From the Columbia University School of Nursing, New York, New York.
J Patient Saf. 2020 Sep;16(3):223-231. doi: 10.1097/PTS.0000000000000279.
Children with complex medical needs are increasing in number and demanding the services of pediatric long-term care facilities (pLTC), which require a focus on patient safety culture (PSC). However, no tool to measure PSC has been tested in this unique hybrid acute care-residential setting. The objective of this study was to evaluate the psychometric properties of the Nursing Home Survey on Patient Safety Culture tool slightly modified for use in the pLTC setting.
Factor analyses were performed on data collected from 239 staff at 3 pLTC in 2012. Items were screened by principal axis factoring, and the original structure was tested using confirmatory factor analysis. Exploratory factor analysis was conducted to identify the best model fit for the pLTC data, and factor reliability was assessed by Cronbach alpha.
The extracted, rotated factor solution suggested items in 4 (staffing, nonpunitive response to mistakes, communication openness, and organizational learning) of the original 12 dimensions may not be a good fit for this population. Nevertheless, in the pLTC setting, both the original and the modified factor solutions demonstrated similar reliabilities to the published consistencies of the survey when tested in adult nursing homes and the items factored nearly identically as theorized.
This study demonstrates that the Nursing Home Survey on Patient Safety Culture with minimal modification may be an appropriate instrument to measure PSC in pLTC settings. Additional psychometric testing is recommended to further validate the use of this instrument in this setting, including examining the relationship to safety outcomes. Increased use will yield data for benchmarking purposes across these specialized settings to inform frontline workers and organizational leaders of areas of strength and opportunity for improvement.
患有复杂医疗需求的儿童数量不断增加，需要儿科长期护理机构（pLTC）的服务，这需要关注患者安全文化（PSC）。然而，尚无工具可用于衡量该文化，且该工具之前从未在这种独特的混合急性护理和住宅环境中进行过测试。本研究的目的是评估经轻微修改后用于 pLTC 环境的疗养院患者安全文化调查工具的心理测量特性。
2012 年，对 3 个 pLTC 中的 239 名工作人员收集的数据进行了因子分析。采用主轴因子分析筛选项目，使用验证性因子分析检验原始结构。进行探索性因子分析，为 pLTC 数据确定最佳模型拟合，并通过 Cronbach alpha 评估因子可靠性。
提取的旋转因子解决方案表明，原始 12 个维度中的 4 个（人员配备、对错误的非惩罚性反应、沟通开放性和组织学习）中的项目可能不适合该人群。然而，在 pLTC 环境中，原始和修改后的因子解决方案在成人疗养院进行测试时，与该调查的公布一致性具有相似的可靠性，且项目的因子分析与理论上几乎相同。
本研究表明，经最小修改的疗养院患者安全文化调查可以作为衡量 pLTC 环境中 PSC 的合适工具。建议进行更多的心理测量测试，以进一步验证该工具在该环境中的使用，包括检查与安全结果的关系。增加使用将为这些专业环境提供基准数据，以便为一线工作人员和组织领导者提供优势和改进机会的信息。
