Iran Journal of Nursing

Mendeley  

Zotero  

Salamat A, Mohammad Aliha J, Mardani Hamooleh M, Mohammadnejad E, Haghani S. Patient Safety Culture in Intensive Care Units in the Viewpoint of Nurses in Tehran, Iran. IJN 2019; 32 (119) :52-63
URL: http://ijn.iums.ac.ir/article-1-2987-en.html

Background & Aims: Optimal safety culture plays a key role in establishing patient safety. This concept is a subset of organizational culture and defines a set of shared values, attitudes, perceptions, beliefs, and behaviors that support the safe performance of the activities of individuals in healthcare organizations. A key feature of a proper safety culture is that individuals have the support and trust of the organization to freely comment and report on events. The role of managers is particularly important in creating an environment where all the employees could easily express their concerns. Promoting a safety culture could help record and report errors and improve interpersonal communication in the event of an error, thereby maintaining patient safety. Despite the efforts of hospital managers, the clinical errors that threaten the safety of patients are still witnessed in different hospital sections, incurring substantial financial and human costs. These errors are often caused by factors such as heavy workload, fatigue of the hospital staff, high work-related stress, and lack of the time, attention, and focus to perform the tasks that require high accuracy and concentration. In intensive care units (ICUs), patients with critical and life-threatening conditions are cared for under the supervision of the most skilled staff using advanced equipment and facilities. The patients admitted to ICUs need special and advanced care measures, as well as attention and quality care due to their critical, unstable condition. In addition, nurses are faced with the challenges of high work pressure and maintaining safety in order to provide services to the patients admitted to ICUs. Therefore, the patient safety culture is crucial to improving the quality of care and determining the health status of the patients admitted to ICUs. Patient safety in ICUs is a more sensitive issue than other hospital wards. For instance, the possibility of threatening the safety of the patients in ICUs is maximized due to the complexities associated with their condition and treatment process, unconsciousness, and dependence on healthcare providers, as well as the presence of numerous electronic devices. The present study aimed to assess the patient safety culture in the viewpoint of ICU nurses.
Materials & Methods: This descriptive, cross-sectional study was conducted on all the nurses working in the intensive care units (ICUs and CCUs) of the hospitals affiliated to Tehran and Iran universities of medical sciences in 2019. The sample population consisted of 200 nurses who participated in the study via the non-probability method. Data were collected using a demographic form and the safety culture questionnaire. The demographic form contained data on the age, gender, marital status, work experience, and employment status. The content validity method was used to assess the validity of the questionnaire; the questionnaire was provided to five nursing professors, and their corrective comments were applied. In addition, the Cronbach's alpha coefficient was used to confirm the reliability of the questionnaire, which was estimated at 0.82 for the entire questionnaire. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (analysis of variance and independent t-test were used to correlate the main variable with the individual variables). In the statistical analysis, the significance level was less than 5%. The study protocol was approved by the Ethics Committee of Iran University of Medical Sciences. To observe ethical considerations, the researcher explained the objectives of the study to the nurses. Furthermore, participation in the study was voluntary, and written consent was obtained from the nurses to conduct the research. The questionnaires were completed by the nurses anonymously, and they were assured of the confidentiality of their personal information.
Results: The mean score of the patient safety culture in the viewpoint of the nurses was 144.33 ± 10.98. Among the dimensions of the patient safety culture, the highest rate of positive responses was observed in 'non-punitive response to error' (67.5%), while the lowest rate belonged to 'supervisor/management expectations and actions promoting patient safety' (28%). Moreover, 60% of the nurses reported no errors during the past year. The majority of the nurses (63%) described their hospital as acceptable in terms of the patient safety culture. The results of the independent t-test were also indicative of a significant correlation between gender as a demographic variable with the patient safety culture (P=0.013).
Conclusion: According to the results, the dimensions that needed improvement in the patient safety culture were 'supervisor/management expectations and actions promoting patient safety', 'periodic questions', and 'reporting of events, and information exchange'. Therefore, in order to improve the performance and expectations of supervisors/managers regarding the enhancement of patient safety, it is imperative for hospital managers to implement training sessions to promote the patient safety culture for supervisors. These sessions could be provided in the form of workshops related to the patient safety culture, held by professors specializing in nursing management. In addition, considering our finding that the studied hospitals had a poor performance in terms of reporting errors and information exchange, it is essential to establish an appropriate and comprehensive system for reporting errors and incidents in hospitals, which leads to the identification of various types of errors and taking the necessary measures to reduce and eliminate these errors. This also indicates that various aspects of the safety culture require improvement in the studied hospitals. According to the obtained results, hospital managers should consider the issues in the hospital regarding the patient safety culture in order to provide the nurses with the opportunity to maintain and promote this culture. Furthermore, providing feedback on error reporting could help nurses learn about the causes of errors in order to reduce the possibility of errors in the future by identifying the preventive approaches. It is also suggested that interventions in the field of promoting the safety culture be implemented in the studied hospitals and further investigations in this regard be conducted to assess the effects of these interventions on the improvement of this category. In terms of nursing education, the results of this study could help nursing managers to raise the awareness of nurses regarding the patient safety culture, along with implementing training workshops and encouraging non-punitive response to error and teamwork for nurses. In these workshops, efforts should be made to clarify the performance and expectations of supervisors about the improvement of patient safety. With respect to clinical nursing, our findings have the message for nurses that whenever they receive non-disciplinary responses to error and their workload increases in the ward mostly in the form of teamwork, the patient safety culture will be promoted.