L o g o 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 objective 2. Introduction 3. Methods 4. Results 5. 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 Bedshospitals <5013.8% % % % % % % >5005.3%

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 Bedshospitals <5013.8% % % % % % % >5005.3%

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 opportunities 3.Appropriate education considering the nursing skills of each nurse 4.Assistance in acquiring the health care knowledge 5.Education for new nurses 2.Reporting1.Appropriate analyses 2.Teaching materials 3.Feedback 4.Unexpected occurrence of mistakes

Results –each factors construct 3.Fatigue reduction 1.Adequate rest 2.Adequate time to sleep 3.Adequate free time 4.Physical fatigue reduction 5.Mental fatigue reduction 4.Superiors’ attitudes 1.Instructions by superiors 2.Superiors’ attitudes toward listening to nurses comments 3.Superiors’ dedication to subordinates 4.Degree of superiors’ reprimanding

Results –each factors construct 5.Nursing conditions 1.Nurse allocations based on ability 2.Nurse allocations based on clinical experience 3.Leeway to properly grasp health conditions of patients 4.Adequate manpower 5.Appropriate workload 6.Communication with physicians 1.Physicians’ cooperation with nurses 2.Appropriate instructions by physicians 3.Open communications with physicians 7.Relationships among nurses 1.Nurses on good terms 2.Mutual help among nurses 3.Nurses’ teamwork

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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