Getting the job done – Positive deviance in perioperative nursing and implications for patient safety


Sharon Bingham

University of Tasmania School of Health Sciences, Australia

: J Nurs Patient Care

Abstract


Despite the focus on perioperative patient safety, patients undergoing surgery continue to suffer adverse events that may result in death, disability or increased length of stay. Perioperative nurses’ clinical activities are directed towards the delivery of safe care and minimizing the risk of harm and are guided by rules and standards that support safe ways of working. The perioperative setting is dynamic with competing demands and pressures to get the get the job done. In responding to these pressures perioperative nurses may adopt ways other than following the rules to get the job done. The intent of this paper is to consider the concept of positive deviance as it applies to perioperative nurses’ practice and getting the job done. The paper draws upon a constructivist grounded theory study that used observations of practice and interviews to explore perioperative nurses’ practice. Findings demonstrate that in certain circumstances, perioperative nurses intentionally deviated from standards and rules. Using exemplars from the research, the paper examines whether these practices are consistent with the attributes of positive deviance. The imperative is to capture and scrutinize the potential benefits of positive deviance with the aim of keeping patient’s safe, meeting organizational demands and progressing professional practice.

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