Just culture in healthcare: An integrative review.

BACKGROUND: In spite of two decades of the patient safety movement in the United States, healthcare safety remains a significant problem. The paucity of empirical literature related to Just Culture in healthcare indicates a need for this concept to be examined and operationalized. PURPOSE: The purpose was to appraise the literature regarding the use and application of Just Culture in healthcare. METHODS: Using Whittemore and Knafl's framework for integrative reviews, a review of the literature was conducted using Cumulative Index to Nursing and Allied Health Literature, PubMed, PsychInfo, and Cochrane Review to identify peer-reviewed literature published between 2010 and 2020. The following search terms were used: "Just Culture" AND "healthcare system" OR "health care" OR "healthcare." RESULTS: After screening for inclusion and exclusion criteria, a set of 10 articles were included in the review. Four main themes were identified: Error Management, Balance, Leadership and Staff, and Systems Leadership for Change. CONCLUSION: There is a paucity of empirical research and quality improvement projects focusing on Just Culture. The themes identified in this integrative review provide the direction and focus for additional research and quality improvement efforts that will promote the adoption of Just Culture and improvement in patient safety.

Exploratory factor analysis of the Just Culture Assessment Tool for nursing education.

BACKGROUND: Just culture has been identified as a vital component of safety culture by national and international organisations. In a just culture, emphasis is not placed on blaming individuals for errors but rather on examining personal and system processes that can best support safety and prevent reoccurrence. Although those in the practice arena have worked to implement the concepts of just culture, the same is not true in nursing education, leaving nursing students lacking the pre-requisite knowledge, skills and attitudes to implement just culture in practice on graduation. AIMS: Assessment of this phenomena is the essential first step to align nursing education with practice in promoting just culture as a mechanism for patient safety. The purpose of this paper is to further refine the Just Culture Assessment Tool-Nursing Education through exploratory factor analysis. METHODS: The Just Culture Assessment Tool-Nursing Education was adapted from the Just Culture Assessment Tool, an instrument created for the practice setting. Validity and reliability were established for the Just Culture Assessment Tool-Nursing Education in a study of 800 nursing students to assess their perceptions and understanding of just culture with their nursing programmes. Using the previously conducted data, an exploratory factor analysis was conducted. RESULTS: Factor analysis supports six subscales, similar to that of the Just Culture Assessment Tool. However, individual items were loaded into different subscales. All subscales demonstrated good reliability. Factor analysis supported further refinement of two items to improve the instrument's ability to capture data. CONCLUSIONS: Perceptions of just culture differ between experienced providers and nursing students; nursing students have less experience with reporting errors. Factor analysis of Just Culture Assessment Tool-Nursing Education items demonstrated these differences, supporting modification of items by the instrument developers. An 'if' statement for students to consider their possible actions rather than experience was added to two items to better capture data from nursing students when completing the assessment.

Nursing Students' Perceptions of Just Culture in Nursing Programs: A Multisite Study.

BACKGROUND: While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education. PURPOSE: The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia. METHODS: Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs. RESULTS: The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (χ[2] = 25.09, P < .001). CONCLUSIONS: The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.

Development and Validation of the Just Culture Assessment Tool for Nursing Education.

BACKGROUND: Patient safety efforts in practice have focused on creating a just culture where errors can be identified and reported, and system remedies created to prevent reoccurrence. The same is not true of nursing education where student experiences with error and the sequelae that follow focus on individual performance. PURPOSE: The purpose of this study was to adapt the Just Culture Assessment Tool (JCAT) used in practice settings into a valid and reliable instrument to evaluate just culture in academic settings. METHODS: A 27-item instrument was adapted for academia. Content validity was established. Reliability was determined in a pilot study with 133 prelicensure nursing students. RESULTS: The scale content validity index (CVI) was calculated at 1. The reliability of the instrument is strong (α = .75). CONCLUSIONS: The CVI and pilot study findings support the use of the JCAT for Nursing Education as a valid and reliable instrument to evaluate student perception of just culture in academia.

Nurses' professional concerns: letters to the editor for 1900-2005.

The purpose of this qualitative study was to broaden the context for understanding nurses' professional concerns as voiced through letters to the editor of the American Journal of Nursing from 1900 to 2005. Two issues from each year were randomly selected. Line-by-line analysis was used to code, categorize, and analyze the data. The following five themes emerged: self-care versus self-sacrifice; nursing's emphasis on holistic care; educational and professional preparation; nurse-physician relationships; and the image of the nurse. The recurrent nature of these themes has important implications for nursing education, clinical practice, leadership, and research.

The relationship between nurse staffing models and patient outcomes: a descriptive study.

In an era of dwindling reimbursement and rising healthcare costs, the impact of nurse staffing models on patient outcomes is a key concern. This study used a descriptive comparison design to examine the effects of a change in the staffing model on length of stay, variable cost, patient satisfaction, incidence of urinary tract infection and penumonia, and pain management in bowel resection patients. There were significant differences in the pain management outcomes between the two staffing models. Other patient outcomes were comparable despite decreasing the total number of caregivers on the unit. Recommendations for further research are discussed.