Date of Award
Spring 2025
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Committee Chairperson
Jacquelyn Owens, DNP, CRNP, FNP-BC
Committee Member
Lorie Fosbenner, DNP, RN, NE-BC, CCRN
Committee Member
Lisa Calvano, PhD
Abstract
The Department of Perioperative Services identified ongoing communication and cultural challenges that compromised team dynamics, psychological safety, and patient care. A culture of safety survey revealed a significant disconnect: while many staff felt comfortable raising safety concerns, nurses and ancillary support staff reported widespread experiences of disrespectful behavior—perceptions not shared by providers. In response, the department implemented the CUS+E (I’m concerned, I’m uncomfortable, this is a safety issue + Explanation) communication tool to enhance the real-time escalation of safety concerns. Project goals included increasing safety reporting, reducing adverse events, and improving staff confidence in raising concerns. Post-implementation surveys indicated that over half of staff and providers felt comfortable either using or responding to CUS+E. However, key limitations were noted, including low provider response rates, inconsistent tool adoption, and unchanged safety event reporting. Despite widespread awareness, the tool's use remained limited to nursing staff, with little application among providers and ancillary personnel. Obstacles like fear of retaliation, insufficient follow-up, and provider dismissiveness limited wider adaptation. The findings emphasize the importance of psychological safety, leadership role modeling, and sustained education to reinforce structured communication practices. While CUS+E shows potential to enhance team communication and empower staff, a more profound cultural shift is needed to ensure equitable participation and long-term impact. Recommendations include interdisciplinary education, strengthened feedback loops, and organizational efforts to foster a culture of mutual respect. This initiative highlights the critical link between team culture, communication, and patient safety in high-risk perioperative environments.
Recommended Citation
Thompson, Sunilka, "CUS+E: Creating a Culture of Safety Through Improved Communication Within Perioperative Services" (2025). West Chester University Doctoral Projects. 327.
https://digitalcommons.wcupa.edu/all_doctoral/327
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