Abstract：
BACKGROUND: Systematic adoption of early warning systems in healthcare settings is dependent on the optimal and reliable application by the user. Psychosocial issues and hospital culture influence clinicians\' patient safety behaviours.
OBJECTIVE: (i) To examine the sociocultural factors that influence nurses\' EWS compliance behaviours, using a theory driven behavioural model and (ii) to propose a conceptual model of sociocultural factors for EWS compliance behaviour.
METHODS: A cross-sectional survey.
METHODS: Nurses employed in public hospitals across Queensland, Australia.
METHODS: Using convenience and snowball sampling techniques eligible nurses accessed a dedicated web site and survey containing closed and open-ended questions. 291 nurses from 60 hospitals completed the survey.
METHODS: Quantitative data were analysed using ANOVA or t-tests to test differences in means. A series of path models based on the theory were conducted to develop a new model. Directed or theory driven content analysis informed qualitative data analysis.
RESULTS: Nurses report high levels of previous compliance behaviour and strong intentions to continue complying in the future (M=4.7; SD 0.48). Individual compliance attitudes (β 0.29, p<.05), perceived value of escalation (β 0.24, p<.05) and perceived ease or difficulty complying with documentation (β -0.31, p<.05) were statistically significant, predicting 24% of variation in compliance behaviour. Positive personal charting beliefs (β 0.14, p<.05) and subjective norms both explain higher behavioural intent indirectly through personal attitudes. High ratings of peer charting beliefs indirectly explain attitudes through subjective norms (β 0.20, p<.05). Perceptions of control over one\'s clinical actions (β -0.24, p<.05) and early warning system training (β -0.17, p<.05) directly contributed to fewer difficulties complying with documentation requirements. Prior difficulties when escalating care (β -0.31, p<.05) directly influenced the perceived value of escalating.
CONCLUSIONS: The developed theory-based conceptual model identified sociocultural variables that inform compliance behaviour (documenting and escalation protocols). The model highlights areas of clinical judgement, education, interprofessional trust, workplace norms and cultural factors that directly or indirectly influence nurses\' intention to comply with EWS protocols. Extending our understanding of the sociocultural and system wide factors that hamper nurses\' use of EWSs and professional accountability has the potential to improve the compliance behaviour of staff and subsequently enhance the safety climate attitudes of hospitals.
CONCLUSIONS: A newly developed model reports nurse\'s personal attitudes, peer influence, perceived difficulties encountered documenting and escalation beliefs all predict early warning system compliance behaviour.
OBJECTIVE: (i) To examine the sociocultural factors that influence nurses\' EWS compliance behaviours, using a theory driven behavioural model and (ii) to propose a conceptual model of sociocultural factors for EWS compliance behaviour.
METHODS: A cross-sectional survey.
METHODS: Nurses employed in public hospitals across Queensland, Australia.
METHODS: Using convenience and snowball sampling techniques eligible nurses accessed a dedicated web site and survey containing closed and open-ended questions. 291 nurses from 60 hospitals completed the survey.
METHODS: Quantitative data were analysed using ANOVA or t-tests to test differences in means. A series of path models based on the theory were conducted to develop a new model. Directed or theory driven content analysis informed qualitative data analysis.
RESULTS: Nurses report high levels of previous compliance behaviour and strong intentions to continue complying in the future (M=4.7; SD 0.48). Individual compliance attitudes (β 0.29, p<.05), perceived value of escalation (β 0.24, p<.05) and perceived ease or difficulty complying with documentation (β -0.31, p<.05) were statistically significant, predicting 24% of variation in compliance behaviour. Positive personal charting beliefs (β 0.14, p<.05) and subjective norms both explain higher behavioural intent indirectly through personal attitudes. High ratings of peer charting beliefs indirectly explain attitudes through subjective norms (β 0.20, p<.05). Perceptions of control over one\'s clinical actions (β -0.24, p<.05) and early warning system training (β -0.17, p<.05) directly contributed to fewer difficulties complying with documentation requirements. Prior difficulties when escalating care (β -0.31, p<.05) directly influenced the perceived value of escalating.
CONCLUSIONS: The developed theory-based conceptual model identified sociocultural variables that inform compliance behaviour (documenting and escalation protocols). The model highlights areas of clinical judgement, education, interprofessional trust, workplace norms and cultural factors that directly or indirectly influence nurses\' intention to comply with EWS protocols. Extending our understanding of the sociocultural and system wide factors that hamper nurses\' use of EWSs and professional accountability has the potential to improve the compliance behaviour of staff and subsequently enhance the safety climate attitudes of hospitals.
CONCLUSIONS: A newly developed model reports nurse\'s personal attitudes, peer influence, perceived difficulties encountered documenting and escalation beliefs all predict early warning system compliance behaviour.
摘要：
背景：医疗保健环境中预警系统的系统采用取决于用户的最佳和可靠应用。心理社会问题和医院文化会影响临床医生的患者安全行为。
目的：(i)研究影响护士EWS依从行为的社会文化因素，使用理论驱动的行为模型和（ii）提出EWS合规行为的社会文化因素概念模型。
方法：横断面调查。
方法：昆士兰州公立医院雇用的护士，澳大利亚。
方法：使用便利和滚雪球抽样技术，符合条件的护士访问了一个专门的网站和调查，其中包含封闭式和开放式问题。来自60家医院的291名护士完成了调查。
方法：使用ANOVA或t检验对定量数据进行分析，以检验均值的差异。基于该理论进行了一系列路径模型，以开发新的模型。定向或理论驱动的内容分析为定性数据分析提供了信息。
结果：护士报告以前的合规行为和未来继续遵守的强烈意愿（M=4.7；SD0.48）。个人依从性态度(β0.29，p<0.05)，提升的感知值(β0.24，p<.05)和遵守文档的感知容易或困难(β-0.31，p<.05)具有统计学意义，预测24％的合规行为变化。积极的个人图表信念（β0.14，p<.05）和主观规范都通过个人态度间接解释了更高的行为意图。同伴图表信念的高评级通过主观规范间接解释了态度(β0.20，p<.05)。对一个人的临床行动（β-0.24，p<.05）和预警系统培训（β-0.17，p<.05）的控制的认识直接导致了较少的困难遵守文件要求。升级护理时的先前困难(β-0.31，p<.05)直接影响了感知的升级价值。
结论：开发的基于理论的概念模型确定了告知合规行为的社会文化变量（记录和升级协议）。该模型突出了临床判断领域，教育,专业间的信任，直接或间接影响护士遵守EWS协议的工作场所规范和文化因素。扩展我们对阻碍护士使用EWS和专业问责制的社会文化和全系统因素的理解，有可能改善员工的合规行为，从而提高医院的安全氛围态度。
结论：新开发的模型报告了护士的个人态度，同伴影响，记录和升级信念所遇到的感知困难都可以预测预警系统的合规行为。
目的：(i)研究影响护士EWS依从行为的社会文化因素，使用理论驱动的行为模型和（ii）提出EWS合规行为的社会文化因素概念模型。
方法：横断面调查。
方法：昆士兰州公立医院雇用的护士，澳大利亚。
方法：使用便利和滚雪球抽样技术，符合条件的护士访问了一个专门的网站和调查，其中包含封闭式和开放式问题。来自60家医院的291名护士完成了调查。
方法：使用ANOVA或t检验对定量数据进行分析，以检验均值的差异。基于该理论进行了一系列路径模型，以开发新的模型。定向或理论驱动的内容分析为定性数据分析提供了信息。
结果：护士报告以前的合规行为和未来继续遵守的强烈意愿（M=4.7；SD0.48）。个人依从性态度(β0.29，p<0.05)，提升的感知值(β0.24，p<.05)和遵守文档的感知容易或困难(β-0.31，p<.05)具有统计学意义，预测24％的合规行为变化。积极的个人图表信念（β0.14，p<.05）和主观规范都通过个人态度间接解释了更高的行为意图。同伴图表信念的高评级通过主观规范间接解释了态度(β0.20，p<.05)。对一个人的临床行动（β-0.24，p<.05）和预警系统培训（β-0.17，p<.05）的控制的认识直接导致了较少的困难遵守文件要求。升级护理时的先前困难(β-0.31，p<.05)直接影响了感知的升级价值。
结论：开发的基于理论的概念模型确定了告知合规行为的社会文化变量（记录和升级协议）。该模型突出了临床判断领域，教育,专业间的信任，直接或间接影响护士遵守EWS协议的工作场所规范和文化因素。扩展我们对阻碍护士使用EWS和专业问责制的社会文化和全系统因素的理解，有可能改善员工的合规行为，从而提高医院的安全氛围态度。
结论：新开发的模型报告了护士的个人态度，同伴影响，记录和升级信念所遇到的感知困难都可以预测预警系统的合规行为。
