AimTo systematically review and synthesise qualitative research on nurses' experiences of speaking up in various contexts and to identify factors facilitating or impeding such a behaviour.DesignThis review was conducted as a qualitative metasynthesis, utilising the qualitative meta‐ethnography approach.MethodsA total of 6250 articles were screened. Two reviewers screened titles, abstracts and full texts. A total of 15 studies were included in this review. Researchers conducted a quality appraisal using the JBI critical appraisal checklist for qualitative research. An a priori protocol was created and registered on the Open Science Framework.Data SourcesLiterature searches were conducted in five international bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global) and five Korean databases (RISS, KISS, DBpia, KCI and NDSL).ResultsThree main themes were identified from the 15 studies used in the metasynthesis: (1) decisional complexity of speaking up, (2) motivators for speaking up and (3) barriers to speaking up. Nurses experienced challenges in speaking up. They were, and continue to be, concerned about negative responses. Hierarchy structure and poor work environment were identified as barriers to speaking up; professional responsibility and a supportive atmosphere were identified as facilitators for speaking up.ConclusionsThis review synthesised nurses' experiences of speaking up and influencing factors. Speaking up is crucial for nurses to improve patient safety, as frontline nurses are ideally positioned to observe early indicators of unsafe conditions in healthcare delivery.ImpactIdentified motivators and barriers of nurses' speaking‐up behaviour offer considerations and opportunities for healthcare leaders and managers. This could lead to improvement in patient safety through the establishment of a safety culture that facilitates nurses' speaking‐up behaviour.Reporting MethodThe review adhered to the ENTREQ guideline.Patient or Public ContributionNo patient or public contribution has been made in this review.

中文翻译：

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护士在医疗保健环境中发声的经验：定性元综合


AimTo 系统地回顾和综合了关于护士在各种情况下发声的经历的定性研究，并确定促进或阻碍这种行为的因素。设计本综述采用定性元综合，采用定性元民族志方法。方法共筛选出 6250 篇文献。两名评价员筛选了标题、摘要和全文。本综述共纳入 15 项研究。研究人员使用 JBI 批判性评估清单进行质量评估以进行定性研究。数据来源文献检索在五个国际书目数据库（MEDLINE、Embase、PsycINFO、CINAHL 和 ProQuest Dissertations and Theses Global）和五个韩国数据库（RISS、KISS、DBpia、KCI 和 NDSL）中进行。结果从元综合中使用的 15 项研究中确定了三个主要主题：（1） 直言不讳的决策复杂性，（2） 直言不讳的动机和 （3） 直言不讳的障碍。护士在发声时遇到了挑战。他们过去和现在都对负面反应感到担忧。等级结构和恶劣的工作环境被认为是发声的障碍;专业责任和支持性氛围被确定为畅所欲言的促进因素。结论本综述综合了护士的发声经验和影响因素。直言不讳对于护士提高患者安全至关重要，因为一线护士非常适合观察医疗保健服务中不安全情况的早期迹象。影响已确定的护士直言不讳行为的动机和障碍为医疗保健领导者和管理者提供了考虑因素和机会。这可以通过建立一种促进护士直言不讳的安全文化来改善患者安全。报告方法本综述遵循 ENTREQ 指南。患者或公众贡献本综述未对患者或公众做出贡献。