Lived Experiences of Staff Nurses' Participation in Quality Improvement Projects in a Secondary Hospital in Saudi Arabia: An Interpretative Phenomenological Analysis

Abstract

Background: Improving quality in healthcare is important for improving patient care, service efficiency and health outcomes. Staff nurses have good knowledge of what needs to be improved. However, barriers may limit their engagement in quality improvement (QI) activities. Aim: This study aimed to explore the lived experiences of staff nurses of barriers affecting their participation in quality improvement projects and to gain a deeper understanding of nurses’ perceptions of these barriers and the meanings they attach to them through Interpretative Phenomenological Analysis (IPA). Methodology: An IPA design was employed in a secondary hospital in Riyadh, Saudi Arabia, involving nine staff nurses selected through purposive sampling. Semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA). Transcripts were repeatedly reviewed, with exploratory comments and emergent themes developed through idiographic analysis and cross-case analysis to identify convergences and divergences across participants’ accounts. A double hermeneutic approach was used in interpreting participants’ lived experiences. The study’s trustworthiness was supported through credibility, dependability, confirmability, and transferability. Results: Six superordinate themes emerged: (1) Making Sense of QI as a Professional and Patient-Safety Responsibility; (2) Negotiating QI Within the Realities of Clinical Work; (3) Experiencing Organizational Conditions as Enabling or Constraining Participation; (4) Negotiating Voice, Recognition, and Professional Agency; (5) Becoming Through QI: Learning, Growth, and Professional Transformation; and (6) Experiencing QI as a Collective and Relational Practice. Participants described QI as a professional and patient-safety responsibility while experiencing workload, staffing, time, communication, leadership support, resources, and opportunities for meaningful participation as factors that could constrain or enable their involvement. Conclusion: The meaningful participation of staff nurses in quality improvement depends on the organization’s willingness and ability to create conditions that enable participation. The findings suggest that when nurses are given opportunities, support, recognition and meaningful involvement, participation in QI may strengthen their voice, confidence, professional agency and development.