Patient Safety Culture, Missed Nursing Care, and Adverse Events in University Hospitals: A Cross Sectional Study
Abstract
Background: Patient safety culture, which reflects fundamental assumptions and actions related to patient safety, remains unchanged after accreditation. Missed nursing care is prevalent in university hospitals and affects the occurrence of adverse events. This study aims to determine the effect of patient safety culture on missed nursing care and adverse events as perceived by nurses at university hospitals.
Materials and Methods: This cross‑sectional study was conducted using an online survey at six university hospitals in Indonesia from September to November 2021. The survey included the Safety Attitude Questionnaire (SAQ), the missed nursing care instrument by the international RN4Cast consortium, and the adverse event instrument by the International Hospital Outcomes Research Consortium. A total of 330 nurses completed the survey.
Results: A total of 330 nurses participated in this study, resulting in an 89% response rate. The findings show a significant correlation between safety culture and missed nursing care (r = 0.153; p < 0.001) and between safety culture and adverse events (r = 0.001 p < 0.001). The positive coefficient value indicates that a better safety culture was associated with reduced missed nursing care. Additionally, there was a significant relationship between missed nursing care and adverse events (r = 0.146, p < 0.001), indicating that a higher incidence of missed nursing care leads to more adverse events.
Conclusions: This study indicates that modification on patient safety culture correlates with changes in missed nursing care and adverse events as quality of nursing services.
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Butler R, Monsalve M, Thomas GW, Herman T, Segre AM, Polgreen PM, et al. Estimating time physicians and other health care workers spend with patients in an intensive care unit using a sensor network. Am J Med 2018;131:972.e9 15. doi: 10.1016/j. amjmed.2018.03.015.
Karadaş A, Ergün S, Kaynak S. Relationship between missed nursing care and patients’ trust in nurses and satisfaction with care: A cross-sectional study. Nurs Health Sci 2024;26:e13149. doi: 10.1111/nhs.13149.
Chaboyer W, Harbeck E, Lee B, Grealish L. Missed nursing care: An overview of reviews. Kaohsiung J Med Sci 2021;37:82 91.
Putra KR, Dewi FM, Rahmayanti AD, Budiati A. The correlation availability nurses and equipment with acute missed nursing care at hospitals. JAKI 2021;9:150 60.
Recio‐Saucedo A, Dall’Ora C, Maruotti A, Ball J, Briggs J, Meredith P, et al. What impact does nursing care left undone have on patient outcomes? Review of the literature. J Clin Nurs 2018;27:2248 59.
Azyabi A, Karwowski W, Davahli MR. Assessing patient safety culture in hospital settings. International journal of environmental research and public health 2021;18:2466.
Hessels AJ, Paliwal M, Weaver SH, Siddiqui D, Wurmser TA. Impact of patient safety culture on missed nursing care and adverse patient events. J Nurs Care Qual 2019;34:287 94.
Kim K J, Yoo MS, Seo EJ. Exploring the influence of nursing work environment and patient safety culture on missed nursing care in Korea. Asian Nurs Res 2018;12:121 6.
Ningrum EH, Evans S, Soh S E, Ernest A. Perception of safety climate among indonesian nurses: A cross sectional survey. J Public Health Res 2021;10. doi: 10.4081/jphr.2021.2182.
Kakemam E, Gharaee H, Rajabi MR, Nadernejad M, Khakdel Z, Raeissi P, et al. Nurses’ perception of patient safety culture and its relationship with adverse events: A national questionnaire survey in Iran. BMC Nurs 2021;20:60.
Berry JC, Davis JT, Bartman T, Hafer CC, Lieb LM, Khan N, et al. Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. J Patient Saf 2020;16:130 6.
Han Y, Kim JS, Seo Y. Cross sectional study on patient safety culture, patient safety competency, and adverse events. West J Nurs Res 2020;42:32 40.
Galvão TF, Lopes MCC, Oliva CCC, Araújo MEdA, Silva MT. Patient safety culture in a university hospital. Rev Lat Am Enfermagem 2018;26:e3014. doi: 10.1590/1518 8345.2257.3014.
Okuyama JHH, Galvão TF, Crozatti MTL, Silva MT. Health professionals’ perception of patient safety culture in a university hospital in São Paulo: A cross sectional study applying the hospital survey on patient safety culture. Sao Paulo Med J 2019;137:216 22.
Muftawu M, Aldogan EU. Measuring patient safety culture: A study at a teaching hospital in Ghana. J Patient Saf Risk Manag 2020;25:250 8.
Martin E, Fisher O, Merlo G, Zardo P, Barrimore SE, Rowland J, et al. Impact of a health services innovation university program in a major public hospital and health service: A mixed methods evaluation. Implement Sci Commun 2022;3:1 9. doi: 10.1186/ s43058 022 00293 3.
Imam A, Obiesie S, Gathara D, Aluvaala J, Maina M, English M. Missed nursing care in acute care hospital settings in low income and middle income countries: A systematic review. Hum Resour Health 2023;21:1 21.doi: 10.1186/s12960 023 00807 7.
Hammad M, Guirguis W, Mosallam R. Missed nursing care, non nursing tasks, staffing adequacy, and job satisfaction among nurses in a teaching hospital in Egypt. J Egypt Public Health Assoc 2021;96:1 9.doi: 10.1186/s42506 021 00083 0.
Diab G, Ebrahim RMR. Factors leading to missed nursing care among nurses at selected hospitals. Am J Nurs Res 2019;7:136 47.
Hu Q, Wu B, Zhan M, Jia W, Huang Y, Xu T. Adverse events identified by the global trigger tool at a university hospital: A retrospective medical record review. J EvidBased Med 2019;12:91 7.
Zanetti ACB, Dias BM, Bernardes A, Capucho HC, Balsanelli AP, Moura AAd, et al. Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital. Plos One 2021;16:e0249531.doi: 10.1371/journal. pone.0249531.
Vikan M, Haugen AS, Bjørnnes AK, Valeberg BT, Deilkås ECT, Danielsen SO. The association between patient safety culture and adverse events–A scoping review. BMC Health Serv Res 2023;23:1 27. doi: 10.1186/s12913 023 09332 8.
Putra KR, Wulandari I, Suharsono T, Hany A. Adverse events during intra hospital transport of critically ill patients: An observational study. Central Eur J Nurs Midwifery 2022;13:699 706.
Kakemam E, Gharaee H, Rajabi MR, Nadernejad M, Khakdel Z, Raeissi P, et al. Nurses’ perception of patient safety culture and its relationship with adverse events: A national questionnaire survey in Iran. BMC Nurs 2021;20:1 10. doi: 10.1186/ s12912 021 00571 w.
Lee SE, Scott LD, Dahinten VS, Vincent C, Lopez KD, Park CG. Safety culture, patient safety, and quality of care outcomes: A literature review. West J Nurs Res 2019;41:279 304.
Mihdawi M, Al Amer R, Darwish R, Randall S, Afaneh T. The influence of nursing work environment on patient safety. Workplace Health Saf 2020;68:384 90.
Moustafa Abdallah Elpasiony N, Gouda Ahmed Abd Elmoghith N. The impact of nursing work environment and patient Safety Culture on missed nursing care at Medical and Surgical Departments. Int Egypt J Nurs Sci Res 2023;3:582 99.
Labrague LJ, De los Santos JA, Tsaras K, Galabay JR, Falguera CC, Rosales RA, et al. The association of nurse caring behaviours on missed nursing care, adverse patient events and perceived quality of care: A cross‐sectional study. J Nurs Manag 2020;28:2257 65.
Mills SL, Duddle M. Missed nursing care in Australia: Exploring the contributing factors. Collegian 2022;29:125 35.
Al Muharraq EH, Alallah SM, Alkhayrat SA, Jahlan AG. An overview of missed nursing care and its predictors in Saudi Arabia: A cross sectional study. Nurs Res Pract 2022;2022:4971890. doi: 10.1155/2022/4971890.
Labrague LJ, de Los Santos JAA, Fronda DC. Factors associated with missed nursing care and nurse‐assessed quality of care during the COVID‐19 pandemic. J Nurs Manag 2022;30:62 70.
Al‐Faouri I, Obaidat DM, AbuAlRub RF, editors. Missed nursing care, staffing levels, job satisfaction, and intent to leave
among Jordanian nurses. Nurs Forum 2021;56:273 83.
Ha TTN, Thanh PQ, Huong TL, Anh VT, Tu NM, Tien PH, et al. Nurses’ perceptions about patient safety culture in public hospital in Vietnam. Appl Nurs Res 2023;69:151650. doi: 10.1016/j. apnr.2022.151650.
Silva SCd, Morais BX, Munhoz OL, Ongaro JD, Urbanetto JdS, Magnago TSBdS. Patient safety culture, missed Nursing care and its reasons in Obstetrics. Rev Lat Am Enfermagem 2021;29:e3461. doi: 10.1590/1518 8345.4855.3461.
Cho SH, Mark BA, Knafl G, Chang HE, Yoon HJ. Relationships between nurse staffing and patients’ experiences, and the mediating effects of missed nursing care. J Nurs Scholarsh 2017;49:347 55.
Cho SH, Lee JY, You SJ, Song KJ, Hong KJ. Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes. Int J Nurs Pract 2020;26:e12803. doi: 10.1111/ ijn. 12803.
Srulovici E, Drach Zahavy A. Nurses’ personal and ward accountability and missed nursing care: A cross sectional study. Int J Nurs Stud 2017;75:163 71.
Witczak I, Rypicz Ł, Karniej P, Młynarska A, Kubielas G, Uchmanowicz I. Rationing of nursing care and patient safety. Front Psychol 2021;12:676970. doi: 10.3389/fpsyg.2021.676970.
Garay S, Haeger M, Kühnlein L, Sulmann D, Suhr R. Interventions to enhance safety culture for nursing professionals in long term care: A systematic review. Int J Nurs Stud Adv 2023;5:100119. doi: 10.1016/j.ijnsa.2023.100119.
Pourmovahed Z, Liravi A, Nazmieh H. The effect of teamwork training on missed nursing care among NICU nurses during the COVID 19 pandemic. World J Peri Neonatol 2023;5:49 57.
Parker AL, Forsythe LL, Kohlmorgen IK. TeamSTEPPS®: An evidence‐based approach to reduce clinical errors threatening safety in outpatient settings: An integrative review. J Healthc Risk Manag 2019;38:19 31.
Ree E, Wiig S. Employees’ perceptions of patient safety culture in Norwegian nursing homes and home care services. BMC Health Serv Res 2019;19:1 7. doi: 10.1186/s12913 019 4456 8.
Taji M, Putra KR, Ismail DDSL. Strategies to improving patient safety in hospitals. Healthc Low resource Settings 2023;11. doi: 10.4081/hls.2023.11181.
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