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This article augments the existing body of literature through examining the creation and design of an instrument measuring unintended consequences (UCs) of electronic health records (EHRs). Data from a previous qualitative study that explored nurses' perceptions of EHR effectiveness as a communication system were analyzed using a theoretical model focused on decision making. The qualitative data, informed by the model, were then organized into an instrument seeking to quantitatively measure nurses' experiences with UCs of EHRs. The model assisted in revealing patterns in nurses' perceptions of the effectiveness of the EHR as a communication system that ultimately strengthened the development of the instrument. Instrumentation from qualitative data has long been considered an acceptable and positive approach to scale development. The process for accomplishing this goal has often been omitted from the literature. We contend that other researchers will find this methods article informative for similar undertakings., (© The Author(s) 2015.)

Aim To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects. Background Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. Methods A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys. Results Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. Conclusions Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. Implications for Nursing Management Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety. [ABSTRACT FROM AUTHOR]