Factors contributing to normalization of deviance among perioperative nurses

Abstract

Introduction

Patient safety in the operating room remains a global concern and perioperative adverse events continue to occur at unacceptable rates. Unidentified factors in a specific operating room cause perioperative nurses to deviate from standard operational procedures. Gradual and steady disconnection from written procedures occur. With repetition and the absence of immediate effect on the patient’s safety, these deviations become acceptable and normalized. If minor deviations are tolerated, it becomes the modus operandi. Normalization of deviance in the operating room is a reality and unsafe practice jeopardizes patient safety and adverse events occur. It was considered important to identify the contributing factors in the particular hospital. Aim

This study aimed to explore and describe the factors that contribute to normalization of deviances among perioperative nurses in a private hospital in South Africa. Research Design

Qualitative contextual, and descriptive study.

Methodology

Self-reported narrative guides were distributed to the total population of twenty perioperative nurses and nineteen shared their perceptions of contributing factors to normalization of deviance. Data were analysed using thematic analysis.

Findings

Three themes and twelve sub-themes were formulated. These themes and sub- themes explored and described the factors contributing to normalization of deviances in the operating room of a specific private hospital. The themes were related to governance, workplace culture and individual factors. Conclusion

The contributing factors to normalization of deviance among perioperative nurses in this particular hospital were described. Normalization of deviance, or the routine violation of safety practices, in the operating room of a private hospital was a concern since a gradual increase of adverse events were observed. The contributing factors were unknown and were explored and described in this study as being related to governance, workplace culture and individual factors. As a result, strategic planning according to these factors could be planned to decreased error and adverse events in the surgical environment; a supportive and transparent relationship between management and staff members could be established and potential system weaknesses could be identified and addressed to benefit patients, perioperative staff, and the organisation.

Keywords

adverse events, normalization of deviance, patient safety, perioperative nurse