Objective: Patient Safety has attained international status, evidenced by major research and health policy initiatives in the United States, Canada, Great Britain, Scandanavia and Japan. However, the dominant themes in health care projects focus on reducing errors, managing risks, avoiding adverse events and preventing injuries. Nursing scholarship is needed to move beyond error-driven approaches and differentiate from concentration on medical-pharmacological modalities. A new vision of Patient Safety is mandated to build safer health care systems with greater attention to the processes of care that nurses shepherd as frontline care-givers. A conceptual framework to cultivate discoveries in Patient Safety is proposed as a means to create synergy for innovations in practice, research and education.
Concepts: Four pillars of excellence are identified as nursing’s contributions to safer health care systems. One is the utilization of technologically-mediated methods to enhance safety relative to precision in assessment and nursing interventions. Another is to apply human factors designs to innovate care-giving approaches that assist nurses dealing with workload, interruptions and fatigue, and ensure healthy workplaces. A third is the promotion of healthy communications and team literacy. The fourth is to deliver processes of safe care that build the infrastructure for clinical supports that nurses deliver such as pain management, screening for early diagnosis, and follow-up services. Four categorical outcomes are targeted for measurement in this model: quality care; optimal communications & working relationships; evidence based practice to transform current clinical services, and organization learning through accountable to patient safety.
Implications: As the principal health care provider with the patient, nurses are the web-linkages in the safety networks for patient care. Thus nursing’s contribution to the redesign of patient care services with a specific vision for interfacing quality and safety is part of the call for increased accountability in the health care system.
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