Purpose: This study applied the participative action research for improving patient safety culture of nurses working at an orthopedics hospital in the city of P. As result of try to induce falling and phlebitis rates and promote patient safety culture at orthopedic hospital. Method: In this study, eight participants had applied the action research model of Kemmis & Mctaggart (2000) for promotion patient safety culture from Jul. 17 to Sep. 24, 2017. This study is as methodological mixed research. developed and applied five action plants through the secondary circulation. Regarding data collection methods, pre and post surveys were conducted with quantitative data including patient safety culture, patient safety nursing activities, and preventive activities of falling and phlebitis; for falling and phlebitis rates, pre-survey, 1st post survey, and 2nd post survey were conducted. As qualitative data collection, focus group interview and personal interview data and participants'' reflection journals were collected. The collected quantitative data were analyzed with SPSS WIN 21.0, and patient safety culture, nursing activities of patient safety, and preventive activities of falling and phlebitis were analyzed with paired t-test. The number of falling and phlebitis cases was analyzed as real number, and the rates of falling and phlebitis were analyzed with percentage and Z-test. For qualitative data analysis, content analysis was applied to participants'' experiences, and then meaningful data were analyzed in terms of subcategory, category, and topic.
Result: the quantitative data collection in this study are presented as follows:
1. After paritcipatory action research, the post-survey score (3.52±0.24) of patient safety culture significantly increased more than the pre-survey score (3.27±0.52) (t=3.34, p=.002).
2. The post-survey score (4.36±0.25) of patient safety nursing activities significantly increased more than the pre-survey score (4.10±0.37) (t=4.24, p<.001).
3. The post-survey score (4.51±0.4) of falling preventive activities significantly increased more than the pre-survey score (3.33±0.85) (t=9.53, p<.001).
4. The post-survey score (4.55±0.41) of phlebitis preventive activities significantly increased more than the pre-survey score(3.95±0.71)(t=5.39, p<.001).
5. Falling rate decreased from 6.9% in pre-survey to 6.4% in 1st post-survey, and there was no statistical significance (Z=0.17. p=.863). But, the rate reduced to 0.9% in 2nd post-survey so that there was a statistically significant difference(Z=2.32, p=.020). Although the rate increased to 3.1% in 3rd post-survey, there was no statistical significance (Z=1.42, p=.155). The difference between the falling rates in 1st post-survey and in 2nd post-survey decreased significantly (Z=2.16, p=.031). Although the falling rate in 3rd post-survey increased more than that in 2nd post-survey, there was no statistical significance (Z=-1.17, p=.241).
6. Phlebitis rate decreased from 9.0% in pre-survey to 5.0% in 1st post-survey, but there was no statistical significance (Z=1.57, p=.116). Although the rate was a reduction between pre-survey and 2nd post-survey, there was no statistical significance (Z=1.35, p=.177). The rate was also a decrease between pre-survey and 3rd post-survey, but there was no statistical significance (Z=1.00, p=.315). Although the phlebitis rates in 1st post-survey and in 2nd post-survey increased, there was no statistically significant difference (Z=-0.27, p=.790). Also, although the phlebitis rates in 2nd post-survey and in 3rd post-survey increased, there was no statistically significant difference (Z=-0.38. p=.702).
The results of the qualitative data collection in this study are presented as follows:
According to the analysis on the final reflective contents after the secondary circulation, five categories and fifteen sub categories were drawn. Five categories were ''concern and fear'', ''patient safety culture activities are interesting'', ''the cooperation of hospital is needed'', ‘expectation of long-term patient safety culture activities'', and ''expectation of the future changes''.
In conclusion, it was found that this research was effective intervention to bring about personal and organizational changes and promote patient safety culture. Therefore, it will be necessary to repeat the participatiory action research of this study to verify that the research is helpful another sized hospital to improve practical skills and develop individuals and organizations.