Systematic adoption of early warning systems in healthcare settings is dependent on the optimal and reliable application by the user. Psychosocial issues and hospital culture influence clinicians' patient safety behaviours. (i) To examine the sociocultural factors that influence nurses' EWS compliance behaviours, using a theory driven behavioural model and (ii) to propose a conceptual model of sociocultural factors for EWS compliance behaviour. A cross-sectional survey. Nurses employed in public hospitals across Queensland, Australia. Using convenience and snowball sampling techniques eligible nurses accessed a dedicated web site and survey containing closed and open-ended questions. 291 nurses from 60 hospitals completed the survey. Quantitative data were analysed using ANOVA or -tests to test differences in means. A series of path models based on the theory were conducted to develop a new model. Directed or theory driven content analysis informed qualitative data analysis. Nurses report high levels of previous compliance behaviour and strong intentions to continue complying in the future (M=4.7; SD 0.48). Individual compliance attitudes (β 0.29, p<.05), perceived value of escalation (β 0.24, p<.05) and perceived ease or difficulty complying with documentation (β −0.31, p<.05) were statistically significant, predicting 24% of variation in compliance behaviour. Positive personal charting beliefs (β 0.14, p<.05) and subjective norms both explain higher behavioural intent indirectly through personal attitudes. High ratings of peer charting beliefs indirectly explain attitudes through subjective norms (β 0.20, p<.05). Perceptions of control over one's clinical actions (β −0.24, p<.05) and early warning system training (β −0.17, p<.05) directly contributed to fewer difficulties complying with documentation requirements. Prior difficulties when escalating care (β −0.31, p<.05) directly influenced the perceived value of escalating. The developed theory-based conceptual model identified sociocultural variables that inform compliance behaviour (documenting and escalation protocols). The model highlights areas of clinical judgement, education, interprofessional trust, workplace norms and cultural factors that directly or indirectly influence nurses' intention to comply with EWS protocols. Extending our understanding of the sociocultural and system wide factors that hamper nurses' use of EWSs and professional accountability has the potential to improve the compliance behaviour of staff and subsequently enhance the safety climate attitudes of hospitals. A newly developed model reports nurse's personal attitudes, peer influence, perceived difficulties encountered documenting and escalation beliefs all predict early warning system compliance behaviour.

中文翻译：

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识别影响护士遵守急性临床恶化早期预警系统的社会文化因素的理论框架：横断面调查


在医疗保健环境中系统地采用早期预警系统取决于用户的最佳且可靠的应用。心理社会问题和医院文化影响临床医生的患者安全行为。 (i) 使用理论驱动的行为模型研究影响护士 EWS 依从行为的社会文化因素，以及 (ii) 提出 EWS 依从行为的社会文化因素的概念模型。横断面调查。澳大利亚昆士兰州公立医院雇用的护士。使用便利和滚雪球抽样技术，符合资格的护士访问了专门的网站和包含封闭式和开放式问题的调查。来自60家医院的291名护士完成了调查。使用方差分析或检验来分析定量数据以测试平均值的差异。基于该理论进行了一系列路径模型以开发新模型。定向或理论驱动的内容分析为定性数据分析提供了信息。护士报告说，他们以前有很高的合规行为，并且有强烈的意愿在未来继续合规（M=4.7；SD 0.48）。个人合规态度（β 0.29，p<.05）、感知升级价值（β 0.24，p<.05）以及感知遵守文档的难易程度（β -0.31，p<.05）具有统计显着性，预测合规行为有 24% 的变化。积极的个人制图信念（β 0.14，p<.05）和主观规范都通过个人态度间接解释了更高的行为意图。同行图表信念的高评级通过主观规范间接解释了态度（β 0.20，p％3C.05）。对临床行为控制的看法（β -0.24，p<.05）和早期预警系统培训（β -0.17，p<.05）。05) 直接减少了遵守文件要求的困难。升级护理时先前遇到的困难 (β -0.31, p<.05) 直接影响升级的感知价值。开发的基于理论的概念模型确定了影响合规行为（记录和升级协议）的社会文化变量。该模型强调了直接或间接影响护士遵守 EWS 协议意愿的临床判断、教育、专业间信任、工作场所规范和文化因素等领域。扩大我们对阻碍护士使用 EWS 和专业责任的社会文化和系统范围因素的理解，有可能改善员工的合规行为，从而增强医院的安全氛围态度。新开发的模型报告了护士的个人态度、同伴影响、记录中遇到的困难以及升级信念，所有这些都可以预测早期预警系统的合规行为。