Patient Safety Culture in Intensive Care Units from the Perspective of Nurses: A Cross‑Sectional Study

Sedigheh Farzi, Azam Moladoost, Masoud Bahrami, Saba Farzi, Reza Etminani


Background: One of the goals of nursing is providing safe care, prevention of injury, and health promotion of patients. Patient safety in intensive care units is threatened for various reasons. This study aimed to survey patient safety culture from the perspective of nurses in intensive care units.

Materials and Methods: This cross‑sectional study was conducted in 2016. Sampling was done using the convenience method. The sample consisted of 367 nurses working in intensive care units of teaching hospitals affiliated to Isfahan University of Medical Sciences. Data collection was  performed using a two‑part questionnaire that included demographic and hospital survey on Patient Safety Culture (HSOPSC) questionnaire. Data analysis was done using descriptive statistics (mean and standard deviation).

Results: Among the 12 dimensions of safety culture, the nurses assigned the highest score to “team work within units” (97.3%) and “Organizational learning‑continuous improvement” (84%). They assigned the least score to “handoffs and transitions”(21.1%), “non‑punitive response to errors” (24.7%), “Staffing” (35.6%), “Communication openness” (47.5%), and “Teamwork across units” (49.4%).

Conclusions: The patient safety culture dimensions have low levels that require adequate attention and essential measures of health care centers including facilitating teamwork, providing adequate staff, and developing a checklist of handoffs and transitions. Furthermore, to increase reporting error and to promote a patient safety culture in intensive care units, some strategies should be adopted including a system‑based approach to deal with the error.


Intensive Care Units; Iran, nurse; patient safery; safety culture

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Cheni‑Chi, Li H. Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMC Health Serv Res 2010;10:152.

[[Last accessed on 2016 Oct 11].

Armitage G, Knapman H. Adverse events in drug adminstration: A literature review. J Nurs Manag 2008;11:130‑40.

Ghorbani Birgani A, Asadpoor S. Nosocomial infections in intensive care unit of Ahvaz Arya Hospital (2008‑2009). Modern Care 2011;8:86‑93

Afkar A, Mahboubi M, Mehrabian F, Farmanbar R, Ghahremani F, Kazemnejad E, et al. Factors predicting pressure ulcers in ICU using the Braden Scale. KUMS 2014;18:220‑5.

Farzi S, Farzi S, Alimohammadi N, Moladoost A. Medication errors by the intensive care units’ nurses and the Preventive Strategies. JAP 2015;6:33‑45.

Valentin A, Capuzzo M, Guidet B, Moreno P, Dolanski L, Bauer P, et al. Patient safety in intensive care: Results from the multinational Sentinel Events Evaluation (SEE) study. Intensive Care Med 2006;32:1591‑8.

Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, et al. Intensive care unit safety culture and outcomes: A US multicenter study. Int J Qual Health Care 2010;22:151‑61.

Sharifi S, Izadi‑tame A, Hatamipour K, Sadeghigooghary N, Safabakhsh L. Patient Safety Culture from Mazandaran Clinical Nurses’ Perspective. IJN 2014;27:77‑87.

Jabari F, Ooshaksaraie M, Azadehdel M, Mehrabian F. Relationship between patient safety culture and professional conduct of nurses in context of clinical governance implementation. Holist Nurs Midwifery 2015;25:27‑33.

Salavati S, Fanoosi T, Dehghan D, Tabesh H. Nurses’ Perspectives on Patient Safety Culture. IJN 2013;26:24‑33.

Weaver S, Lubomksi L, Wilson R, Pfoh E, Martinez K, Dy S. Promoting a Culture of Safety as a Patient Safety Strategy: A Systematic Review. Ann Intern Med 2013;158:369‑74.

Baghaee R, Nourani D, Khalkhali H, Pirnejad H. Evaluation patient safety culture in personnel of academic hospitals in Urmia University of Medical Sciences in 2011. J Urmia Nurs Midwifery Fac 2011;10:155‑64.

Ballangrud R, Hedelin B, Hall‑Lord ML. Nurses’ perceptions of patient safety climate in intensive care units: A cross‑sectional study. Intensive Crit Care Nurs 2012;28:344‑54.

Akbary R, Zarei E, Gholami A, Mousavi H. A survey of patient safety culture: A Tool for Improving Patient Safety in Healthcare Providers Service Organizations. Iran Occup Health 2015;12:76‑88.

Arshadi Bostanabad M, Jebreili M, Kargari Rezapour M. Patient safety culture assessment in neonatal intensive care units of Tabriz from the perspective of nurses in 2013. IJNR 2015;10:26‑35.

Izadi AR, Drikvand J, Ebrazeh A. The Patient Safety Culture in Fatemeh Zahra Hospital of Najafabad, Iran. Health Info Manag 2013;9:895‑907.

Timmel J, Kent S, Holzmueller G, Paine L, Schulick D, Pronovost J. Impact of the Comprehensive Unit‑based Safety Program (CUSP) on safety culture in a surgical inpatient unit. Jt Comm J Qual Patient Saf 2010;36:252‑60.

Moghri J, Ghanbarnezhad A, Moghri M, Rahimi Forooshani A, Akbari Sari A, Arab M. Validation of Farsi version of hospital survey on patient Safety culture questionnaire, using confirmatory factor analysis method. Hosp Quart 2012;11:19‑30.

Yaghobi Far MA, Takbiri A, Haghgoshaye E, Tabarraye Y. The Survey Of Patient Safety Culture And Recognizing Its Weknesses And Strenths In Sabzevar Hospitals. JSUMS 2011;20:154‑64.

Mahfoozpour S, Ainy E, Mobasheri F, Faramarzi A. Patients’ safety culture status among educational hospitals of Shahid Beheshti University of Medical Sciences in 2011. Pajoohandeh J 2012;17:134‑41.

Faghihzadeh S, Motamed N, Shoghli AR, Asuri M, Safaian Amoli M. Assessment of Nurse Viewpoints on Patient Safety Culture in Amol Hospitals in Iran, 2012. Prev Care Nurs Midwifery J (PCNM) 2014‑2015:4:45‑55.

Mohebi Far R, Alijan zade M, Safari Variani A, Khoshtarkib H, Ghanati E, Teymouri F, et al. Studying patient safety culture from the viewpoint of staffs in educational hospitals in Tehran City. J Health Saf Work 2015;5:57‑64.

Moghri J, Akbari Sari A, Rahimi Forooshani A, Arab M. Patient Safety Culture Status in General Hospitals Affiliated to Tehran University of Medical Sciences. Hakim Res J 2013;16:243‑50.

Dehghani M, Hayavie Haghighi M, Salimi J, Khorami F. Culture of Patient Safety from Nurses’ Perspective. Iran J Nurs 2015;28:42‑54.

Bahrami MA, Chalak M, Montazeralfaraj R, Tafti A. D. Iranian nurses’ perception of patient safety culture. Iran Red Crescent Med J 2014;16:e11894.

Afshari A, Piruzi M, Afshari S, Hejab K. Patient safety culture assessment in Seidolshohada hospital of Semirom. Medical Surgical Nursing. Iran J Nurs Res 2016;11:1‑8.

Despins LA. Patient safety and collaboration of the intensive care unit team. Crit Care Nurs 2009;29:85‑91.

Rose L. Interprofessional collaboration in the ICU: How to define?. Nurs Crit Care 2011;16:5‑10.

Sehgal NL, Fox M, Vidyarthi AR, Sharpe BA, Gearhart S, Bookwalter T, Wachter RM. A multidisciplinary teamwork training program: The Triad for Optimal Patient Safety (TOPS) experience. J Gen Intern Med 2008;23:2053‑7.

Esmail R, Banack D, Cummings C, Duffett‑Martin J, Shultz J, Thurber T, et al. Is your patient ready for transport? Developing an ICU patient transport decision scorecard. Healthcare Quart 2006;9:80‑6.

Habibzadeh F, Imanipour M, Mohammad Aliha J, Mehran A. Effect of applying checklist on quality of intra‑hospital transport of intensive care patients. Cardiovasc Nurs J 2014;3:30‑7.

El‑Jardali F, Dimassi H, Jamal D, Jaafar M, Hemadeh N. Predictors and outcomes of patient safety culture in hospitals. BMC Health Serv Res 2011;11:1‑12.

Farzi S, Abedi H, Ghodosi A, Yazdannik AR. Nurses’ Experiences of Medication Errors. J Qual Res Health Sci 2014;2:310‑9.


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