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A Balance of Unsafe Care Incidents and Interactive Cooperative Care:
A Constructivist Grounded Theory Study of Safe Care Ecosystem for Older
Inpatients
1
L. Yan and X. Hu 1
1 West China School of Nursing, Sichuan University, China
Background: Research interest in the conceptualization of safe care for older inpatients was growing,
and these studies were predominantly reported from a single or healthcare perspective. There is a
shortage of literature on how non-medical groups conceptualize safe care.
Objective: This study aims to explore the safe care experience of non-medical groups and how this
relates to the safe care practice of older inpatients.
Methods: This is a constructivist grounded theory study reported using the Standards for Reporting
Qualitative Research checklist. Stage 1 included semi-structured interviews with inpatients. Stage
2 included semi-structured interviews with caregivers and six field notes. Purposive and theoretical
Oral Presentation Abstracts
sampling were used to recruit 61 participants across six healthcare institutions. Using constant
comparison, field notes, and memo writing, data analysis moved from initial coding to focused
coding, through to theoretical coding, resulting in the emergence of core concepts, categories, and
the theory.
Results: The substantive theory to emerge from the data is A balance of unsafe care incidents and
interactive cooperative care. This core concept is informed by four categories: unsafe care incidents;
interactive cooperative care; person-centered care; contextual conditions, and one care outcome.
The relationships between these categories constitute a balance in which patient-centered care is
the core, unsafe care incidents are the barriers, interactive cooperative care is the facilitator, and the
result of the balance is the care outcome. The balance constitutes a patient safety care ecosystem
under the interaction of contextual conditions.
Conclusion: Interactive cooperative care was vital in enabling care stakeholders to reduce the
occurrence of unsafe care incidents, which facilitated them to achieve safe care and further
construct a health care ecosystem. This theory identified barriers and facilitators encountered by care
stakeholders to cope with everyday problems, guides them in developing personalized care plans to
ensure patient safety.
Keywords: safe care, older inpatients, unsafe care incidents, constructivist grounded theory
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Correspondence: Lupei Yan, West China School of Nursing, Sichuan University, China
E-mail: charmingpei@qq.com
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