Iran Journal of Nursing

Background & Aims: One of the basic rights of patients in the health system of all countries in the world, including Iran, is receiving safe care based on up-to-date knowledge and the superiority of patient interests. The first book of national accreditation standards was published in Iran by the Ministry of Health in 2010 and has been officially used by hospitals and healthcare centers since 2012. Since then, healthcare centers have provided inpatient and hospitalization services based on the criteria introduced by the ministry of health. In this regard, the standards applied were revised five times up to 2016. The criteria exist for the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) and are assessed every year in these wards. In Iran, findings from scattered studies have reported different percentages of errors, including drug error, in these areas. One of the defects of the studies has been the lack of actual statistics on errors due to lack of reports. In addition, there was a lack of a specific center to present statistics on this issue, which has led to a lack of accurate reports on safety and errors made in pediatrics care. Patient care error is an independent concept, meaning that medical errors are not just made by nurses in the pediatrics wards of Iran. However, it could be expressed that nurses in pediatrics wards have different perceptions of error, which can endanger the lives of children and hospitalized patients. In a qualitative research, the error concept was mentioned as injury, without care, wrong thinking and action, and being in a situation from the perspective of nurses. It seems that high workload, lack of drug resources, the inefficient performance of colleagues, and lack of experience and knowledge in prescribing drugs are the most important reasons for errors in hospital wards. In Iran, a limited number of studies have been performed on the safety culture in the pediatric wards and no research has been carried out on the safety culture in PICUs and NICUs. Factors affecting communication and cultural sensitivity in the pediatrics wards include organizational factors such as inefficient policy-making, lack of a specific definition of hospital culture, insufficient staff education about the topic, and human factors including communication between nurses and patients and cultural differences between nurses and families. Given the high cultural diversity in Iran, improvement of education, and changing cultural policies in hospitals will increase patient safety and quality and communications. Moreover, identifying cultural differences and the impact of culture on care, adaptation to different cultures, interpersonal communication, and recognizing the cultural values of the child and family are effective factors in pediatrics and family care. According to the results of previous studies, it seems that the level of safety culture is low and medium in the neonatal intensive care unit, and nurses believe that there is a shortage of staff in these sections, which has led to the occurrence of errors at a large scale. In addition, accurate and full education is not provided to promote the culture of safety. With this background in mind, this comprehensive review was performed to evaluate safety in pediatrics wards in Iran.
Materials & Methods: In this comprehensive review, we searched valid Persian databases, including Magiran, SID, and IranMedex, and English databases such as Elsevier, Scopus, Medline, Google Scholar, ScienceDirect, and PubMed using keywords of “patient safety” and “pediatric intensive care unit” and their Farsi equivalents without a time limitation.
Results: In total, 35 articles were selected from 61 papers found. However, only 10 articles that directly evaluated safety in PICUs in Iran and were published in domestic and foreign scientific-research journals and their full text was available were entered into the study based on the research objectives.
Conclusion: Given the lack of accurate information about the safety of PICUs in Iran, it seems that insufficient knowledge of nurses about how to give safe medicine, high workload, the existence of an incorrect safety culture in the wards and inappropriate policies in ensuring the safety of patients are important factors affecting the inadequate observance of safety in the PICUs. Moreover, research in PICUs has focused more on medication error, infection control, hospital culture, parenting experience, shift delivery, shifts, and nurses' knowledge of the concept of error. Relatively high prevalence of medication error due to lack of medication information of nurses, lack of infection control due to not using clinical guidelines and lack of nursing facilities, insufficient observance of professional communication and weakness in the safety culture of these sectors, non-delivery of work shifts according to the related standards, nurses’ attitude to the concept of safety and their information about the matter have necessitated accurate planning to eliminate these issues. The most important safety issue in the PICU seems to be the lack of accurate and dispersed statistics, which makes deciding about safety status difficult. Studies show that most researchers are interested in drug safety and other safety-related factors have received less attention. Furthermore, there is scarce research on inadvertent and intentional errors made in PICUs. It seems that work pressure and inappropriate policy-making about the provision of children’s safety have been among the factors affecting inadequate observance of safety in PICUs. Therefore, it is suggested that future studies be conducted on this topic.

Background & Aims: Nurses are exposed to significant occupational stress compared to other healthcare professionals, which predisposes them to the risk of cognitive failure and the incidence of clinical errors. The present study aimed to assess the correlation of occupational stress and cognitive failure in the incidence of clinical errors among nurses.
Materials & Methods: This cross-sectional study was conducted on 367 nurses at eight hospitals in Tehran, Iran in 2017. The participants were full-time nurses employed in the selected hospitals with more than six months of clinical experience. Demographic data of the participants were collected, and the scores of occupational stress and cognitive failure and frequency of medical errors were determined using self-administered questionnaires. Moreover, a binary logistic regression model was applied to verify the influential factors in the incidents associated with patient safety among the nurses.
Results: In total, there were 367 valid responses, and 19.61% of the nurses had experienced clinical errors. Mean total scores of occupational stress and cognitive failure were 3.48 and 1.98, respectively. According to the binary logistic regression analysis, the most important influential factors in the incidence of clinical errors were the received wages (odds ratio [OR]=0.066), clinical experience (OR=2.114), cognitive failure (OR=3.897), duty-related stressors (OR=2.837), and interpersonal relations associated with stressors (OR=0.340).
Conclusion: According to the results, the incidence of clinical errors was influenced by cognitive failure, occupational stress, received wages, and clinical experience. Therefore it is recommended that hospital managers retire the nurses with higher clinical experience and recruit younger nursing staff. In addition, nursing managers should develop and apply appropriate policies and strategies to reduce occupational stress, which in turn diminishes the incidence of clinical errors.

Background & Aims: Patient falls are among the most significant threats to patient safety. Nurses play a pivotal role in maintaining and improving the standards of patient safety. The work environment of nurses is among the major influential factors in this regard. The present study aimed to investigate the association between the incidence of patient falls and work environment of nurses.
Materials & Methods: This correlational study was conducted on 300 nurses employed in the hospitals affiliated to Tehran University of Medical Sciences, Iran, who were selected via proportionate stratification sampling. Data were collected using a questionnaire with three sections of demographic data, work environment of nurses, and patient falls. Data analysis was performed in SPSS version 16 using Pearson’s correlation-coefficient, Kruskal-Wallis test, t-test, and frequency tables.
Results: Mean age of the participants was 32±6.17 years, and the majority were female (86.7%) and married (64%). Mean incidence of patient falls was 6±1.61 within the past three months, and the mean score of the work environment of nurses was estimated at 67.34 (favorable). A significant, weak correlation was observed between the work environment of nurses and incidence of patient falls (P<0.034; r=-0.15).
Conclusion: Given the significant association between the incidence of patient falls and work environment of nurses, it seems essential that nursing managers adopt effective strategies to improve the working conditions of nurses through the participation of nurses in decision-making, support, and adequate staff and resources, thereby facilitating safe patient care.

Background & Aims: Patient safety is considered to be an inherent element of healthcare quality. Unsafe attitudes of healthcare employees are a major issue for healthcare providers in promoting the quality of care, which is closely correlated with the occurrence of hospital errors and incidents. On the other hand, development of optimal patient safety is not possible without establishing safety attitudes in healthcare facilities. The present study aimed to investigate the attitudes of healthcare providers toward patient safety in the operating room in the teaching hospitals in Isfahan, Iran.
Materials & Methods: This cross-sectional, descriptive-analytical study was conducted on 217 healthcare practitioners in the teaching hospitals in Isfahan, Iran in 2018. The research units were selected via quota sampling. Data were collected using the standard safety attitude questionnaire (SAQ). Data analysis was performed in SPSS version 18 using descriptive and inferential statistics (independent t-test and Pearson's correlation-coefficient).
Results: The mean score of the total safety attitude of the healthcare providers was 59.06±11.84 (total: 100). The highest score belonged to the dimension of stress recognition, with the mean score of 79.93±17.46, and the lowest score belonged to the dimension of working conditions, with the mean score of 48.01±18.07. Accordingly, 49.3% of the participants described their patient safety attitude to be good/excellent, while 50.7% described their attitude to be average/poor.
Conclusion: According to the results, the average safety attitude was not ideal in the operating room personnel. Therefore, it is recommended that hospital managers and staff attempt to implement effective interventions in order to promote the culture and attitude of patient safety in the operating room personnel.

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.

Background & Aims: Quality of care is an important issue in the health system of every country, especially in healthcare centers. The quality of care services encompasses various elements, one of the most pivotal of which is patient safety. Studies have indicated the inadequacy of safety in patient care. Due to the high incidence of medical errors, it is essential to recognize the patient safety culture in the health sector in order to change and modify the existing culture in accordance with recent developments. Safety experts consider the patient safety culture as an inherent element in the promotion of the safety and quality of patient care, and the World Health Organization (WHO) has emphasized on this issue as well. Culture could be defined as the beliefs and values of individuals, which are manifested in their behaviors. The patient safety culture constantly seeks to minimize the adverse events caused by the care provision process in patients, while also indicating the priority of patient safety from the perspective of healthcare employees and their organization. Assessing the current culture could be the starting point for the development of an appropriate safety culture using proper instrument, so that hospital officials would become aware of the status of the patient safety culture and find solutions to improve the culture. The present study aimed to evaluate the patient safety culture among the nurses employed in the selected hospitals affiliated to Tehran University of Medical Sciences, Iran.
Materials & Methods: This cross-sectional study was conducted in the late 2019 at seven selected teaching hospitals affiliated to Tehran University of Medical Sciences. Nurses with the minimum clinical experience of one year were enrolled, and those with incomplete questionnaires were excluded from the study. The participants were selected via simple random sampling by the researcher with the cooperation of the nursing manager of each hospital using the random number table. The sample size was determined to be 295 using the Cochran's formula, and the share of each hospital was 40-45 nurses. The data collection instrument consisted of two sections; the first section contained the demographic and organizational variables of the nurses, and the second section was the hospital survey on patient safety culture (HSPSC). The HSPSC had 12 dimensions of organizational learning, feedback and communication about error, teamwork within units, supervisor/manager expectations and actions promoting patient safety, frequency of event reporting, non-punitive response to error, staffing, teamwork across units, overall perception of patient safety, communication openness, management support for patient safety, and information exchange and transmission. The HSPSC has been used frequently to evaluate the patient safety culture across the world, and its final version has been translated into Persian by Iranian researchers, the validity and reliability of which have been confirmed. After referring to the research environment and making the necessary arrangements with the hospital officials, the researcher received the permit to enter the wards. In addition, informed consent was obtained from the eligible nurses, and the participants were allowed to withdraw from the research at any stage. Data analysis was performed in SPSS version 16 using descriptive statistics (number, percentage, mean, and standard deviation) and analytical statistics (independent t-test and one-way ANOVA) at the significance level of less than 0.05.
Results: Out of 295 distributed questionnaires, 260 (89.8%) were returned. According to the results of descriptive analysis, the mean age of the nurses was 34.14 ± 8.27 years, and the majority were female and married. The mean clinical experience of the participants was 9.98 ± 7.35 years. In addition, the majority of the nurses had a BSc and were employed in general wards. The mean total score of the patient safety culture was 3.06 ± 0.40, with the highest mean scores observed in the dimensions of organizational learning (3.45 ± 0.74), feedback and communication about error (3.44 ± 0.82), and teamwork within units (3.42±0.88). On the other hand, the lowest mean scores belonged to the dimensions of information exchange and transmission (2.45 ± 0.86), management support for patient safety (2.62 ± 0.65), and communication openness (2.87 ± 0.73). The analytical results indicated no significant correlations between the patient safety culture status and demographic and organizational characteristics of the nurses (P>0.05).
Conclusion: According to the results, the total score of the patient safety culture was moderate in this study. Among various dimensions of the patient safety culture, the highest and lowest mean scores belonged to the dimensions of organizational learning and information exchange and transmission, respectively. Therefore, it could be concluded that enhancing the safety of care service recipients in health care organizations is influenced by several factors, such as managers' support for the patient safety culture in hospitals, nurses' recognition of the patient safety culture, teamwork within organizational units, feedback and communication about errors, staff-related issues, and facilitating information exchange and transmission. Furthermore, promoting interactions, more teamwork within hospital units, and creating a non-punitive environment in order to report more events could be effective in this regard. It is also recommended that the quality improvement unit of hospitals provide appropriate training courses to familiarize nurses with the patient safety culture, implement exams during these courses, and use the feedback to enhance the quality of new and similar training courses. Since this study was only conducted at the hospitals affiliated to Tehran University of Medical Sciences, the results should be generalized to other healthcare centers with caution. For further investigations in this regard, it is suggested that studies be focused on the governmental and non-governmental hospitals of other provinces and larger sample sizes from the perspective of other healthcare employees.

Background & Aims: Ensuring patient safety is the first vital step in improving the quality of healthcare services. Patient safety is defined as an event that prevents unwanted injuries to a patient due to functional and unintentional actions. Safety standards are a set of requirements that are critical to implementing patient safety programs at hospitals. These standards provide an operational framework to help the hospitals fully match with the dimensions of patient safety in order to provide quality and patient-centered services. Therefore, 100% compliance with the required standards of patient safety-friendly hospital should be the priority of every hospital. The COVID-19 pandemic is one of the emerging infectious diseases that has affected the whole world in recent months. As its outbreak is an unexpected event or sequence of events of enormous scale and overwhelming speed, it has led to a high degree of uncertainty and has posed a variety of challenges to healthcare systems. Therefore, the realization of this important issue is felt more than ever in the structures and processes of each hospital of the healthcare system, in order to successfully control and efficiently manage this disease and preserve national assets. Therefore, this study aimed to determine the compliance of Imam Khomeini Hospital of Tehran with the patient safety-friendly hospital standards with respect to COVID-19 pandemic in 2020.
Materials & Methods: This descriptive-analytical cross-sectional study was conducted from September- December 2020 in Imam Khomeini Hospital Complex of Tehran during COVID-19 pandemic. 266 nurses with inclusion criteria were selected via stratified random sampling. For this purpose, the required list of 1,200 nurses was received from the nursing office of the complex. 866 nurses from 50 different wards were selected from the list based on the inclusion criteria. Then, the nurses who were in the same wards were placed in one stratum, so that the existing 50 wards including emergency department, operating room, ICU, CCU, NICU, dialysis, internal ward, surgical ward, infectious disease wards, oncology, pediatric ward, VIP and diagnostic wards were finally placed in 13 strata. Therefore, 292 samples were selected based on the quota of nurses from 13 existing strata via simple random sampling to provide a specified sample size of 266 nurses with an additional 10% to manage their attrition. Online sampling was performed by sending the link of the questionnaires through the virtual network of the study. The questionnaires included nurses' demographic information and patient safety-friendly hospital standards (Parvizi et al), including 27 items and five dimensions. The minimum score was 27 and the maximum score was 135. A higher score from the point of view of the research unit meant that the hospital was more in line with the standards of a patient safety-friendly hospital. Item 21 was scored in reverse. Scores 108-135 showed high compliance, scores 80-107 indicated moderate compliance, and scores 27-79 indicated the poor compliance of the hospital with the standards of patient safety friendly hospital. The internal consistency of the instrument was determined to be 0.934 using Cronbach's alpha. After introducing the researcher and explaining the research objectives to the research units, data were collected. Data were analyzed using descriptive statistics including absolute and relative frequency distribution, mean and standard deviation in SPSS software version 16.
Results: The mean and standard deviation of the age of nurses was 38.6 ± 7.94 years and most of them (90.2%) were female. The mean and standard deviation of the total length of service as a nurse and the length of service in the current ward was 13.87 ± 7.41 and 6.87 ± 5.80 years, respectively. ICU nurses had the highest frequency, 25.6%, compared to other hospital wards, and also rotating shifts with 42.4% had the highest frequency. The level of compliance with the standards of patient safety friendly hospitals was 97.35 ± 16.59 from the perspective of most nurses (61.7%) (80-107), and 3.58 ± 0.62 based on a Likert scale, which indicates moderate compliance. Continuing education dimension with the average compliance equal to 3.87 ± 0.69 had the highest mean and governance and leadership with the average compliance equal to 3.41 ± 0.71 had the lowest mean scores. Mean scores of dimensions of a safe environment, participation, and interaction with patients and the community, safe clinical services were 3.45 ± 0.67, 3.44 ± 0.85, and 3.71 ± 0.7, respectively.
Conclusion: Based on the findings of the present study, the level of compliance with the standards of a patient safety-friendly hospital was moderate in the Imam Khomeini Hospital complex during the coronavirus pandemic. The highest and lowest levels of compliance were related to the dimension of continuing education and the dimension of governance and leadership included in the standards of patient safety-friendly hospital. To improve the current situation, purposeful and evidence-based management of organizational resources, attention to "barriers to achievement" dimensions of patient safety, institutionalizing patient safety culture and promoting safety, attention and focus on patient safety indicators, continuous and effective training of educational staff needs are needed to improve the safety of beneficiaries, especially during the COVID-19 pandemic. Relying on the results of the present study, managers can take appropriate corrective measures to achieve 100% compliance with patient safety-friendly hospital standards and national accreditation standards, and achieve patient safety goals and provide quality and patient-centered services in the healthcare system. The results of the present study can provide a basis for examining the patient safety status and monitoring it in future researches. It is recommended that future researchers, in order to ensure patient safety and monitor the quality of healthcare and patient-centered services, analyze non-compliance in mandatory, basic, and advanced standards of patient safety-friendly hospitals using PSFHI checklist of the World Health Organization through the process of observation, interview, and review of documents in the Imam Khomeini Hospital complex.
 

Background & Aims: One of the basic principles of health care is to maintain patient safety. Today, patient safety is a priority for any healthcare system that seeks to ensure and improve the quality of care. Being safe from dangers and injuries when receiving healthcare services is one of the most obvious and fundamental human rights. Despite advances in healthcare, patient safety, and patient-centeredness are still worrying issues around the world.  According to the World Health Organization, tens of millions of people die or become disabled annually due to clinical errors or unsafe treatment processes, which is one of the five leading causes of death in the world. Recent reports also show that approximately, 13.5% of hospitalized patients experience at least one adverse event during their hospitalization each year, 44% of which is preventable. The biggest challenge to make the healthcare system safer is changing the culture. Assessing the patient safety culture can provide information on how structures and processes within the system affect patient outcomes. However, the question remains that, given the structure of the existing healthcare system and the fact that in recent years, patient safety has been at the forefront of accreditation of medical centers, has the safety culture been able to find and establish its place in these centers and has the staff of medical centers (especially nurses) paid attention to patient safety culture due to the changes that have taken place in the past years. Therefore, this study was conducted to compare patient safety culture in nurses of Sabzevar Vasei Hospital between 2016 and 2020.
Materials & Methods: The present study is a descriptive-analytical cross-sectional study that was conducted between 2016 and 2020. 123 nurses of Vasei Hospital were selected in 2016 and 124 were selected in 2020 via convenience sampling. Inclusion criteria were having at least 6 months of work experience and consent to participate in the present study, applied in both 2016 and 2020. A two-part questionnaire was used to collect data. In the first part, the demographic information of the samples including age, gender, field and degree, occupation, type of employment, work experience in the hospital, work experience in the recent ward, working hours per week were examined. The second part of the questionnaire included the Persian version of the "Patient Safety Culture Survey" (HSOPSC). The questionnaire was designed by American Agency for Healthcare Research and Quality in 2004. In the present study, the questionnaire was given to 10 experts to confirm the validity, and their opinions were applied. The reliability of the questionnaire was investigated in 2016 using Cronbach's alpha coefficient which was between 0.74-0.81 for safety culture and its various dimensions. This questionnaire has 42 questions designed on a 5-point Likert scale ranging from strongly disagree to strongly agree. Therefore, each question was assigned a score of 1 to 5. This questionnaire has 12 dimensions including the frequency of reporting events, the overall perception of safety, managerial expectations and actions, organizational learning, teamwork within the organization, open communication channels, communication and feedback, non-punitive response to errors, staff-related work issues, safety management support, teamwork out of the organization, transmission and exchange of information. In this study, after calculating the percentage of positive responses in each dimension (sum of completely agree and disagree options), and based on the questionnaire guide and examining the 12 dimensions, an average positive response of at least 70 indicated optimal safety culture, between 50-69 showed a moderate level of safety culture, and below 50 indicated a low level of safety culture. Data analysis was performed using descriptive statistics, chi-square, Fisher's exact test, and independent t-test in SPSS version 16, and the significance level was set at P<0.05.
Results: The obtained results regarding the individual characteristics of the study units showed most subjects were women and married. There was no significant difference in terms of demographic characteristics of nurses in 2016 and 2020 (P>0.05). The overall score of patient safety culture in 2016 was 41.9 ± 6.9% which was low, also the overall score of patient safety culture in 2020 was 51.2 ± 7.7% which was moderate. In 2016, expectations and managerial actions had the highest score (63.1 ± 29.3%) and non-punitive response to errors had the lowest score (11.3 ± 15.6%). In 2020, the dimensions of communication and feedback and non-punitive response to errors had the highest scores (70.6 ± 23.4% and 31.8 ± 24.3% respectively) among the various dimensions of patient safety culture. The comparison of the mean scores of some dimensions in 2016 and 2020 was also statistically significant (P<0.001). The results showed better performance of some dimensions such as the frequency of reporting, open communication channels, communication and feedback, non-punitive response to errors, staff-related work issues, and transmission and exchange of information in 2020 compared to the initial survey in 2016. Regarding the dimensions of organizational learning and teamwork within the organization, the average score was higher in 2016, which was also statistically significant. Comparison of mean changes in other dimensions of the overall perception of safety, management expectations and actions, safety management support, and teamwork outside the organization in 2016 and 2020 were not statistically significant (P>0.05). In 2016, 61% of nursing staff made no errors, which was equal to 47.6% in 2020and is not statistically significant. Also in 2016, 12.2% of patients reported the safety of the ward to be very good or excellent, which was 26.6% in 2020, and is statistically significant (P<0.05).
Conclusion: The findings of the study indicate that while there are significant improvements in the overall score of safety culture and some of its dimensions, there are still dimensions of patient safety culture that managers and officials should strive to improve and strengthen. In this regard, general strategies for further improvement of patient safety practices and more investment in determinants of patient safety culture, especially in the areas of organizational learning and teamwork within the organization, should be guided and informed. Also, regular management and assessment of patient safety can enable hospitals to better understand and perform more efficiently.

Background & Aims: Patient safety is one of the most essential components of health care systems and is one of the most important pillars of quality in these organizations. Healthcare providers can improve a patient's safety status by interacting with patients and their families, controlling procedures, learning from mistakes, and communicating effectively with others on the health care team. Given that nurses spend more time caring for patients than other health care providers, they should be considered as the main group for planning to prevent and reduce the occurrence of medical errors. Increasing reporting and sharing of error information increases patient safety and prevents medical errors from recurring. Explicit disclosure of adverse events can maintain trust between health care providers and patients and reduce disputes and allegations of medical abuse. Therefore, considering the importance of patient safety, the researcher has decided to conduct a study with the aim of determining nurses' perception of the disclosure of patient safety.
Materials & Methods: This descriptive cross-sectional study was conducted in the period of October to March 2020 in Tehran. The study population consisted of all nurses working in selected educational and medical centers of Iran University of Medical Sciences ( Rasoul Akram, Shahid Motahari, Shahid Hasheminejad, Shafa Yahyaian and Firoozgar Hospitals). The study was performed on 315 nurses. The sampling method in this stratified study was proportional .The tools used in this study consist of two parts: Demographic information form including questions about age, gender, marital status, education, employment status, work experience, work experience in other centers, ward, shift work and average overtime in Is the moon. Nurses' perceptions of the disclosure of patient safety incidents were measured using the Lee and Kim questionnaire. This questionnaire was translated and used for the first time in Iran. To determine the reliability of this questionnaire, the internal correlation of questions Cronbach's alpha and reproducibility were tested by test on 20 nurses at one week intervals, where Cronbach's alpha of the whole instrument was 0.885 and its intra-cluster correlation coefficient was 0.793. Analyzes were performed using SPSS software version 22 and using descriptive statistics (mean and standard deviation) and inferential statistics (independent t-test and analysis of variance). Finally, a significant level was considered less than 0.05 in the analyzes.
Results: The results of the analysis showed that the general perception of nurses about the disclosure of patient safety Incidents with a mean of 55.66±13.20 (based on 0 to 100). The mean score (based on 0 to 100) was highest in the dimension of "nurses'perception of facilitators of open disclosure" with an average of 71.49 and in the dimension of "nurses' perception of the negative consequences of open disclosure" was the lowest with an average of 35.23. Nurses' perception of the disclosure of patient safety incidents had a statistically significant relationship only with the type of employment (P=0.04). A pairwise comparison showed that the average score of nurses with contract employment was significantly lower than formal (P=0.033) and contract (P=0.008). Also, the average score obtained in corporate nurses was significantly lower. It was less than conventional (P=0.029) and at other levels this difference was not significant.

Conclusion: Based on the findings of the present study that nurses' overall perception of the disclosure of patient safety Incidents was positive, it is suggested that in order to improve patient safety Incidents disclosure, hospitals should create a positive culture in which explicit the disclosure of patient safety Incidents is first and foremost an opportunity Be considered to actively improve hospital safety. The people and the media must also create an atmosphere that reflects the trust and support of health care providers and institutions in exposing patient safety incidents. This allows healthcare providers to have positive perceptions of the disclosure of patient safety Incidents.