Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing.

Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven ICUs and ten RNs from a post-graduate programme (II). The data were collected with questionnaires (II) and measurement scales (III), and analysed with statistics. In Study IV, 18 RNs were interviewed and the data were analysed with a qualitative content analysis.

Main findings: The RNs had positive perceptions of the overall patient safety culture in the ICUs. Hence, a potential for improvements was identified at both the unit and hospital level. Differences between types of ICUs and between hospitals were found. The dimensions at the unit level were predictors for the outcome dimensions (I). The RNs evaluated the simulation-based team training programme in a positive way. Differences with regard to scenario roles, prior simulation experience and area of intensive care practice were found (II). The expert raters assessed the teams’ performance as advanced novice or competent. There were differences between the expert raters’ assessments and the RNs’ self-assessments (III). One main category emerged to illuminate the RNs’ perceptions of simulation-based team training for building patient safety: Regular training increases the awareness of clinical practice and acknowledges the importance of structured work in teams (IV).

Conclusions: Patient safety culture measurements have the potential to identify areas in need of improvement, and simulation-based team training is appropriate to create a common understanding of structured work in teams with regard to patient safety.

Baksidestext

Intensive care represents potential patient safety challenges for critically ill patients. Human errors are the most common cause of incidents, and failures in team performance are identified as contributory factors. The measurements of patient safety culture and simulation-based team training are recommended initiatives to improve patient safety. The aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. The nurses had a positive perception of the overall patient safety culture. A potential for improvements were found in incident reporting, feedback and communication about errors and organizational learning. The RNs evaluated the simulation-based team training programme in a positive way. The assessments of nurses’ team performance with respect to communication, leadership and decision-making in a simulation-based emergency situation showed a variation in competencies from advanced novice to competent. There were differences between expert raters’ assessments and nurses’ self-assessments. The nurses perceived that simulation-based team training on a regular basis increases the awareness of clinical practice and acknowledges the importance of structured teamwork.