Lee Seung Eun, Lee Jeong Won
Mo-Im KIM Nursing Research Institute, College of Nursing, Yonsei University, Seoul 03722, Republic of Korea.
Department of Business Administration, College of Software and Management, Kyonggi University, Suwon 16227, Republic of Korea.
J Nurs Manag. 2024 Nov 19;2024:6564570. doi: 10.1155/jonm/6564570. eCollection 2024.
Patient safety is paramount in healthcare, and effective communication is a cornerstone of preventing adverse patient events. Despite nurses' crucial role in improving patient safety, they often keep silent about their concerns. This study investigated links among hierarchical unit culture, nurses' power distance orientation, perception of futility, and silence behavior in healthcare environments. Moreover, we aimed to determine whether nurse-perceived hospital management support for patient safety moderated the association between nurses' perceived futility and silence behavior. This cross-sectional, correlational study utilized survey data from 730 direct-care nurses working in 88 medical, surgical, or medical-surgical units across 34 hospitals in South Korea. Validated psychometric scales measured the study variables, and data were analyzed using a 2-1-1 type of multilevel structural equation model. Hierarchical unit culture and power distance orientation showed significant positive associations with nurses' perception of futility ( = 0.62, < 0.001, and = 0.37, < 0.001, respectively) and subsequently with their silence behavior ( = 0.22, < 0.01, and = 0.31, < 0.001, respectively). Futility was found to mediate the relationship of both hierarchical unit culture (indirect effect = 0.222, 95% confidence interval (CI) [0.006, 0.438]) and power distance orientation (indirect effect = 0.132, 95% CI [0.003, 0.261]) to silence behavior. Hospital management support for patient safety significantly moderated the relationship between futility and silence behavior ( = 0.04, < 0.05); nurses were less likely to remain silent when they perceived high management support as opposed to low support, regardless of their futility level. Our findings highlight the crucial influence of organizational culture on nurses' silence behavior. The findings also underscore the importance of hospital management support with respect to patient safety. Management support may be necessary to combat nurses' perceived futility and to promote open communication.
患者安全在医疗保健中至关重要，而有效的沟通是预防不良患者事件的基石。尽管护士在提高患者安全方面发挥着关键作用，但他们常常对自己的担忧保持沉默。本研究调查了医疗环境中等级单位文化、护士的权力距离取向、对徒劳感的认知以及沉默行为之间的联系。此外，我们旨在确定护士所感知到的医院管理层对患者安全的支持是否调节了护士所感知到的徒劳感与沉默行为之间的关联。这项横断面相关性研究利用了来自韩国34家医院88个内科、外科或内科 - 外科科室的730名直接护理护士的调查数据。经过验证的心理测量量表测量了研究变量，并使用2 - 1 - 1类型的多层次结构方程模型对数据进行了分析。等级单位文化和权力距离取向与护士对徒劳感的认知呈显著正相关（分别为β = 0.62，p < 0.001，以及β = 0.37，p < 0.001），随后与他们的沉默行为也呈显著正相关（分别为β = 0.22，p < 0.01，以及β = 0.31，p < 0.001）。发现徒劳感介导了等级单位文化（间接效应 = 0.222，95%置信区间[CI][0.006，0.438]）和权力距离取向（间接效应 = 0.132，95%CI[0.003，0.261]）与沉默行为之间的关系。医院管理层对患者安全的支持显著调节了徒劳感与沉默行为之间的关系（β = 0.04，p < 0.05）；无论徒劳感水平如何，当护士感知到高管理层支持而非低支持时，他们保持沉默的可能性较小。我们的研究结果突出了组织文化对护士沉默行为的关键影响。研究结果还强调了医院管理层在患者安全方面提供支持的重要性。管理层的支持对于应对护士所感知到的徒劳感以及促进开放沟通可能是必要的。
