Relationships Between Nurses' Work System, Safety-Related Performance, and Outcomes: A Structural Equation Model

The relationship between perceived management commitment to safety, psychological empowerment, and safety performance among emergency nurses in Jordan

PURPOSE

Nurses are susceptible to unfavorable effects of workplace accidents and injuries, therefore, perceived management commitment to safety and psychological empowerment can help nurses to participate in safety measures and adhere to safety performance. Thus, this study aimed to examine the relationship between perceived management commitment to safety, psychological empowerment, and safety performance among emergency nurses in Jordan.

METHODS

A cross-sectional, descriptive correlational design was used and 306 registered nurses working in the emergency department in Jordanian governmental hospitals were recruited. A self-structured questionnaire consisting of the perceived management commitment to safety scale, psychological empowerment scale, and safety performance scale was used to collect data during the period from July 2022 to August 2022.

RESULTS

The findings demonstrated that the levels of study variables revealed as follows: the perceived management commitment to safety mean was 3.1 (SD = 0.66) out of 5, which indicated an acceptable level, the mean score of psychological empowerment was 5.37 (SD = 0.94) out of 7, which reflected that the nurses perceived the work environment to be psychologically empowered, and the mean score for safety performance was 4.02 (SD = 0.56) out of 5, which indicated an acceptable level of safety performance among the participants, and the mean for subscales (safety compliance and participation) was 4.07 (SD = 0.57) and 3.93 (SD = 0.69) out of 5, respectively. Also, there was a positive correlation between safety performance and perceived management commitment to safety (r = 0.334, p < 0.001), and psychological empowerment (r = 0.592, p < 0.001).

CONCLUSION

It is necessary to implement continuous interventions centered on empowering emergency nurses psychologically, which has a positive effect on safety performance. Given management's commitment to safety as a priority topic of discussion at group meetings creating a work environment that encourages nurses' safety performance should be encouraged.

Using an early warning score for nurse shift patient handover: Before-and-after study

PURPOSE

This study aimed to examine the impact of using an early warning score for shift patient handover on nurse and patient outcomes.

METHODS

A before-and-after study was conducted with nurses and patients in three general wards in a tertiary teaching hospital. A short-time nurse education on the National Early Warning Score 2 and the use of a checklist for score calculation were performed from June 4, 2019 to June 30, 2019. Outcomes of nurse response (safety competency, handover quality, teamwork, safety climate, and documentation of vital signs and clinical concerns), patient response (deterioration occurrence post-admission, hospitalization length, and discharge status), and adverse events (mortality, cardiopulmonary arrest, and unplanned intensive care unit admission) were measured using questionnaires and medical record reviews. Data from 89 nurses and 388 patients were analyzed.

RESULTS

Regarding nurse outcomes, handover quality (p <.001), teamwork (p = .004), safety climate (p = .018), and recordings of vital signs (p = .047) and clinical concerns (p = .008) increased after early warning score use. However, no significant change in the safety competency scores was observed. Regarding patient outcomes, there were no significant changes in the occurrence of deterioration, hospitalization length, discharge status, and occurrence of adverse events between pre-and-post intervention.

CONCLUSION

Despite no significant changes in patient outcomes, using a simple, evidence-based early warning score for patient handover enhanced socio-cultural factors for patient safety, with improved patient monitoring. The findings provide evidence that supports the active implementation of an early warning score to improve patient safety.