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Safety climate and motivation toward patient safety among Japanese nurses in hospitals of fewer than 250 beds

Industrial Health 47 (2009), 70–79

報告者：林秀芸

Contents

1. Study objective1. Study objective1. Study objective1. Study objective

2. Introduction2. Introduction2. Introduction2. Introduction

3. Methods3. Methods3. Methods3. Methods

4. Results4. Results4. Results4. Results

5. Discussions5. Discussions5. Discussions5. Discussions

Study objective

Examine the relationships between safety climate and nurses’ motivation toward patient safety

Which dimension of safety climate would significantly affect nurses’ motivation to prevent mistakes?

Introduction

Safety climate (Zohar, 1980; Hofmann DA, 1996)

workers’ perceptions of safety Influence workers’ motivation toward safety behavior

Many studies explored the association between safety climate and its outcome, e.g. safety behavior, accidents, and patient safety.

(Cheyne et al., 1998; Masuchi A, 2002)

Safety climate dimensions

Industry (except health care)

1. Management/supervision

2. Safety system

3. Risk

4. Work pressure

5. Competence (Flin et al.,2000)

Health care (esp. patient safety)

1. Leadership

2. Policies & Procedures

3. Staffing

4. Communications

5. Reporting(Colla et al., 2005)

1. Organizational attitude & behavior

2. Communications

3. Workers’ committment(Masuchi A, 2002)

This study

Design of safety climate survey should depend on nations’ situation, such as career development, and public policy of health care.

This study developed a new safety climate scale.

Factor analysis examine the association between the dimensions and “Nurses’ motivation to prevent mistakes”

Methods

Population: In Japan, most hospitals are small or medium-sized.

Subjects Japanese 6 private hospitals nursing directors 637 female nurses January ~ May (2007)

Independent variable: nurses’ attributes & safety climate scale

Dependent variable: nurses’ motivation to prevent mistakes

Principal factor methods Promax rotation

Population

Beds hospitals

<50 13.8%

50-99 26.0%

100-149 16.1%

150-200 13.7%

200-299 12.7%

300-399 8.5%

400-499 3.9%

>500 5.3%

Methods

Population: In Japan, most hospitals are small or medium-sized.

Subjects Japanese 6 private hospitals nursing directors 637 female nurses January ~ May (2007)

Independent variable: nurses’ attributes & safety climate scale

Dependent variable: nurses’ motivation to prevent mistakes

Principal factor methods Promax rotation

Population

Beds hospitals

<50 13.8%

50-99 26.0%

100-149 16.1%

150-200 13.7%

200-299 12.7%

300-399 8.5%

400-499 3.9%

>500 5.3%

Methods

Nurses’ attributes Age Job type (registered, licensed, assistant) Marital status (married / single) Children (with/without)

Methods

Safety climate scale (Kudo et al., 2008)

Exploratory factor analysis confirmatory factor analysis Cronbach’s alpha

Safety climate scale of this study (5-point scale) Superiors’ attitudes Relationships among nurses Communications with physicians Fatigue reduction Opportunities for nursing education Nursing conditions Reporting

Methods

Nurses’ motivation to prevent mistakes 5-point Likert scale

Definition Near miss

• Nurses’ incorrect practice was discovered before it resulted in patients’ harm.

• Nurses’ incorrect practice was done, but it didn’t hurt the patients.

Mistake• Incorrect practice affected patients’ safety

Results –each factors construct

1. Opportunities for nursing education

1. Continuous education to improve the nursing skills

2. Training opportunities3. Appropriate education considering the nursing

skills of each nurse4. Assistance in acquiring the health care

knowledge5. Education for new nurses

2. Reporting 1. Appropriate analyses2. Teaching materials3. Feedback4. Unexpected occurrence of mistakes

Results –each factors construct

3. Fatigue reduction

1. Adequate rest 2. Adequate time to sleep3. Adequate free time4. Physical fatigue reduction5. Mental fatigue reduction

4. Superiors’ attitudes

1. Instructions by superiors2. Superiors’ attitudes toward listening to nurses

comments3. Superiors’ dedication to subordinates4. Degree of superiors’ reprimanding

Results –each factors construct

5. Nursing conditions

1. Nurse allocations based on ability2. Nurse allocations based on clinical experience3. Leeway to properly grasp health conditions of

patients4. Adequate manpower5. Appropriate workload

6. Communication with physicians

1. Physicians’ cooperation with nurses2. Appropriate instructions by physicians3. Open communications with physicians

7. Relationships among nurses

1. Nurses on good terms2. Mutual help among nurses3. Nurses’ teamwork

Results

Results

Results

Factors associated with motivation to prevent mistakes Multiple linear regression analysis

Conclusions

This extracted 7 dimensions of safety climate by factor analysis.

Nurses’ motivation to prevent mistakes was significantly associated with reporting, nursing conditions, and communications with physicians.

Occupations of nurses and physicians is taken into account in this study.

Career development and public policy of health care may have great impact on safety climate.

Discussions

Reporting system is also introduced in other industry, such as aviation industry.

Staff can learn something about risks from report.

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