantity of continuous nursing and medical supervision and by use of sophisticated monitoring and resuscitative equipment; organized for the care of specific patient groups (Farlex The Free Medical Dictionary, 2017).
1.5 Research Objectives
1. To identify the nurses’ perception of patient safety in the intensive care units in a private hospital in Selangor.
2. To determine whether is there any significant association between socio demographic data and nurses’ perception of patient safety in the intensive care units in a private hospital in Selangor.
1.6 Research Question
1. What are the nurses’ perception of patient safety in the intensive care units?
2. Are there any significant association between socio demographic data and nurses’ perception of patient safety in the intensive care units in a private hospital in Selangor?
H0: there is no significant association between socio demographic data and nurses’ perception of patient safety in a private hospital in Selangor.
H1: There is association between socio demographic data and nurses’ perception of patient safety in a private hospital in Selangor.
1.8 Significance of the Study
Research has illustrated that patient safety culture is an important aspect of care in intensive care units. Hence, perception of factors affecting patient safety is imperative for nurses who are responsible to ensure the safety of patients in their care in intensive care units.
The outcome of this study will hopefully provide information on the nurses’ perception of patient safety in intensive care units. With this information made available, it is hoped that the healthcare institution would be able to adopt appropriate measures to address any issues highlighted.
Further, there are limited local studies that have examined nurses’ perception of patient safety in intensive care units and this study may provide some insight in this area.