Patient-safety caring: A Constructivist Grounded Theory of carers’ contributions to patient safety in Australian hospitals

Background: Despite safety and quality policies incorporating carer involvement in acute hospital processes, little research has investigated the experience of carers’ contributions to patient safety. Method : Using a Constructivist Grounded Theory methodology, 32 intensive interviews were conducted with carers who had patient safety concerns for their relatives from a recent hospital stay. Interviews were transcribed and analysed using the constant comparative method simultaneously with data collection, collection ceasing when theoretical saturation was reached. Results: Carers played a significant and unique role in acute hospitals, engaging in the process of ‘patient-safety caring’. A theory of the process is presented, involving the following three intensities of patient-safety caring: ‘caring without concern’ (low intensity), ‘being proactive about safety’ (moderate intensity) and ‘wrestling for control’ (high intensity). Wrestling for control was associated with low trust and a high sense of personal responsibility whereas contributing without concern was associated with higher levels of trust and lower levels of personal responsibility. Carers acted with the same or varying degrees of intensity over the course of the hospitalisation. Although wrestling for control heightened the level of protection from harm for the patient, it also resulted in negative consequences for the carer and their interactions with health practitioners. Resistance and obstruction from staff was common. Discussion: This theory of patient-safety caring proposes that carers can provide continuous, broad-spectrum protection from harm at varying levels of intensity. Carers’ safety contributions were underpinned by their unique knowledge of the patient and time spent at the patient’s bedside. Innovation in safety and quality policies is needed to improve staff recognition and acceptance of carers’ contributions to avoid shifting an unreasonable degree of responsibility for safety to carers. Conclusion: Adoption of partnership and ...