Lee Seung Eun, Dahinten V Susan, Lee Jong Hyun
Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
BMC Nurs. 2023 Feb 6;22(1):32. doi: 10.1186/s12912-023-01196-x.
Despite evidence linking a safety culture with patient safety, the processes by which aspect of safety culture influences patient safety are not yet well understood. Thus, this study aimed to test a theoretical model of the relationships between three enabling factors (supervisor/clinical leader support for patient safety, hospital management support for patient safety, and psychological safety), and four enacting factors of patient safety culture (handoffs and information exchange, teamwork, error reporting intention, and withholding voice) with nurse assessments of patient safety.
A cross-sectional, descriptive correlational study design was used. Between May and June 2020, 526 nurses who provided direct care to patients in medical surgical units in three Korean hospitals completed an online survey that included four standardized scales or subscales. Structural equation modelling was used to test the hypothesized model.
Among the three enabling factors, psychological safety was associated with all four enacting factors, and all enacting factors were associated with overall patient safety. Hospital management support was associated with all enacting factors except teamwork, but supervisor/clinical leader support was associated with only handoffs and information exchange, and withholding voice. Thus, teamwork was influenced only by psychological safety. Findings demonstrate overall support for the theoretical model of safety culture wherein enabling factors influence enacting factors which, in turn, lead to patient safety outcomes, but emphasize the critical nature of psychological safety among nursing staff.
This study provides further insight into the importance of support from hospital management and unit supervisors/clinical leaders for patient safety to motivate and enable hospital nurses to enact behaviours necessary for patient safety. However, such support must also take the form of enhancing psychological safety for nursing staff.
尽管有证据表明安全文化与患者安全相关，但安全文化的各个方面影响患者安全的过程尚未得到充分理解。因此，本研究旨在检验一个理论模型，该模型涉及三个促成因素（上级/临床领导对患者安全的支持、医院管理层对患者安全的支持以及心理安全）与患者安全文化的四个实施因素（交接班与信息交流、团队合作、错误报告意愿以及保留意见）与护士对患者安全的评估之间的关系。
采用横断面描述性相关研究设计。2020年5月至6月期间，韩国三家医院内科和外科病房中526名直接护理患者的护士完成了一项在线调查，该调查包括四个标准化量表或分量表。采用结构方程模型对假设模型进行检验。
在三个促成因素中，心理安全与所有四个实施因素相关，所有实施因素均与整体患者安全相关。医院管理层的支持与除团队合作外的所有实施因素相关，但上级/临床领导的支持仅与交接班与信息交流以及保留意见相关。因此，团队合作仅受心理安全影响。研究结果总体上支持安全文化的理论模型，即促成因素影响实施因素，进而导致患者安全结果，但强调了护理人员心理安全的关键性质。
本研究进一步深入了解了医院管理层和科室上级/临床领导对患者安全提供支持的重要性，以激励并促使医院护士实施患者安全所需的行为。然而，这种支持还必须采取增强护理人员心理安全的形式。
