Patient safety culture among nurses

Face Validity, Content Validity, and Psychometric Testing of the Hospital Survey on Patient Safety Culture Among Undergraduate Nursing Students

Background and Purpose: Nursing students have an essential role in patient safety. The purpose of this study was to evaluate the face validity, content validity, and psychometric properties of the Hospital Survey on Patient Safety Culture for Nursing Students (HSOPS-NS). Methods: The cross-sectional study was carried out between January and October 2021. The participants were undergraduate nursing students (N = 482) from 16 Czech nursing faculties. Results: Exploratory factor analysis revealed an 8-factor structure, which was verified by confirmatory factor analysis using the optimization process that results in adequate goodness-of-fit indices (root mean squared error approximation = .037; standardized root mean squared residuals = .056; comparative fit index = .935; Tucker-Lewis index = .926; incremental fit index = .936). The internal consistency of a new model was excellent (α = .914). Conclusion: The results indicate that the HSOPS-NS shows evidence of reliability and validity and is a valuable measure of safety culture as perceived by nursing students.

The effects of flipped learning and gamification on nursing students' patient safety education: A mixed method study

Background

The importance of enhancing education to promote nursing students' patient safety competency is increasing. Hence, implementing diverse educational programs and assessing their outcomes is essential.

Objectives

To examine the effects of flipped learning and gamification on nursing students' patient safety education.

Design

A mixed-method design employing a quasi-experimental design with a pre-post control group design and qualitative thematic analysis.

Methods

The study was conducted at a South Korean university in W City from September to December 2022. It included 55 s-year nursing students. The experimental group (n = 28) participated in a 30-h patient safety education course using flipped learning and gamification, whereas the control group (n = 27) received only written patient safety education materials. Learning motivation, collective efficacy, patient safety competency, and game evaluations were measured. Data were analyzed using the χ2 test, Fisher's exact test, t-test, repeated-measures multivariate analysis of covariance, repeated measure analysis of covariance, and generalized estimating equations. Self-reflection journals on game participation experiences were analyzed using qualitative thematic analysis.

Results

Learning motivation scores did not differ significantly between groups for time, or interactions between groups and time, but collective efficacy and patient safety competency scores showed significant differences in the interactions between groups and time. The experimental group showed a high satisfaction score in game evaluation. Qualitative analyses were used to extract four themes-three positives: "fun and immersion differentiated from existing classes," "improved the learning outcomes and learning motivation," and "realized the value of collaboration and communication," and one negative: "feeling down due to unfamiliarity."

Conclusions

This program creates positive learning experiences and enhances nursing students' collective efficacy and patient-safety competencies. It is expected to be utilized in various future nursing courses.

Assessment of patient safety culture in Moroccan primary health care: a multicentric study

BACKGROUND

Promoting patient safety is a critical concern for developing-countries health systems like Morocco. There is an increasing acknowledgment of the need to create a patient-centered culture with the aim to decrease the number of adverse events related to care and improve health-care quality in Morocco.

OBJECTIVE

The purpose of this study is to examine the perceptions of health professionals working in primary care level of care facilities in Morocco about the concept of patient safety culture.

METHODS

We conducted a multicentric cross-sectional study of a quantitative nature in primary healthcare facilities in ten Moroccan cities, measuring ten patient safety culture dimensions, from February 2022 to June 2022. Data was collected using the French version of the HSOPSC questionnaire.

RESULTS

The most developed dimension of the culture of patient safety was found to be Teamwork within Units (69%), followed by Supervisor/Manager's Expectations & Actions Promoting Patient Safety (59%). The least developed dimensions were Staffing (34%) and Nonpunitive Response to Errors (37%).

CONCLUSION

Improving patient safety culture should be a priority for primary healthcare facility administrators and all stakeholders, addressing, in particular, the shortage of human resources. In addition, health personnel should be encouraged to report errors without fear of punitive consequences.

The Relationship between Clinical Environment and Adverse Events Reporting: Evidence from Lithuania

BACKGROUND

The clinical environment plays a crucial role in patient safety, as it encompasses the physical, organizational, and cultural aspects of healthcare delivery. Adverse events, such as active errors, can often be attributed to systemic issues within the clinical environment. Addressing and improving environmental factors is essential for minimizing adverse events and enhancing overall patient care quality.

METHODS

A descriptive, cross-sectional design was applied. The study utilized two questionnaires: the Reporting of Clinical Adverse Events Scale (RoCAES) and the Revised Professional Practice Environment (RPPE) scale. A total of 1388 questionnaires were fully filled out, with a response rate of 71 percent.

RESULTS

Nurses who expressed higher levels of satisfaction with various aspects of the clinical environment were more inclined to indicate their intention to report adverse events in the future. These positive relationships suggest that a contented clinical environment fosters a greater willingness among nurses to report adverse event occurrences.

CONCLUSION

The findings of our study support the evidence that demonstrated that the clinical environment plays a significant role in influencing the reporting of adverse events in healthcare settings. It significantly influences nurses' attitudes, quality of care, and adverse event reporting rate.

Nursing students' patient safety competencies in the classroom and clinical settings: a cross-sectional study

INTRODUCTION

Patient safety is one of the critical indicators of providing qualified and high-quality health care services. Determining nursing students' patient safety competencies will significantly contribute to the literature. Therefore, this study aimed to investigate Iranian nursing students' patient safety competencies in classroom and clinical settings.

METHODS

In this cross-sectional study data were collected from 215 nursing of a university of medical sciences between February and May 2022, using a general questionnaire form and the Health Professional Education in Patient Safety Survey. Data analysis was done using descriptive and analytical statistics such as percentage, mean and paired-samples t-test.

RESULTS

The mean scores of nursing students' the Health Professional Education in Patient Safety Survey were 3.50 ± 0.55 in the classroom and 3.45 ± 0.57 in the clinical setting. The highest mean scores of nursing students were in subdimension of "clinical safety" in both the clinical (3.91 ± 1.13) and classroom settings (3.91 ± 0.78). In addition, a statistically significant difference was found in patient safety learning confidence in the classroom versus clinical setting in the "culture of safety" subdimension.

CONCLUSION

It appears that current educational programs provide opportunities to improve nursing students' patient safety, but they are not enough. Nurse educators should apply new teaching methods and evaluate clinical strategies to meet educational needs.

Strategies to prevent medical errors by nursing interns: a qualitative content analysis

BACKGROUND

Nursing interns often face the serious challenges and stress of clinical training. Identifying effective strategies in reducing medical errors can improve student performance and decrease patient risk and injury from errors. The purpose of this study was to identify strategies to prevent medical errors by nursing interns in Medical Universities in Sistan and Baluchistan, Southeast of Iran.

METHODS

This is a qualitative study using a content analysis approach. Purposive sampling was used. The study was conducted in 3 medical universities. Ten nursing interns participated in this study. Open-ended, semi-structured, and face-to-face, interviews were used to explore the experience of nursing interns about strategies to prevent medical errors during their internship.

RESULTS

Findings include 20 subcategories, 6 categories and one theme. The main theme is "strategies to prevent medical errors during internship". Six categories included "strategies to prevent medical errors during internship". These included "Professional acceptance and support", "Revision of the implementation of the educational curriculum", "Retraining courses for challenging skills", "Creating learning opportunities" "Professionalization", and "Facilities and requirements".

CONCLUSIONS

Preventing medical errors requires different strategies before and during nursing internship. Error prevention strategies include retraining and preparatory courses for challenging areas, evaluation of students' performance, and accepting students as members of the health care team, respecting and supporting them and protecting their rights. Learning from medical errors, analysis and reflection on errors should be part of the curriculum during the internship.

Paediatric nurses' burnout, quality of life and perceived patient adverse events during the COVID-19 pandemic: Testing an integrated model using structural equation modelling

PURPOSE

A model was hypothesised by integrating two theoretical models: the compassion satisfaction-compassion fatigue and empowerment models. This study aimed to assess the extent to which this integrated model can explain the relationships between paediatric nurses' burnout quality of life, perceived patient safety and work-related variables during the COVID-19 pandemic.

BACKGROUND

Nurses' burnout is negatively associated with quality of life (QOL) and positively with patient safety. Several theoretical models were introduced to explain burnout determinants and outcomes such as Golembiewski, Munzenrider and Stevenson model, Leiter and Maslach's process model, and Lee and Ashforth's model. However, few models described burnout in relation to QOL or patient safety.

METHODS

A sample of 225 paediatric nurses responded to questionnaires about burnout, QOL, adverse events and work-related variables. Compassion satisfaction - compassion fatigue and empowerment models were integrated into a single model and tested using structural equation modelling analysis. This study was prepared and is reported according to the STROBE checklist.

RESULTS

The final model explained 65% of the variance of burnout and 37% of the variance of QOL. The work-related variables (co-workers' support, job satisfaction, satisfaction with the monthly salary, participation in continuous education and exposure to violence) are predicting paediatric nurses' burnout and quality of life.

CONCLUSION

The Compassion satisfaction - compassion fatigue -Empowerment integrated model allows for assessing the different paths in the relationship between work-related variables and burnout.

RELEVANCE TO CLINICAL PRACTICE

These results might be essential for nursing managers to develop strategies that improve nurses' work environment and minimise their burnout during COVID-19 pandemic. These strategies should focus on enhancing co-workers' support, job satisfaction and participation in continuous education. Furthermore, paediatric nurses should be protected from any violence.

Nursing students' evaluation of patient safety culture in three central European countries: a cross-sectional study

OBJECTIVES

This cross-sectional study aimed to investigate and compare the perceptions of nursing students regarding patient safety culture (PSC) during the COVID-19 pandemic in three Central European countries.

METHODS

Data were collected from 624 nursing students between April and September 2021 using the Hospital Survey on Patient Safety Culture.

RESULTS

The evaluation of the PSC dimensions did not reach the expected level of 75 %. Significant associations were found between the perception of the dimensions of the individual PSC and age, student status, study year, and clinical placement. The overall patient safety grade, the number of events reported, and the number of events reported by nursing students were significantly predicted by several dimensions of the PSC (p<0.05).

CONCLUSIONS

The evaluation of patient safety culture by nursing students offers a unique perspective. Students come with 'fresh eyes' and provide different perspectives that can provide healthcare leaders with a practical opportunity to identify blind spots, review and improve safety protocols, and foster a more inclusive culture that prioritizes patient safety.

Work Climate, Improved Communication, and Cohesive Work Linked with Patient Safety Culture: Findings from a Sports Medicine Hospital

BACKGROUND

This study aims to investigate the patient safety culture at a sports medicine hospital and explore the quality of healthcare and associated factors.

METHODS

In a cross-sectional study design, the Hospital Survey on Patient Safety Culture (HSOPC) tool was administered online among staff at a sports medicine hospital in Doha, Qatar. Out of 898 staff who received an email invitation, 504 participated (56.1%).

RESULTS

The results showed that 48.0% of the staff rated the patient safety grade as excellent and 37.5% as very good, totaling 85.5%. Factors associated with excellent or very good patient safety grades were management support OR 4.7 95% CI (1.8 to 12.3); team communication OR 3.0 95% CI (1.4 to 6.3), supervisor action supporting patient safety OR 3.5 95% CI (1.7 to 7.0) and other items related to work area such as working together: OR 3.0 95% CI (1.2 to 7.6), helping out busy areas OR 2.5 95% CI (1.1 to 5.5) and having good procedures and systems: OR 2.8 95% CI (1.4 to 5.8).

CONCLUSIONS

Addressing management support, enhancing communication, and cohesive work within the work area facilitates a culture of trust that improves patient safety grades.

Staff Experiences in Managing Incidents in Nursing Homes: A Descriptive Qualitative Study

Introduction

Adverse incidents in nursing home (NH) may occur as the result of inadequate monitoring for signs of unobservable initial complications, medical errors, improper nursing interventions, lack of communication, and inadequate reporting.

Purpose

This study explores incident types, causes, handling, and documentation in Indonesian NHs through a qualitative approach.

Patients and Methods

In-depth interviews were conducted with 23 NH staff members, including managers, nurses, and support staff.

Results

Five themes and 17 sub-themes emerged, with falls and resident-to-resident abuse as common adverse incidents. Causes included older adults' conditions, environment, and misunderstanding. Follow-up action included first aid, hospital referrals, and assertive communication. Adverse incidents were actively reported through verbal and written reports or WhatsApp groups. Reports and documentation remain unstructured, however, as there were no standard operating procedures regarding incident reporting, documentation, and the types of adverse incidents that staff should report.

Conclusion

Improvements in management, documentation, and reporting adverse incidents are highlighted in this research. Practitioners, nurses, and social workers should develop guidelines for handling, reporting, and documenting adverse incidents in NHs.

The motivational factors and the perceived effects of attaining higher education among post-diploma graduate nurses and midwives in Kumasi, Ghana: A cross-sectional study

BACKGROUND

Globally, there has been increased demand for higher education in nursing and midwifery to support evidence-based practice. It is believed that higher education in nursing leads to improved quality of care. The motivation for pursuing higher education, the choice of institution for learning and the effects of higher education programs have not been given much attention in research literature in Ghanaq OBJECTIVE: To assess the motivating factors, reasons for the choice of institution and the perceived effects of attaining higher educational qualifications among post-diploma graduate nurses and midwives.

STUDY DESIGN

Descriptive cross-sectional study.

SETTING

Kumasi.

PARTICIPANTS

Convenience and snowball sampling were used to select 523 nurses and midwives who had pursued higher education after their Diploma in Nursing or Midwifery education.

METHOD

A researcher-developed questionnaire was used to collect data on motivation, choice of institution and perceived effects of higher education by nurses and midwives. Data were analyzed through descriptive statistics, Pearson correlation and linear regression at 0.05 significance level.

RESULTS

The greatest motivation for higher education by nurses/midwives was to improve clinical judgment. Academic quality and reputation of the institution were the main reasons for the choice of institution (n = 458, 92.7 %). There were weak but positive significant correlations between the perceived effects of higher nursing and midwifery education and pressure from the workplace (r = 0.204, p < .001), and increasing new demands from clients (r = 0.284, p < .001). Increasing demands from clients (β = 0.203, p < .001) and improving social status (β = 0.264, p < .001) were the motivating factors that influenced the perceived effects of higher nursing and midwifery education.

CONCLUSION

The desire for improved professionalism and increased expertise are the reasons nurses and midwives seek higher education. Health managers should support nurses and midwives to attain higher education to improve the quality of care.

Patient-Safety Culture among Emergency and Critical Care Nurses in a Maternal and Child Department

INTRODUCTION

The quality of healthcare has multiple dimensions, but the issue of patient safety stands out due to the impact it has on health outcomes, particularly on the achievement of the Sustainable Development Goals (SDGs), expressly SDG3. In the services that we propose to study, the patient-safety culture had never been evaluated.

AIM

To evaluate nurses' perceptions of the patient-safety culture in the Emergency and Critical Care Services of the Maternal and Child Department of a University Hospital and to identify strengths, vulnerabilities, and opportunities for improvement.

METHODS

This an exploratory, cross-sectional study with a quantitative approach, using the Hospital Survey on Patient Safety Culture as an instrument for data collection. The population were all nurses working in the emergency and critical care services of the maternal and child-health department, constituted, at the time of writing, by 184 nurses, with a response rate of 45.7%.

RESULTS

Applying the guidelines from the Agency for Healthcare Research and Quality (AHRQ), only teamwork within units had a score greater than 75%. For this reason, it is considered the strength (fortress) in the study. The lowest-rated were non-punitive responses to errors and open communication.

CONCLUSION

The overall average percentage score is below the benchmark of the AHRQ, indicating that issue of patient safety is not considered a high priority, or that the best strategies to make it visible have not yet been found. One of the important implications of this study is the opportunity to carry out a deep reflection, within the organization, that allows the development of a non-punitive work environment that is open to dialogue, and that allows the provision of safe nursing care.

Assessment of nurse's perceived just culture: a cross-sectional study

BACKGROUND

The non-punitive approach to error investigation in most safety culture surveys have been relatively low. Most of the current patient safety culture measurement tools also lack the ability to directly gauge concepts important to a just culture (i.e. perceptions of fairness and trust). The purpose of this study is to assess nurses' perceptions of the six just culture dimensions using the validated Just Culture Assessment Tool (JCAT).

METHODS

This descriptive, cross-sectional study was conducted between November and December 2020. Data from 212 staff nurses in a large referral hospital in Qatar were collected. A validated, self-reported survey called the JCAT was used to assess the perception of the just culture dimensions including feedback and communication, openness of communication, balance, quality of event reporting process, continuous improvement, and trust.

RESULTS

The study revealed that the overall positive perception score of just culture was (75.44%). The strength areas of the just culture were "continuous improvement" dimension (88.44%), "quality of events reporting process" (86.04%), followed by "feedback and communication" (80.19%), and "openness of communication" (77.55%) The dimensions such as "trust" (68.30%) and "balance" (52.55%) had a lower positive perception rates.

CONCLUSION

A strong and effective just culture is a cornerstone of any organization, particularly when it comes to ensuring safety. It places paramount importance on encouraging voluntary error reporting and establishing a robust feedback system to address safety-related events promptly. It also recognizes that errors present valuable opportunities for continuous improvement. Just culture is more than just a no-blame practice. By prioritizing accountability and responsibility among front-line workers, a just culture fosters a sense of ownership and a commitment to improve safety, rather than assigning blame.

Impact of Target Management Card on Patient Safety in the Emergency Department: A Mixed Methods Study

Purpose

This study aimed to investigate the potential impact of the Target Management Card on patient safety in the emergency department.

Patients and Methods

A mixed method design was developed, combining a one-group pretest-posttest design with a qualitative study. Target Management Cards were formulated for 32 emergency nurse practitioners and focus group interviews were conducted after the intervention. Wilcoxon's signed rank test was used to compare pre-test and post-test scores. The interview data were subject to content analysis.

Results

After developing the Target Management Card, there were significant improvements in safety behaviors (Z = 4.709, p < 0.01) and perception of patient safety (Z = 4.257, p < 0.01) among emergency nurse practitioners. The nurses in the focus group interviews agreed that the Target Management Card could improve patient safety by warning and supervising nursing work in the emergency department, promoting a positive change in nurses' attitudes and behaviors toward patient safety.

Conclusion

Our study found that nurses and nursing managers jointly formulating Target Management Cards in emergency departments significantly enhances patient safety.

Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals

BACKGROUND

The connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people.

METHODS

This cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture-norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff's professions and years of work experience.

RESULTS

The most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience.

CONCLUSIONS

This study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.

Psychometric properties of the Indonesian version of the nursing home survey on patient safety culture

INTRODUCTION

The development of resident safety culture in nursing homes (NH) represents a major challenge for governments and NH owners, with a requirement for suitable tools to assess safety culture. Indonesia currently lacks suitable safety cultures scales for NH.

OBJECTIVES

To evaluate the psychometric properties of the translated Indonesian version of the Nursing Home Survey on Patient Safety Culture (NHSOPSC-INA).

METHODS

This study was a cross-sectional survey conducted using NHSOPSC-INA. A total of 258 participants from 20 NH in Indonesia were engaged. Participants included NH managers, caregivers, administrative staff, nurses and support staff with at least junior high school education. The SPSS 23.0 was used for descriptive data analysis and internal consistency (Cronbach's alpha) estimation. The AMOS (version 22) was used to perform confirmatory factor analysis (CFA) on the questionnaire's dimensional structure.

RESULTS

The NHSOPSC CFA test originally had 12 dimensions with 42 items and was modified to eight dimensions with 26 items in the Indonesian version. The deleted dimensions were 'Staffing' (4 items), 'Compliance with procedure' (3 items), 'Training and skills' (3 items), 'non-punitive response to mistakes' (4 items) and 'Organisational learning' (2 items). The subsequent analysis revealed an accepted model with 26 NHSOPSC-INA items (root mean square error of approximation = 0.091, comparative fit index = 0.815, Tucker-Lewis index = 0.793, CMIN = 798.488, df = 291, CMIN/Df = 2.74, GFI = 0.782, AGFI = 0.737, p < 0.0001) and a factor loading value of 0.538-0.981. Expert feedback confirmed the relevance of the instrument items (content validity index [CVI] = 0.942).

CONCLUSION

The modified NHSPOSC-INA model with eight dimensions (26 items) fits the data set in the context of Indonesian NH services.

IMPLICATIONS FOR PRACTICE

The NHSPOSC-INA is a valid and reliable instrument for assessing staff perceptions of NH resident safety culture in Indonesia. The questionnaire can now be used to evaluate interventions for resident safety in Indonesian NH.

The association of patient safety culture with intent to leave among Jordanian nurses: a cross-sectional study

BACKGROUND

The existence of patient safety culture is crucial for healthcare providers' retention, particularly for nurses. Patient safety culture is getting more attention from healthcare organizations worldwide, and Jordan is no exception. Nurses' satisfaction and retention are paramount to providing safe, high-quality patient care.

PURPOSE

To investigate the relationship between patient safety culture and intent to leave among Jordanian nurses.

METHODS

A descriptive cross-sectional design was used. A sample of 220 nurses was selected through convenience sampling from one governmental and one private hospital in Amman. The patient safety culture survey and anticipated turnover scale were used to collect data. Descriptive statistics and Pearson r correlation were used to answer the research questions.

RESULTS

The findings showed that nurses had 49.2% positive scores for patient safety. Teamwork (65.3%) and handoff and exchange of information (62% each) had the highest scores, while staffing and workplace (38.1%) and response to error (26.6%) had the lowest. Moreover, nurses had strong intentions to leave their jobs (M = 3.98). A moderately significant but not highly negative relationship existed between patient safety culture and intent to leave (r = -0.32, p = 0.015).

CONCLUSIONS

There are opportunities to improve patient safety culture, satisfaction, and nurse retention in Jordanian hospitals by implementing several recommendations, such as ensuring better staffing patterns and increasing staff motivation by utilizing various available methods.

Status and Factors Affecting Patient Safety Culture at Dilla University Teaching Hospital: A Mixed-Method Cross-Sectional Study

Background

Patient safety culture is now at the forefront of the global health agenda and has been designated as a human right. Assessing safety culture is seen to be a prerequisite for improving safety culture in health-care organizations. However, no research has been conducted to examine the current study setup. Therefore, this study aims at assessing the status and factors influencing patient safety culture at Dilla University Teaching Hospital.

Methods

This cross-sectional institutional-based study was conducted from February to March 2022 at Dilla University Hospital. The study used both qualitative and quantitative methods. A total of 272 health professionals were included in the survey. The qualitative data was collected using Key Informant Interviews and In-depth Interviews and 10 health professionals were selected purposively to meet the study objective.

Results

The overall composite positive patient safety culture response rate in the current study hospital was 37% (95% CI: 35.3, 38.8). Out of the 12 dimensions, teamwork within hospital units was the highest (75.3%), while frequency of event reporting was the lowest (20.7%) positive percentage response. Only two of the 12 dimensions scored above 50%. Factors affecting patient safety culture majorly at organizational and individual level were poor/low attitude of health professionals, poor documentation practice, and poor cooperation by clients, lack of training and continuous education, lack of standard operating procedure, Staff shortage and high work load.

Conclusion

This study revealed that the overall composite positive patient safety culture response rate within the surveyed facility was alarmingly low compared to other hospitals in various countries. The results indicate that there is a need for improvement in areas such as event reporting, documentation, health-care workers' attitude, and staff training. Hospitals must prioritize patient safety by cultivating a strong safety culture through effective leadership, adequate staffing, and education to enhance overall patient care.

Patient safety culture and associated factors among nurses working at public hospitals in Gamo Zone, Southern Ethiopia

BACKGROUND

Patient safety culture is the prevention of errors and adverse effects to patients associated with health care delivery. It is a vital component in the provision of quality care. In healthcare settings where there is a safety culture, the people (providers, staff, administrators, and patients/families) are engaged, encouraged, and supported to make care safer. Though it is an essential component in the provision of quality care, little is known about its level, contributory, and hindering factors from the nurses' perspectives. This study aimed to assess patient safety culture and associated factors among nurses working at public Hospitals in Gamo Zone, Southern Ethiopia.

METHODS

This institution-based cross-sectional study was conducted among 398 nurses working at public hospitals in Gamo Zone. Data were collected by pretested, well-structured self-administered questionnaire from June 1 to 30, 2022. The collected data were checked, coded, and entered into Epi-data version 4.6.0.2 and were exported to SPSS version 25 for analyses. Bivariable and multivariable logistic regression was done to identify independent factors associated with patients' safety culture.

RESULTS

This study revealed that 202(50.8%), 95% CI: (46%-56%) of the participants had indicated good patient safety culture. From factors analysis, having an educational status of a bachelor's degree and above [AOR = 2.26, 95%CI: (1.13-4.52)], working in a surgical ward [AOR = 5.48, 95%CI: (1.96-15.34)], not being blamed when medical errors happened [AOR = 3.60, 95%CI: (1.82 - 7.14)], and working 40 up to 49 h per week [AOR = 0.30, 95%CI: (0.13 - 0.74)] were identified to be significantly associated with good patient safety culture.

CONCLUSION

Based on the study findings, it could be observed that good patient safety culture was indicated only by half of the study participants. Implementing actions that support dimensions of patient safety culture, and creating opportunities for continuous educational advancement is recommended. Moreover, Hospital administrators, nurses' directors, and healthcare policy-makers should work in collaboration to improve the patient safety culture, and also it would be better to create a blame-free environment to promote event reporting practices.

Association between the Nursing Practice Environment and Safety Perception with Patient Safety Culture during COVID-19

AIMS

In this study, we aimed to identify the relationship between nursing practice environments (NPEs) and safety perceptions with patient safety culture (PSC) during COVID-19.

DESIGN

We conducted a quantitative, non-experimental, correlational, and cross-sectional study. We interviewed 211 nurses from Peru using two scales: PES-NWI and HSOPSC. We used the Shapiro-Wilk test and Spearman's coefficient and estimated two regression models.

RESULTS

NPE was reported as favorable by 45.5% of the participants, and PSC was reported as neutral by 61.1%. Safety perception, the workplace, and NPE predict PSC. All NPE factors were correlated with PSC. However, safety perception, support of nurses subscale, the nurse manager's ability, and leadership were predictors of PSC.

CONCLUSION

To promote a safe work culture, health institutions should foster leadership that prioritizes safety, strengthens managers' abilities, encourages interprofessional collaboration, and considers nurses' feedback for constant improvement.

Exploring the Knowledge Structure of Patient Safety in Nursing Using a Keyword Network Analysis

Patient safety is a critical and long-standing issue in nursing research. The purposes of this study were to explore the knowledge structure of patient safety and to provide a direction for future research by offering new perspectives and a theoretical clarification of patient safety in nursing. Keyword network analysis was performed by extracting keywords from abstracts of 6072 published articles. To reflect nursing perspectives, focus group interviews were conducted and Kim's typology consisting of four domains was used as the framework of analysis. Visualized knowledge structure showed avoiding medication error and preventing pressure ulcers or falls remain important topics within this research field. The distribution of core keywords as per four domains was in the following order: practice, client, environment, and client-nurse domain. Within the client domain, patients' harm-related core keywords were limited to physical harm. The detailed knowledge structure consisted of five themes: patient, preventable patient harm, practice, error, and environment. It comprised risk assessment for patients' characteristics and environmental elements surrounding patient and nursing practice, and risk management using information as knowledge-based nursing practice. Regarding further research, we suggest a multidimensional approach to patient harm, and the utilization of the client-nurse relationship and information systems as strategies for patient safety.

Nurses' Perceptions of Patient Safety on Patient Safety Climate

PURPOSE

The purpose of this study was to determine the relationship between nurses' perception of patient safety and the safety climate.

DESIGN

Descriptive study.

METHODS

The sample consisted of 262 surgical nurses. Data were collected with an online questionnaire system using the Leiden Operating Theatre and Intensive Care Safety (LOTICS) Scale and Patient Safety Climate (PSC) Scale.

FINDINGS

Intensive care unit (ICU) nurses were found to have higher perceptions of patient safety (106.0 ± 15.2 vs 102.6 ± 17.0) and safety climate (59.2 ± 20.9 vs 50.9 ± 24.3) than Operating Room (OR) nurses. According to ICU nurses, OR nurses stated that teamwork was weak, they did not feel like a part of the team, and teamwork was incompatible. They stated that there was no preliminary information about the operation, that they could not get enough information during the operation, that sufficient materials were not available in the OR in case of need, and that the worn-out materials were not replaced and repaired in a timely manner.

CONCLUSION

As nurses' perception of patient safety increases; patient safety climate perceptions also increased. Providing both professional and in-service trainings to raise awareness of patient safety, developing strategies that prevent team conflicts, providing preliminary information about the surgery, and eliminating material deficiencies can increase nurses' perception of PSC.

Hospital Work Conditions and the Mediation Role of Burnout: Residents and Practicing Physicians Reporting Adverse Events

Background

"Patient Safety" in everyday practices is a target of healthcare leaders, and adverse events reported by healthcare providers directly reflect patient safety in the health system. Recognising how residents and practising physicians rate adverse events concerning their work conditions and burnout must be explored.

Objective

This study aims to explore the mediation effect of burnout dimensions (emotional exhaustion and burnout-interpersonal disengagement) between the effects of work conditions on perceived patient safety by exploring the adverse events that residents and practising physicians reported.

Methods

A quantitative and cross-sectional study collected data from 249 residents and practising physicians in a huge teaching hospital and primary health care centre (PHC) in the Eastern Province of Saudi Arabia. Hayes Macro regression analysis was employed to evaluate the multiple mediation effect of burnout dimensions, with 5000 bootstrapping and a confidence interval (CI) of 95% for statistical inference and p≤0.05 for the significance level.

Results

Leadership support (B= 0.39, t= 6.24, p<0.001) and physician engagement (B=0.43, t=6.50, p<0.001) were associated with a decreased rate of adverse events to patient safety, whereas workload (B=-0.23, t=-3.73, p<0.001) was negatively associated with an increased rate of adverse events. Burnout was shown to mediate the relationship between the effects of physician's leadership support (R²=0.26, F=27.50, p<0.001), work engagement (R²=0.25, F=27.07, p<0.001) and workload (R²=0.23, F=24.23, p<0.001) on the rate of adverse events.

Conclusion

This study provides insights into burnout dimensions and their consequences on patient safety indicators (ie, adverse events). Work conditions (ie, leadership support, physician engagement, and workload) directly affect the rate of adverse events and indirectly through mediators like burnout-emotional exhaustion and burnout-interpersonal disengagement.

Prevalence of falls, incontinence, malnutrition, pain, pressure injury and restraints in home care: A narrative review

Global demographic changes and the strategy of 'ageing in place' will increase the importance of home care in the future. To deliver safe and high-quality care, clinical data on nursing-sensitive indicators and transparency are needed. A comprehensive narrative review of the literature was conducted to describe the prevalence and incidence of nursing-sensitive indicators, namely, falls, incontinence, malnutrition, pain, pressure injury and restraints in home care. A literature search was carried out in May 2021 in PubMed and CINAHL, and 28 studies were included. Data were extracted using two extraction tables designed for this review. Prevalence and incidence rates varied widely and internationally within each indicator. The prevalence range for falls was 4.8%-48%; urinary incontinence, 33.7%-62.5%; malnutrition, 20%-57.6%; pain, 6.5%-68.5%; pressure injury, 16%-17.4% and physical restraints, 5%-24.7%. Due to various measurements and different instruments, the rates are not comparable. The use of standardised measurement and risk assessment tools to assess nursing-sensitive indicators in home care is needed to implement suitable interventions and to prevent these indicators.

Patient safety culture in Austria and recommendations of evidence-based instruments for improving patient safety

This study aimed to investigate the patient safety culture in Austria. We identified factors that contributed to a higher degree of patient safety and subsequently developed evidence-based suggestions on how to improve patient safety culture in hospitals. Moreover, we examined differences in the perception of patient safety culture among different professional groups. This study used a cross-sectional design in ten Austrian hospitals (N = 1,525). We analyzed the correlation between ten patient safety culture factors, three background characteristics (descriptive variables), and three outcome variables (patient safety grade, number of adverse events reported, and influence on patient safety). We also conducted an analysis of variance to determine the differences in patient safety culture factors among the various professional groups in hospitals. The findings revealed that all ten factors have considerable potential for improvement. The most highly rated patient safety culture factors were communication openness and supervisor/manager’s expectations and actions promoting safety; whereas, the lowest rated factor was non-punitive response to error. A comparison of the various professional groups showed significant differences in the perception of patient safety culture between nurses, doctors, and other groups. Patient safety culture in Austria seems to have considerable potential for improvement, and patient safety culture factors significantly contribute to patient safety. We determined evidence-based practices as recommendations for improving each of the patient safety factors.

Nurses' Perception of Patient Safety Culture in Primary Care During the COVID-19 Pandemic: A Preliminary Results

Investigation of nurses' perceptions of patient safety culture (PSC) might be beneficial in identifying safety areas that need improvement, especially during the COVID-19 pandemic. The study reports on the PSC in primary care from the nurses' perspective during the pandemic. Nurses (n = 117) evaluated teamwork (87.3%) and staff training (80.9%) positively but work pressure and pace (26.1%) and patient care tracking (45.3%) concerning PSC dimensions negatively. Limited care coordination and continuity lead to patient hospitalizations and care fragmentation. However, regular assessment of PSC can lead to adopting the necessary strategies to reinforce weaknesses and thus improve patient safety in primary care.

Assessing managerial patient safety practices that influence adverse events reporting among nurses in the Savannah Region, Ghana

Introduction

Patient safety is a global concern for both health professionals and the public. Studies show that evaluating patient safety culture can help improve patient safety outcomes. Nursing care strategically places nurses at the centre of patient safety promotion and their proximity to patients makes them the drivers of patient safety. Managerial decisions regarding patient safety impact greatly on patient safety outcomes in the healthcare organization. This study aimed to assess the managerial patient safety practices that influence adverse event reporting in three hospitals in the Savannah Region of Ghana.

Methods

A quantitative cross-sectional design was used to collect data from 210 participants in three hospitals. Data were analysed using descriptive, Pearson's correlation and linear regression.

Results

It was found that patient safety practices with good positive rating scores were management support (56.6%), managers' expectations (62.8%) and feedback about errors (56.2%). Areas with weak patient safety practices were staffing levels (42.4%), open communication (40.2%) and non-punitive response to errors (36.7%). Again, nurses' attitude towards adverse events reporting was generally low (37.3%). Managerial patient safety practices that had significant associations with adverse events reporting were management support ( r = .18, p < .001), open communication ( r = .19, p < .001), non-punitive to errors ( r = .21, p < .001) and feedback about errors ( r = .37, p < .001). Again, the significant predictors of adverse events reporting were feedback about errors ( β  =  .36, p < .001) and non-punitive response to errors ( β  =  .21, p  < .01).

Conclusion

Nurses perceived patient safety culture in their units to be good. Although nurses' attitude towards adverse events reporting was low, the significant predictors of adverse events reporting were feedback about errors and non-punitive response to errors. Therefore, healthcare managers should continually strengthen patient safety to ensure optimal care outcomes.

Implications for nursing practice

Feedback on errors and non-punitive response to errors had a great influence on adverse events reporting, managerial failure to provide feedback and a non-punitive work environment could result in under-reporting of adverse events. This can be a major threat to patient safety; hence clinical practice should be aware of this and put in strategies to appropriately address them.

Patient safety culture in Palestine: university hospital nurses' perspectives

Background

Understanding the perspectives of healthcare workers toward patient safety-related activities is critical in maintaining a healthy safety climate. The objectives of this research are 1) to examine the perception of Patient Safety Culture (PSC) at a university hospital in Palestine, and to highlight areas in need of improvement, and 2) to assess the relationship between the outcome dimensions (frequency of events reported, and overall perceptions of safety) and the other dimensions of PSC, and 3) to determine the relationship among selected demographic variables (gender, age, hospital tenure, work tenure, profession tenure, and hours worked per week) and nurses’ perceptions of PSC.

Methods

A cross-sectional study design was used with a convenience sample of 107 nurses. Nurses were asked by email to complete the Arabic version of the Hospital Survey of Patients’ Safety Culture (HSOPSC) using the SurveyMonkey® online account form within two weeks. The survey data were analyzed using descriptive and inferential statistics. Univariate and multiple regression were used to examine the relationships.

Results

The dimensions of patient safety with the highest positive response were organizational learning and continuous improvement (87%) and teamwork within units (86%). The dimension with the lowest positive score was the nonpunitive response to error (22%). Multiple regression revealed that the dimension of communication openness was a predictor of the overall perceptions of safety (β = 0.257, p = 0.019). In addition, the dimension of feedback and communication about error was a predictor of the frequency of the reported events (β = 0.334, p = 0.005). Furthermore, age was found to be a predictor of PSC (p < 0.05).

Conclusions

This study provides a general assessment of perceived safety among nurses in a hospital. However, we found that nurses negatively perceive a nonpunitive response to error. Therefore, strenuous efforts are required by hospital management to improve the culture of incident reporting.

A qualitative exploration of cultural safety in nursing from the perspectives of Advanced Practice Nurses: meaning, barriers, and prospects

BACKGROUND

Cultural safety requires healthcare professionals and organisations to improve healthcare, facilitate patient access to healthcare, and achieve equity within the workforce.

METHODS

This ethnomethodological study, which consisted of two phases, explored the concept of cultural safety from the perspective of Advanced Practice Nurses. Semi-structured interviews and the nominal group technique were used to prioritise challenges related to cultural safety, identify barriers to clinical practise and assess educational needs. The data collected was subjected to thematic analysis.

RESULTS

Nurses working in Austria, Germany and Switzerland were recruited (N = 29). Accordingly, the phenomenon of cultural safety in health care is not generally known and there is little prior knowledge about it. The most frequently discussed themes were communication difficulties, lack of knowledge, the treatment of people with insufficient language skills and expectations of treatment goals and outcomes, which can lead to conflicts and accusations of unequal treatment due to diverse cultural backgrounds.

CONCLUSION

Diverse cultures are encountered in German-speaking healthcare settings. Cultural safety is also about healthcare staff, as nurses with different socialisations encounter prejudice, discrimination and racism. Although the issue of power was not discussed, academic nurses were willing to make an effort to change. Only a minority were aware that lasting change requires challenging one's own cultural structures and adapted behaviours, rather than pushing for the mere acquisition of cultural competence. Organisations were encouraged to introduce self-reflection sessions and provide better access to translation services to improve equity and support nurses.

The Influence of Workplace Factors on the Nursing Work Environment: A Study Before and After COVID-19

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted the world and healthcare settings, particularly regarding onerous job responsibilities and changes in work culture for nurses. Nurses, known to provide skilled, compassionate, and humanitarian care to patients and families, require continual assistance and organization. Nurses must work in a good environment that encourages them to achieve their highest levels of performance and productivity to offer high-quality and safe care. Commitment to a nursing career necessitates professional dedication especially during times of crisis, as is in the case of the COVID-19 pandemic.

Objectives: The study looked at the elements that influenced nursing work culture at Sultan bin Abdul Aziz Humanitarian City (SBAHC) Riyadh, Saudi Arabia during the COVID-19 epidemic. Leadership, satisfaction, teamwork, nurse behaviour in practice, and professional commitment were among these elements. The factors are interrelated together and help in shaping the nursing work culture considering the COVID-19 scenario.

Methods: A hospital-based cross-sectional study was conducted from January 2020 to December 2020, covering a period before the outbreak of COVID-19 and a period after. The study, conducted at SBAHC, Riyadh, Saudi Arabia, followed a quantitative, positivist approach undertaken in two phases utilizing an analytical survey design before and after the COVID-19 pandemic. An initial electronic survey was distributed to 439 nurses at SBAHC nursing units. Three hundred twenty-two nurses participated in the first survey and the second survey responses after COVID-19 were 205 nurses.

Results: There was a significant difference between the two groups in their responses (p<0.05). In all five scales used, the score of mean declined in the ‘after' group, clearly showing the effect of all the five elements that influence nursing work culture due to the COVID-19 pandemic.

Conclusion: The study concluded that the workplace factors influencing the nursing work environment were greatly affected due to the COVID-19 outbreak in Saudi Arabia. The findings of this study should be considered by nurse managers and leaders when drafting the policies and programs to reduce the negative impact of COVID-19 on nurse retention. It should also provide baseline information that will allow health authorities to prioritize training programs that will support nurses during difficult times.

Stepwise Interactive Situated Training Program for Young Nurses’ Safety Behavior and Interrupted Coping Behavior

Young nurses’ safety behavior and interrupted coping behavior affect patient safety. A stepped, interactive and situated training program should be evaluated to assist young nurses in improving themselves. This study aimed to evaluate the effect of the stepwise interactive situated training program on safety behavior and practice ability with respect to nursing interruptions for young nurses and its influencing factors. This was a quasi-experimental, one-group, self-control and pretest–post-test design study. Six hundred young nurses in two provinces were included. The participants underwent a stepwise interactive situated training program from March to August 2019. The program was delivered by designated head nurses and consisted of five themes: mobilization, theoretical training, operational training, specialized training and self-improvement. Five hundred and sixty-two young nurses completed this study. The safety behavior and the practice of nursing interruption were significantly higher after intervention than before. Professional titles, age and occupational time were the influence factors. The stepwise interactive situated training program was effective at improving young nurses’ safety behavior and interrupted coping behavior. Nurses with higher professional titles performed better with regard to the safety behavior and the practice of nursing interruption.

Nursing Students’ Perception of Patient Safety Culture During the Covid-19 Pandemic – Results of a Pilot Study

Introduction: The COVID-19 pandemic posed health and social threats and directly affected the quality and safe care. Many nursing students had mandatory practical training in hospitals to help the national system respond to the crisis. The investigation of nursing students’ perceptions of patient safety culture (PSC) might be beneficial in identifying safety areas that need improvement.

Aim: The pilot study aimed to investigate nursing students’ perception of PSC during the second wave of the COVID-19 pandemic.

Methods: The data were collected using the Hospital Survey on Patient Safety Culture - Nursing Students (HSOPS-NS). The HSOPS-NS tool was distributed online via the Google Forms platform between February and April 2021. The respondents studied in the 3rd year of the bachelor’s degree in nursing (n = 66). Three nursing faculties from 3 regions in Slovakia were addressed. Descriptive statistics (mean, SD, frequency) was used for the sample characteristics and the HSOPS-NS tool. The Mann-Whitney U test and the Kruskal Wallis test analysed associations between sociodemographic data. The predictors of outcome dimensions of the HSOPS-NS were analysed by a multiple regression analysis.

Results: The nursing students evaluated the overall patient safety grade as very acceptable. Concerning PSC dimensions, the best-rated dimensions were “Feedback & communication about the error” (55.04%) and “Communication openness” (53.53%). The worst-rated dimensions were “Frequency of events reported” (33.32%) and “Staffing” (35.22%). A significant relationship was found between the perception of PSC and age, current area/unit, awareness of reporting systems, and supervision. The overall patient safety grade, the number of reported events, the number of reported events by nursing students were significantly predicted by several PSC dimensions (p ≤ 0.05).

Conclusions: The nursing students’ perspective on PSC revealed a weak perception of reporting adverse events. The awareness of reporting adverse events requires an increase in theoretical knowledge and the support of nursing students during their clinical training. A regular and comprehensive evaluation of PSC may strengthen patient safety and the overall awareness of patient safety among nursing students.

Cross-culture adaptation and validation of the Indonesian version of the Hospital Survey on Patient Safety Culture (HSOPSC 2.0)

Background

Hospital Survey on Patient Safety Culture (HSOPSC) is considered one of the most scientifically rigorous tools available with excellent psychometric properties. However, it is not yet available in an Indonesian version.

Objective

This study aimed to determine the validity of the content and psychometric properties of HSOPSC 2.0 for use in Indonesian hospitals.

Methods

The study was divided into three stages: translation, adaptation, and validation. Culture-adaptation was assessed using cognitive interviews with ten direct care nurses who worked in the hospital to evaluate their perceptions and the coherence of the translated items, response categories, and questionnaire directions. Content validity was also done by ten experts from academic and clinical settings. Finally, Confirmatory Factor Analysis (CFA) and reliability testing were conducted among 220 nurses from two Indonesian hospitals.

Results

The cognitive test results indicated that the language clarity was 87.8 % and 84.5% for cultural relevance. The Content Validity Index (CVI) ranged between 0.73 to 1.00, while the construct validity results indicated that each factor had factor loadings above 0.4, from 0.47 to 0.65. The fit indices showed an acceptable fit for the data provided by the 10-factor model, with RMSEA = 0.052, SRMR = 0.089, and CFI = 0.87. The Pearson correlation coefficients between the ten subscales ranged from 0.276 to 0.579 (p < 0.05). The Cronbach's alpha for all sub-scales was more than 0.70, except for organizational learning - continuous improvement, response to error, and communication openness.

Conclusion

This study offers initial evidence of the psychometric properties of the Indonesian-HSOPSC 2.0. Future studies are needed to examine its psychometric features to improve generalizability. However, nurses and other healthcare professionals could use the tool to measure hospital patient safety culture in Indonesia.

Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking

Background

Patient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses’ point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes.

Methods

A cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis.

Results

The results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in “Staffing” to 53.8% in “Teamwork across Hospital Units”. Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p <  0.05).

Conclusions

This is one of few studies that examine nurses’ perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

Assessing patient safety culture in 15 intensive care units: a mixed-methods study

BACKGROUND

Within hospitals, intensive care units (ICUs) are particularly high-risk areas for medical errors and adverse events that could occur due to the complexity of care and the patients' fragile medical conditions. Assessing patient safety culture (PSC) is essential to have a broad view on patient safety issues, to orientate future improvement actions and optimize quality of care and patient safety outcomes. This study aimed at assessing PSC in 15 Tunisian ICUs using mixed methods approach.

METHODS

A cross-sectional mixed methods approach using a sequential explanatory design was conducted from December 2019 to January 2020. The first quantitative stage was conducted in 15 ICUs belonging to the two university hospitals in the region of Sousse (Tunisia). All the 344 healthcare professionals (clinical staff) working for more than 1 month in these ICUs were contacted in order to take part in the study. In the second qualitative stage 12 participants were interviewed based on purposive sampling.

RESULTS

All of the PSC dimensions had a score of less than 50%. The developed dimension was 'teamwork within units' (48.8%). The less developed dimensions were 'frequency of event reporting' (20.8%), 'communication openness' (22.2%) and 'non-punitive response to error' (19.7%). Interviews' thematic analysis revealed four main themes including "Hospital management/system failure", "Teamwork and communication", "Error management" and "Working conditions".

CONCLUSION

This research revealed that PSC is still in need of improvement and provided a clearer picture of the patient safety issues that require specific attention. Improving PSC through the use of quality management and error reporting systems may help to improve patient safety outcomes.

Assessing Patient Safety Culture in United States Hospitals

A positive patient safety culture plays a major role in reducing medical errors and increasing productivity among healthcare staff. Furthermore, understanding staff perceptions of patient safety culture and effective patient safety factors is a first step toward enhancing quality of care and patient safety. The objectives of this study were to assess patient safety culture in hospitals in the United States and to investigate the effects of hospital and respondent characteristics on perceived patient safety culture. An analysis of 67,010 respondents in the 2018 Agency for Healthcare Research and Quality (AHRQ) comparative database was conducted with partial least squares structural equation modeling (PLS-SEM). The results revealed that perceptions of patient safety culture had a positive influence on the overall perceptions of patient safety and frequency of event reporting. Moreover, staff position, teaching status, and geographic region were found to have varying influence on the patient safety culture, overall perceptions of patient safety, and frequency of event reporting.

Spanish Version of the Scale "Eventos Adversos Associados às Práticas de Enfermagem" (EAAPE): Validation in Nursing Students

Healthcare carried out by different health professionals, including nurses, implies the possible appearance of adverse events that affect the safety of the patient and may cause damage to the patient. In clinical practice, it is necessary to have measurement instruments that allow for the evaluation of the presence of these types of events in order to prevent them. This study aims to validate the "Eventos adversos associados às práticas de enfermagem" (EAAPE) scale in Spanish and evaluate its reliability. The validation was carried out through a cross-sectional study with a sample of 337 nursing students from the University of Valencia recruited during the 2018-19 academic year. An exploratory factor analysis was carried out using principal components and varimax rotation. The factor analysis extracted two factors that explained 32.10% of the total variance. Factor 1 explains 22.19% and refers to the "adverse results" of clinical practice (29 items), and factor 2 explains 9.62% and refers to "preventive practices" (24 items). Both factors presented high reliability (Cronbach's alpha 0.902 and 0.905, respectively). The Spanish version of the EAAPE is valid and reliable for measuring the perception of adverse events associated with nursing practice and the presence of prevention measures.

Patients’ Perceptions of Quality of Care: A Teamwork Intervention Study in a Surgical Ward

Introduction

Improving teamwork competencies among health care professionals is important for patient safety. Few previous studies have investigated whether a teamwork intervention has an impact on patients’ perceptions of quality of care.

Objective

To investigate patients’ perceptions of quality of care before and after the implementation of a team training program in a surgical ward.

Methods

A quasi-experimental pre- and posttest design was used. The TeamSTEPPS® team training program was implemented in a surgical ward. Three groups of consecutively sampled patients responded to the Quality from the Patient's Perspective (QPP) questionnaire including four dimensions with 25 items. In addition to the QPP, six items were developed for this study. In total, 223 patients responded to the questionnaire. The mean age was 59.6 years, and there were 128 males and 94 females.

Results

The physical-technical condition dimension and four items showed significantly higher scores after six months of intervention. The majority of the patients scored quality of care in the four dimensions as very high at all three time points. Younger patients reported the lowest care quality.

Conclusion

The results in this study indicate that the teamwork intervention had a minimal impact on the patients’ perceptions of quality of care, with only significant differences between baseline and six months of intervention in one dimension and three items. At each data collection time point, the numbers of patients who perceived quality of care as modest decreased slightly. Younger patients were more likely to perceive care quality as modest.

Interdisciplinary differences in patient safety culture within a teaching hospital in Southeast Asia

BACKGROUND

Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. The healthcare providers perception and their role are utmost important in delivering quality care and patient safety. This study aimed to determine the interdisciplinary differences in patient safety culture in a tertiary university hospital.

METHOD

A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement scores of 60% was considered satisfactory. Comparisons were made between doctors, nurses, allied health professionals, nursing assistants and support staff.

RESULTS

Of 6562 respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range = 31.1 to 84.7%), with job satisfaction (72.3% ± 21.9%) and stress recognition (58.3 ± 25.6%) representing the highest and lowest mean domain scores, respectively. Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety climate, job satisfaction and working conditions compared to nurses.

CONCLUSIONS

The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.

Patient safety culture among nursing professionals in the intensive care environment

OBJECTIVE

To analyze the patient safety culture among intensive care nursing professionals.

METHOD

This is a cross-sectional study carried out in Intensive Care Units of a public hospital. Data collection was carried out from September to October 2017 with nursing professionals, using the Hospital Survey on Patient Safety Culture questionnaire. Cronbach's Alpha, Pearson's Chi-Square or Fischer's Exact tests (5% significance level) were performed.

RESULTS

The final sample consisted of a total of 163 nursing professionals. No strong areas were observed for patient safety. The dimensions "teamwork in the unit", "expectations and actions of the supervisor/manager for the promotion of patient safety" and "organizational learning and continuous improvement" had the highest rates of positive responses, whereas the dimensions "opening for communication" and "feedback and communication about the error" had the lowest percentages. The general degree of patient safety was considered very good 72 (47%) and underreporting of the events was observed, most of them were carried out by nurses.

CONCLUSION

No dimension assessed was considered to be a strong area. However, most were shown to be potential areas for patient safety culture.

Manager's influence on the registered nurse and nursing assistant relational quality and patient safety culture

AIMS

The purpose of this study is to describe the perceptions of relational quality of the registered nurse and nursing assistant and examine how their view of the manager's influence impacts overall patient safety culture of a unit.

BACKGROUND

The primary delivery of nursing care within acute care systems uses teams of registered nurses and nursing assistants.

METHODS

A cross-sectional secondary analysis of data collected in the spring of 2018 using the Agency for Healthcare and Quality Hospital Survey of Patient Safety Culture and a seven-item questionnaire measuring relational quality was conducted. The sample included 1,152 responses.

RESULTS

The manager influenced overall perceptions of safety regardless of the relational quality between the registered nurse and nursing assistant.

CONCLUSIONS

This study found manager behaviours that promote patient safety and also influence overall perceptions of patient safety culture regardless of the relational quality between the registered nurse and nursing assistant.

IMPLICATIONS FOR NURSING MANAGEMENT

Positive registered nurse and nursing assistant relational quality amplifies perceptions of patient safety culture, yet it is the manager's behaviours regarding safety that make the stronger contribution in building a culture of safety.

Nurse manager communication and outcomes for nursing: An integrative review

AIM

To evaluate literature on the importance of good communication between managers and nurses, and its influence on nurses and patient care.

BACKGROUND

In the nursing scenario, concepts such as engagement and job satisfaction are tied to manager communication and influence the care provided (Kunie et al., 2017). It is crucial to recognize the importance of manager communication on the nurses and patient care. The evaluation was guided by this question: in the review of post-2014 quantitative studies, is there evidence that nurse managers with high communication competence have better patient/staff outcomes than those with lower competencies?

EVALUATION

We evaluated current research through an evidence review on the day-to-day influence of nurse manager communication. We conducted our search using common health databases. Since the American Organization for Nurse Leadership developed nurse manager competencies in 2014, we only included articles published after that year. Further inclusion criteria included primary, quantitative and peer-reviewed research.

KEY ISSUES

Thirty articles remained after the application of inclusion/exclusion criteria with five themes emerging: patient safety and quality, job satisfaction, leadership styles, innovative practice and general management skills.

CONCLUSION

Research associates positive patient and staff outcomes with a leader who exhibits communication competences.

IMPLICATIONS FOR NURSING MANAGEMENT

Assessment of current competence levels in communication in nurse managers is needed. Education for improving communication skills is also needed.

Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study

OBJECTIVES

This study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes.

DESIGN

The study combined the use of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys.

SETTING

This study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia.

PARTICIPANTS

One thousand hospital staff participated in the survey. Thirty-one executive board members and directors and four focus groups of frontliners were qualitatively interviewed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Twelve safety culture dimensions were assessed to study the patient safety culture as perceived by the healthcare professionals. An additional semi-structured interview was conducted to identify organisational factors, changes, and barriers affecting the patient safety culture. Furthermore, suggestions to improve patient safety were proposed.

RESULTS

Comparing the results revealed a general positive trend in scores from 2012 to 2019. The areas of strength included teamwork within and across units, organisational learning, managerial support, overall perception of safety and feedback and communication about error. Non-punitive response to error, staffing and communication and openness consistently remain the lowest-scoring composites. Interview results revealed that organisational changes may have influenced the answers of the participants on some survey composites.

CONCLUSIONS

Patient safety is a moving target with areas for improvement that are continuously identified. Effective quality improvement initiatives can lead to visible changes in the patient safety culture in a hospital, and consistent leadership commitment and support can maintain these improvements.

Assessing Patient Safety Culture in Hospital Settings

The current knowledge about patient safety culture (PSC) in the healthcare industry, as well as the research tools that have been used to evaluate PSC in hospitals, is limited. Such a limitation may hamper current efforts to improve patient safety worldwide. This study provides a systematic review of published research on the perception of PSC in hospitals. The research methods used to survey and evaluate PSC in healthcare settings are also explored. A list of academic databases was searched from 2006 to 2020 to form a comprehensive view of PSC's current applications. The following research instruments have been applied in the past to assess PSC: the Hospital Survey on Patient Safety Culture (HSPSC), the Safety Attitudes Questionnaire (SAQ), the Patient Safety Climate in Health Care Organizations (PSCHO), the Modified Stanford Instrument (MSI-2006), and the Scottish Hospital Safety Questionnaire (SHSQ). Some of the most critical factors that impact the PSC are teamwork and organizational and behavioral learning. Reporting errors and safety awareness, gender and demographics, work experience, and staffing levels have also been identified as essential factors. Therefore, these factors will need to be considered in future work to improve PSC. Finally, the results reveal strong evidence of growing interest among individuals in the healthcare industry to assess hospitals' general patient safety culture.

Multiprofessional perspectives on the identification of latent safety threats via in situ simulation: a prospective cohort pilot study

Objectives

To describe the association between participant profession and the number and type of latent safety threats (LSTs) identified during in situ simulation (ISS). Secondary objectives were to describe the association between both (a) participants’ years of experience and LST identification and (b) type of scenario and number of identified LSTs.

Methods

Emergency staff physicians (MDs), registered nurses (RNs) and respiratory therapists (RTs) participated in ISS sessions in the emergency department (ED) of a tertiary care teaching hospital. Adult and paediatric scenarios were designed to be high-acuity, low-occurrence resuscitation cases. Simulations were 10 min in duration. A written survey was administered to participants immediately postsimulation, collecting demographic data and perceived LSTs. Survey data was collated and LSTs were grouped using a previously described framework.

Results

Thirteen simulation sessions were completed from July to November 2018, with 59 participants (12 MDs, 41 RNs, 6 RTs). Twenty-four unique LSTs were identified from survey data. RNs identified a median of 2 (IQR 1, 2.5) LSTs, significantly more than RTs (0.5 (IQR 0, 1.25), p=0.04). Within respective professions, MDs and RTs most commonly identified equipment issues, and RNs most commonly identified medication issues. Participants with ≤10 years of experience identified a median of 2 (IQR 1, 3) LSTs versus 1 (IQR 1, 2) LST in those with >10 years of experience (p=0.06). Adult and paediatric patient scenarios were associated with the identification of a median of 4 (IQR 3.0, 4.0) and 5 LSTs (IQR 3.5, 6.5), respectively (p=0.15).

Conclusions

Inclusion of a multidisciplinary team is important during ISS in order to gain a breadth of perspectives for the identification of LSTs. In our study, participants with ≤10 years of experience and simulations with paediatric scenarios were associated with a higher number of identified LSTs; however, the difference was not statistically significant.

Improving the quality of nursing care in Austria: 10 years of success

AIMS

We provide more updated and comprehensive insights, including descriptions of changes that have taken place in the quality of pressure injury care provided in hospitals over a 10-year period.

BACKGROUND

Various nursing quality measurements do not present a comprehensive view on nursing-sensitive quality indicators or place a focus on one specific care problem.

METHODS

It is a repeated cross-sectional multicentre study conducted annually on 1 day including comprehensive data regarding nursing-sensitive care problems and quality indicators on the structure, process and outcome levels.

RESULTS

The prevalence of pressure injuries decreased over the years from 4.4% to 2.9%, and the frequency of interventions increased.

CONCLUSION

The Nursing Quality Measurement 2.0 initiative shows considerable improvements over a 10-year period. Therefore, the maintenance of such nursing databases should be treated as a prerequisite to providing high-quality nursing care and safe nursing practice. One main benefit of creating and maintaining such databases is that allow users to screen for improvements, for example in pressure injury care. These observations can be used to develop marketing strategies and/or to empower and engage nursing staff.

IMPLICATIONS FOR NURSING MANAGEMENT

Participation in such quality measurements allows the comparison of data collected in wards and institutions in many different countries, enabling them to set appropriate benchmarks. Furthermore, the results can be compared over a period of time, highlighting systematic changes, trends or improvements (e.g., due to implemented innovations).

Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study

OBJECTIVE

To explore the association between clinical leadership and quality of work life, as well as the mediating role of coping style in this relationship.

SETTING

Three tertiary-level hospitals in Liaoning Province, China.

PARTICIPANTS

A total of 1209 nurses were recruited for this study. Registered nurses who work full time with at least 1 year of work experience were eligible as subjects. Exclusion criteria were nurses who work indirectly with patients, such as in education, administration or research.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaires consisting of the work-related Quality of Life Scale, the Nurse Leadership Scale and the Simplified Coping Style Questionnaire, as well as a demographic data sheet, were used to collect participant information. Pearson's correlation analysis, hierarchical multiple regression analysis, and asymptotic and resampling strategies were used to analyse the data.

RESULTS

The mean overall quality of work life score among Chinese nurses was 3.50±0.60. After adjusting for demographic characteristics, clinical leadership was positively associated with the score of quality of work life (β=0.55, p<0.01). Clinical leadership explained 27% of the variance in quality of work life. Coping style partially mediated the relationship between clinical leadership and quality of work life. The proportion of mediation of active coping was 21.82% and of passive coping was 5.79%.

CONCLUSIONS

Clinical leadership was positively associated with quality of work life and coping style partially mediated the relationship between clinical leadership and quality of work life among nurses in China. Implementing measures focusing on both clinical leadership and coping style may provide success in improving the quality of work life of nurses.

Patient safety culture and associated factors among health care professionals at public hospitals in Dessie town, north east Ethiopia, 2019

Introduction

Patient safety culture is defined as the attitudes, perceptions, and values that staffs share within an organization related to patient safety. The safety of health care is now a major global concern. It is likely that millions of people suffer disabling injuries or death directly related to medical care. Particularly in developing and transitional countries, patient harm is a global public health problem. The objective of the study is to assess patient safety culture and associated factors among health care professionals working in public hospitals in Dessie town, North East Ethiopia, 2019.

Methods

Facility based quantitative study was employed from March 15 –April 30, 2019 in public hospitals in Dessie town. Four hundred and twenty two health care professionals were recruited to complete a structured pretested self-administered questionnaire. The data was cleaned, coded and entered in to Epi Info-7 and exported to SPSS version 20. Data was further analyzed using bivariate and multivariate logistic regression analyses. Variables with P value of less than 0.05 in multivariate analysis were declared as statistically significant at 95% CI.

Results

Of the 422 recruited a total of 411 participants completed the survey with a response rate of 97.4%. Close to half (184(44.8%)) of the participants indicated good patient safety culture. Good patient safety culture was positively associated with working in primary hospital (AOR = 2.56, 95% CI = 1.56, 4.21). On the other hand, good patient safety culture was negatively associated with health professional’s age between 25–34 year (AOR = 0.25, 95% CI = 0.08–0.74) and working in Pediatrics ward (AOR = 0.39, 95% CI = 0.17–0.9) and in emergency ward (AOR = O.25, 95%CI = 0.09–0.67).

Conclusion

The overall level of patient safety culture was under 50%. Good patient safety culture had positive association with working in primary hospital and negative association with professionals’ age between 25–29 year, 30–34 year and working in pediatrics and emergency ward. Implementing actions that support all dimensions of safety culture should be promoted at all levels of hospitals.