Safety climate in the surgical environment: a qualitative study
DOI:
https://doi.org/10.4025/ciencuidsaude.v24i1.73451Keywords:
Organizational culture, Surgicenters, Nursing, Patient safety, COVID-19Abstract
Objective: To understand the perception of multidisciplinary teams in university surgical centers regarding safety climate domains during the COVID-19 pandemic. Method: This is a qualitative, descriptive-exploratory study conducted in two university hospitals. We developed a semi-structured interview guide based on the domains of the Safety Attitudes Questionnaire/Operating Room. Data were collected between February and May 2021 and between June and July 2022, following participant consent and the signing of the Informed Consent Form. We analyzed the data using IRaMuTeQ. Results: Communication was perceived as challenging in both settings. Management was considered responsive to the challenges of the pandemic, particularly in providing personal protective equipment; however, the exchange of information between leadership and staff was deemed insufficient. Healthcare professionals experienced fear, anxiety, and physical and mental exhaustion. Final considerations: Management must advance by engaging collaboratively with professionals, listening to them, and moving away from a punitive culture. Promoting learning from errors and creating spaces that prioritize professionals’ mental healthare key strategies for improvement.
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References
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16. Ribeiro OMPL, Trindade LL, Fassarella CS, Pereira SCA, Teles PJFC, Rocha CG, et al. Impact of COVID-19 on professional nursing practice environments and patient safety culture J Nurs Manag. 2022;30(5):1105–1114. Doi: https://doi.org/10.1111/jonm.13617
17. Skegg E, McElroy C, Mudgway M, Hamill J. Debriefing to improve interprofessional teamwork in the operating room: A systematic review. J Nurs Scholarsh. 2023;55(6):1179–88. Doi: https://doi.org/10.1111/jnu.12924
18. Diaz-Navarro C, Enjo-Perez I, Leon-Castelao E, Hadfield A, Nicolas-Arfelis JM, Castro-Rebollo P. Implementation of the TALK© clinical self-debriefing tool in operating theatres: a single-centre interventional study. Br J Anaesth. 2024;133(4):853-861. Doi: https://doi.org/10.1016/j.bja.2024.05.044
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21. Nyberg A, Olofsson B, Fagerdahl A, Haney M, Otten V. Longer work experience and age associated with safety attitudes in operating room nurses: an online cross-sectional study. BMJ Open Qual. 2024;13(1):e002182. Doi: https://doi.org/10.1136/bmjoq-2022-002182
22. Ferreira JESM, Cavalcante TF, Jansen RC, Damasceno DFO, Oliveira LR, Silva MJN, et al. Challenges for maintaining surgical care practices in the COVID-19 pandemic: an integrative review. Invest Educ Enferm. 2023;40(1). Doi: https://doi.org/10.17533/udea.iee.v40n1e16
23. Ribeiro OMPL, Cardoso MF, Trindade LL, Rocha KG, Teles PJFC, Pereira S, et al. From the first to the fourth critical period of COVID-19: what has changed in nursing practice environments in hospital settings? BMC Nurs. 2023;22(1):1–12. Doi: https://doi.org/10.1186/s12912-023-01207-x
24. Dal’Bosco EB, Floriano LSM, Skupien SV, Arcaro G, Martins AR, Anselmo ACC. Mental health of nursing in coping with COVID-19 at a regional university hospital. Rev Bras Enferm. 2020;73:e20200434. Doi: https://doi.org/10.1590/0034-7167-2020-0434
25. Santos JLGD, Menegon FHA, Andrade GB, Freitas EO, Camponogara S, Balsanelli AP, et al. Changes implemented in the work environment of nurses in the COVID-19 pandemic. Rev Bras Enferm. 2022;75(suppl 1):1–6. Doi: https://doi.org/10.1590/0034-7167-2020-1381
26. Klemenc-Ketiš Z, Poplas SA. Safety culture at primary healthcare level: a cross-sectional study among employees with a leadership role. Zdr Varst. 2020;59(1):42-6. Doi: https://doi.org/10.2478/sjph-2020-0006
27. Spolverato G, Capelli G, Restivo A, Bao QC, Pucciarelli S, Pawlik TM, et al. The management of surgical patients during the coronavirus dieases 2019 (COVID-19) pandemic. Surgery. 2020;168(1):4-10. Doi: https://doi.org/10.1016/j.surg.2020.04.036
28. Berdida DJE, Grande RAN. Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study.
J Nurs Scholarsh. 2024;29. Doi: https://doi.org/10.1111/jnu.12960
29. Passos EM, Santos RB, Ribeiro R, Nogueira BVS. Teaching patient safety in undergraduate nursing in the state of Bahia. Ciênc. cuid. saúde. 2022;210. Doi: https://doi.org/10.4025/ciencuidsaude.v21i0.57704
30. Faridah I, Setyowati S, Lestari F, Hariyati RTS. The correlation between work environment and patient safety in a general hospital in Indonesia. Enferm Clin. 2021;31(2):S220–S224. Doi: https://doi.org/10.1016/j.enfcli.2020.12.026.
2. Lourenção DCA, Tronchin DMR. Safety climate in the surgical center: validation of a questionnaire for the Brazilian scenario. Rev. Eletr. Enf. 2018;20:1–11. Doi: https://doi.org/10.5216/ree.v20.47570
3. Souza SS, Farias MTD, Bandeira AKC, Magalhães MSSP, Sales MGS, Rodrigues AS, et al. Nurses conduct in the surgical center in the Covid-19 pandemic scenario. Nursing (Ed. brasileira. Online). 2022;25(291):8394-403. Doi: https://doi.org/10.36489/nursing.2022v25i291p8394-8403
4. Oliveira Junior NJ, Lourenção DCA, Poveda VB, Riboldi CO, Martins FZ, Magalhães AMM. Safety culture in surgical centers from the perspective of the multiprofessional team. Rev Rene. 2022;23:e78412. Doi: https://doi.org/10.15253/2175-6783.20222378412
5. United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development [on-line]. 2015.[citado em 09 fev 2025]. Disponível em: URL: https://documents.un.org/doc/undoc/gen/n15/291/89/pdf/n1529189.pdf
6. World Health Organization. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care [online]. 2021. [citado em 09 fev 2025]. Disponível em: URL: https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan
7. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–357. Doi: https://doi.org/10.1093/intqhc/mzm042
8. Souza MAR de, Wall ML, Thuler AC de MC, Lowen IMV, Peres AM. O uso do software IRAMUTEQ na análise de dados em pesquisas qualitativas. Rev Esc Enferm USP. 2018;52:e03353. Doi: https://doi.org/10.1590/S1980-220X2017015003353
9. Costa CJND, D’Artibale EF, Duarte ÊRM, Ribeiro MRR, Martins ETJ, Ferreira GE. Clima de segurança em saúde no contexto de pandemia da covid-19 em um hospital universitário. renome. 2022;10(2):47–56. Doi: https://doi.org/10.46551/rnm23173092202100206
10. Macedo LL, Silva AMR, Silva JFM, Haddad MCFL, Girotto E. A cultura em torno da segurança do paciente na atenção primária à saúde: distinções entre categorias profissionais. Trab educ saúde. 2020;18(1):e0023368. Doi: https://doi.org/10.1590/1981-7746-sol00233
11. Seo JK, Lee SE. Mediating roles of patient safety knowledge and motivation in the relationship between safety climate and nurses’ patient safety behaviors: a structural equation modeling analysis. BMC Nurs. 2022;21(1):335. Doi: https://doi.org/10.1186/s12912-022-01123-6
12. Gurková E, Zeleníková R, Friganovic A, Uchmanowicz I, JaroÅ¡ová D, Papastavrou E, et al. Hospital safety climate from nurses’ perspective in four European countries. Int Nurs Ver. 2020;67(2):208-217. Doi: https://doi.org/10.1111/inr.12561
13. Burlakov N, Rozani V, Bluvstein I, Kagan I. The association between quality and safety climate of a hospital ward, family members’ empowerment, and satisfaction with provided care. J Nurs Scholarsh. 2021;53:727-736. Doi: https://doi.org/https://doi.org/10.1111/jnu.12682
14. Martins KN, Bueno A de A, Mazoni SR, Machado VB, Evangelista RA, Bolina AF. Management process in surgicenters from the perspective of nurses. Acta Paul Enferm. 2021;34:eAPE00753. Doi: https://doi.org/10.37689/acta-ape/2021AO00753
15. Hoffmann M, Schwarz CM, Schwappach D, Banfi C, Palli C, Sendlhofer G. Speaking up about patient safety concerns: view of nursing students. BMC Health Serv Res. 2022;22:1547. Doi: https://doi.org/10.1186/s12913-022-08935-x
16. Ribeiro OMPL, Trindade LL, Fassarella CS, Pereira SCA, Teles PJFC, Rocha CG, et al. Impact of COVID-19 on professional nursing practice environments and patient safety culture J Nurs Manag. 2022;30(5):1105–1114. Doi: https://doi.org/10.1111/jonm.13617
17. Skegg E, McElroy C, Mudgway M, Hamill J. Debriefing to improve interprofessional teamwork in the operating room: A systematic review. J Nurs Scholarsh. 2023;55(6):1179–88. Doi: https://doi.org/10.1111/jnu.12924
18. Diaz-Navarro C, Enjo-Perez I, Leon-Castelao E, Hadfield A, Nicolas-Arfelis JM, Castro-Rebollo P. Implementation of the TALK© clinical self-debriefing tool in operating theatres: a single-centre interventional study. Br J Anaesth. 2024;133(4):853-861. Doi: https://doi.org/10.1016/j.bja.2024.05.044
19. Van Dalen ASH, Swinkels JA, Coolen S, Hackett R, Schijven MP. Improving teamwork and communication in the operating room by introducing the theatre cap challenge. J Perioper Pract. 2022;32(1–2):4–9. Doi: https://doi.org/10.1177/17504589211046723
20. Silva LC, Caldas CP, Fassarella CS, Souza PS. Effect of the organizational culture for patient safety in the hospital setting: A systematic review. Aquichan. 2021;21(2):e2123. Doi: https://doi.org/10.5294/aqui.2021.21.2.3
21. Nyberg A, Olofsson B, Fagerdahl A, Haney M, Otten V. Longer work experience and age associated with safety attitudes in operating room nurses: an online cross-sectional study. BMJ Open Qual. 2024;13(1):e002182. Doi: https://doi.org/10.1136/bmjoq-2022-002182
22. Ferreira JESM, Cavalcante TF, Jansen RC, Damasceno DFO, Oliveira LR, Silva MJN, et al. Challenges for maintaining surgical care practices in the COVID-19 pandemic: an integrative review. Invest Educ Enferm. 2023;40(1). Doi: https://doi.org/10.17533/udea.iee.v40n1e16
23. Ribeiro OMPL, Cardoso MF, Trindade LL, Rocha KG, Teles PJFC, Pereira S, et al. From the first to the fourth critical period of COVID-19: what has changed in nursing practice environments in hospital settings? BMC Nurs. 2023;22(1):1–12. Doi: https://doi.org/10.1186/s12912-023-01207-x
24. Dal’Bosco EB, Floriano LSM, Skupien SV, Arcaro G, Martins AR, Anselmo ACC. Mental health of nursing in coping with COVID-19 at a regional university hospital. Rev Bras Enferm. 2020;73:e20200434. Doi: https://doi.org/10.1590/0034-7167-2020-0434
25. Santos JLGD, Menegon FHA, Andrade GB, Freitas EO, Camponogara S, Balsanelli AP, et al. Changes implemented in the work environment of nurses in the COVID-19 pandemic. Rev Bras Enferm. 2022;75(suppl 1):1–6. Doi: https://doi.org/10.1590/0034-7167-2020-1381
26. Klemenc-Ketiš Z, Poplas SA. Safety culture at primary healthcare level: a cross-sectional study among employees with a leadership role. Zdr Varst. 2020;59(1):42-6. Doi: https://doi.org/10.2478/sjph-2020-0006
27. Spolverato G, Capelli G, Restivo A, Bao QC, Pucciarelli S, Pawlik TM, et al. The management of surgical patients during the coronavirus dieases 2019 (COVID-19) pandemic. Surgery. 2020;168(1):4-10. Doi: https://doi.org/10.1016/j.surg.2020.04.036
28. Berdida DJE, Grande RAN. Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study.
J Nurs Scholarsh. 2024;29. Doi: https://doi.org/10.1111/jnu.12960
29. Passos EM, Santos RB, Ribeiro R, Nogueira BVS. Teaching patient safety in undergraduate nursing in the state of Bahia. Ciênc. cuid. saúde. 2022;210. Doi: https://doi.org/10.4025/ciencuidsaude.v21i0.57704
30. Faridah I, Setyowati S, Lestari F, Hariyati RTS. The correlation between work environment and patient safety in a general hospital in Indonesia. Enferm Clin. 2021;31(2):S220–S224. Doi: https://doi.org/10.1016/j.enfcli.2020.12.026.
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2025-04-22
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Safety climate in the surgical environment: a qualitative study . (2025). Ciência, Cuidado E Saúde, 24(1). https://doi.org/10.4025/ciencuidsaude.v24i1.73451
