title: 'It's a matter of patient safety': understanding challenges in everyday clinical practice for achieving good care on the surgical ward - a qualitative study.
abstract: BACKGROUND
  Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting.
  
  
  OBJECTIVE
  To explore situations and processes that support or hinder good safe patient care on the surgical ward.
  
  
  METHODS
  This qualitative study was based on a strategic sample of 10 department and ward leaders in three hospitals and six surgical wards in Sweden. Repeated reflective interviews were analysed using systematic text condensation.
  
  
  RESULTS
  Four themes described the leaders' view of a complex healthcare setting that demands effectiveness and efficiency in moving patients quickly through the healthcare system. Quality of care and patient safety were often hampered factors such as a shift of care level, with critically ill patients cared for without reorganisation of nurses' competencies on the surgical ward.
  
  
  CONCLUSIONS
  There is a gap between what is described in written documents and what is or can be performed in clinical practice to achieve good care and safe care on the surgical ward. A shift in levels of care on the surgical ward without reallocation of the necessary competencies at the patient's bedside show consequences for quality of care and patient safety. This means that surgical wards should consider reviewing their organisation and implementing more advanced nursing roles in direct patient care on all shifts. The ethical issues and the moral stress on nurses who lack the resources and competence to deliver good care according to professional values need to be made more explicit as a part of the patient safety agenda in the surgical ward.
authors.affiliation: Department of Surgical Sciences, Uppsala University and Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Jangland
authors.affiliation: Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Berit
authors.initials: B
authors.lastname: Nyberg
authors.affiliation: Research & Development Unit in Local Health Care and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Yngman-Uhlin
mesh_terms: D002983:Clinical Competence; D017598:Efficiency, Organizational; D006801:Humans; D061214:Patient Safety; D010563:Personnel Turnover; D036301:Qualitative Research; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000592:standards*; D013548:Sweden
keywords: ethics; leadership; patient safety; qualitative approaches; quality of care; surgical nursing; surgical ward